Table 3 Translation of second order constructs

Patient as stakeholder

Building a picture

Patients respond better to advice that is tailored to their needs –but staff do not always do this.

[25; 28; 31; 38; 39]

Personalised advice

Appropriateness

Meaning/Understanding

Sharing and finding common ground

Patients feel ownership when their views and experiences are valued - but staff attitudes can undermine this.

[25; 26; 32; 38; 39]

Ownership

Resource allocation

Patients value sustainable support and information provision - but this is resource intensive

[27; 28; 34; 37; 48; 51]

Resource use

Timeliness

Timeliness

Patients benefit from having gaps in their knowledge addressed at their own pace (e.g. if they can ask fundamental questions beyond the initial assessment) – without these opportunities lay interpretations develop.

[25; 31; 35; 42]

Access

Phased approach

Contextual knowing

Consciousness raising

Patients value having information and support that matches their current perspective (e.g. if/when they are ready to understand their responsibility) – otherwise patients can disengage with service provision and/or self-management.

Aligning patients’ needs

Responsive advice

Implementing a sustainable plan

Patients are motivated to change their behaviour, when practices are perceived as improving their quality of life –but suggestions from staff that are perceived as impairing quality of life can be perceived of as out of touch with reality

[11; 26; 28; 32; 45]

Self-management behaviours

Empowerment

Empowerment

With understanding, some patients are able to develop a flexible regimen (e.g. titrate exercise to treats and cheats) – but without ongoing support some do not develop appropriate causal models.

[25; 26; 28; 35; 36; 37; 41; 42; 45]

Down to me/Up to them

Sustainability

Flexible regimens can enhance both control of blood glucose and quality of life – but without tailored/ ongoing education that goes beyond ‘learning by rote’ many patients find this difficult to achieve.

[28; 32; 34; 35; 36; 43; 44; 45]

Commitment

Accounts as resources

Forgetfulness