JMIR Publications

ABSTRACT

Background:

Type 2 diabetes risk is disproportionately higher among structurally marginalized communities, partly due to influences from social, economic, and environmental determinants of health. Individual-level diabetes prevention strategies address proximal factors, such as modifiable behaviours, often overlooking the role of multi-level socio-ecological factors that contribute to diabetes risk and inequities. Multi-level diabetes prevention interventions involve actions that address multiple health determinants across the individual, community, and systemic levels of influence, offering a promising approach to reducing inequities in diabetes risk.

Objective:

This scoping review aimed to systematically map the types of health determinants addressed in multi-level diabetes prevention interventions that have been implemented for addressing population inequities in diabetes risk and to describe what evidence exists regarding their effectiveness.

Methods:

A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase, Web of Science, and grey literature sources (websites of government agencies and local/international non-governmental health organizations) for studies published from the year 2000 to 2024. The research team developed a conceptual framework to guide the scoping review and define multi-level interventions for eligibility. Eligibility criteria included studies focusing on multi-level diabetes prevention interventions targeting diabetes relevant risk factors at more than one level of influence (micro, meso, and macro) and where intervention outcomes were reported. Data extraction included study characteristics, intervention target populations and coverage, targeted health determinants, and intervention outcomes, and was completed by two independent reviewers. Data synthesis involved mapping health determinants addressed by each multi-level intervention according to our conceptual framework and a narrative synthesis of findings on themes corresponding to intervention types and reported outcomes.

Results:

Of 7,813 articles retrieved, a total of 25 studies met the inclusion criteria. Interventions consisted of targeted interventions for high-risk populations (n=7), environmental-based interventions (n=7), and community-based interventions (n=11). Most interventions addressed health determinants at two-levels (micro and macro) (48%) or three levels (micro, meso, macro) (44%). All studies reported on proximal outcomes, most frequently on weight, physical activity, and dietary behaviours. One-third (32%) of studies reported outcomes on changes in metabolic risk. None of the studies reported on equity outcomes related to changes in population inequities in diabetes incidence. Only 8% of studies reported an equity outcome capturing disparities in a diabetes risk factor level between disadvantaged and advantaged population groups.

Conclusions:

Our review identified a research gap in that outcomes on population inequities in diabetes risk have not been consistently measured in multi-level diabetes prevention interventions, and the impact of these interventions on reducing population inequities in diabetes incidence is not consistently examined or reported. Future research should prioritize equity outcomes in evaluations of multi-level diabetes prevention interventions and emphasize impacts on disadvantaged populations and population inequities. Clinical Trial: Not applicable.