Determinants and promotion strategies for type 1 diabetes screening in children: A qualitative study from a parental...

First-degree relatives (FDRs) of type 1 diabetes (T1D) patients are at high risk for T1D. Early screening enables timely intervention, yet participation remains suboptimal, missing opportunities in this high-risk group. Understanding determinants of screening participation and translating them into actionable, theory-informed, family-centered strategies is essential to optimize preventive care.

In this qualitative study in China, semi-structured interviews were conducted with 21 adult T1D probands or parents of pediatric T1D patients who have unaffected children. The Theoretical Domains Framework (TDF) guided data collection and analysis. Barriers were mapped to Behavior Change Techniques (BCTs).

We identified 18 facilitators, 11 barriers, and 2 neutral factors, mapped across 12 TDF domains. Key barriers included limited awareness, misconceptions, cost, restricted medical resources, insufficient publicity, and anxiety; key facilitators included perceived benefits, optimism, health beliefs, and social support. Through TDF-BCT mapping, 34 intervention strategies were categorized into 13 categories targeting knowledge enhancement, environmental adaptation, social and emotional support, and self-efficacy building.

This study provides a systematic, theory-based analysis of factors influencing screening participation for T1D. The resulting strategy map offers a set of theory-informed, family-centered suggestions to guide nurses and educators in supporting parents and improving early detection in clinical practice, subject to future empirical validation.

Nurses and educators should develop localized, family-centered screening promotion programs guided by theory-driven frameworks and BCTs. Concurrently, systemic enablers-such as resource allocation, financial support, and routine follow-up guidance-must be established to comprehensively address barriers to participation in screening.