Multilevel barriers to type 2 diabetes prevention and screening in Ukraine

Background

Prevention, screening, and early detection of type 2 diabetes (T2D) in primary health care (PHC) represent a complex multilevel process influenced by system-level factors, health workforce capacity, patient behavioural factors, and community context. Despite the key role of PHC, its capacity in Ukraine remains insufficiently explored.

Methods

A qualitative study was conducted in the Khmelnytskyi region, covering 32 PHC facilities. Data collection included 8 focus group discussions (57 health professionals), 20 in-depth interviews with patients with T2D, and analysis of local noncommunicable disease (NCD) and diabetes prevention programmes. Key barriers and challenges in service provision and utilization were identified.

Results

Multilevel barriers were identified, at the system level: limited access to selected laboratory tests, unstable resource availability and technical constraints. At the provider level: high administrative workload and limited time for preventive counselling. At the patient level: low motivation for prevention, delayed care-seeking and difficulty achieving lifestyle change. Additional factors included financial and logistical barriers, migration and the impact of the ongoing war. Access to diagnosis and medications was perceived as relatively adequate, however, the main challenges were related to adherence to recommendations and sustained behavioural change. Analysis of local programmes revealed a lack of dedicated T2D strategies, with activities embedded in broader NCD programmes and implemented in a fragmented manner.

Conclusions

Prevention and screening of T2D in PHC require a systemic multilevel approach. Findings highlight the need for comprehensive interventions, including strengthening community-level planning, improving access to diagnostics, enhancing resources, reducing administrative burden and implementing patient-centred approaches. These results can inform policies and programmes in similar settings.

Key messages

• Multilevel barriers limit effective T2D prevention and screening in PHC in Ukraine, highlighting the need for integrated, system-wide interventions.

• Strengthening PHC capacity, improving access to diagnostics, and implementing patient-centred approaches are key to improving T2D prevention outcomes.