Identifying barriers to diabetes technology use: LIFESTEPS, a newly developed clinical support tool for healthcare...

Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, structured tools to support healthcare professionals (HCPs) in systematically exploring these barriers in routine care remain limited. To address this gap, a clinically oriented questionnaire was developed by a multidisciplinary panel of diabetes experts. This paper describes the development of the questionnaire and its preliminary evaluation in terms of clarity, comprehensibility, usability, relevance, and perceived acceptability.

A panel of 12 diabetes experts from 11 countries across Europe, the Middle East, and Africa (EMEA) reviewed the literature on barriers to diabetes technology use, grouped these barriers into key thematic domains, and developed a structured questionnaire that was translated into multiple languages. The questionnaire then underwent a two-round end-user evaluation involving HCPs and PWT1D to assess clarity, comprehensibility, practicality, relevance, and potential bias. Feedback from the first round informed refinement of the questionnaire before reassessment in a second round. The evaluation was descriptive and focused on end-user feedback; formal psychometric testing and hypothesis-driven validation analyses were not undertaken.

The expert panel named the questionnaire LIFESTEPS, reflecting its core thematic domains. The questionnaire covers the following areas of discussion related to barriers to technology: psychological and relational aspects of diabetes, experience with technology and body image, and anticipation and adaptation to new technology. In the first evaluation round, feedback was obtained from 19 HCPs and 37 PWT1D recruited by panel members. Following revision of the questionnaire, a second round involving 5 HCPs and 7 PWT1D was conducted to reassess clarity and usability. Overall, participants reported that the final version of the questionnaire was understandable, perceived as easy to complete, and potentially useful for supporting discussion of barriers to diabetes technology use in clinical practice.

LIFESTEPS is a newly developed, multilingual clinical support tool designed to facilitate structured discussion of psychosocial and lifestyle-related barriers to diabetes technology use. The findings provide preliminary support for its clarity, acceptability, and perceived clinical usefulness. Further psychometric and prospective clinical evaluation is needed before broader analytical or predictive applications can be considered. Accordingly, LIFESTEPS should be interpreted as a preliminary conversation-support tool rather than as a validated measurement instrument.