Supporting change in a complex reality: a qualitative study of specialist nurses' perceptions of counselling patients at risk of type 2 diabetes.

Abstract

Specialist nurses in primary health care play a key role in supporting individuals at risk of type 2 diabetes to adopt healthier eating habits. Although dietary counselling is central to prevention, limited knowledge exists on how nurses experience providing individualized advice that considers gender, cultural background, and patients' everyday contexts. To explore specialist nurses' perceptions of delivering individualized dietary advice to patients at risk of type 2 diabetes, with attention to gender, culture, and contextual factors. Qualitative study based on semi-structured interviews. Specialist nurses in Swedish primary health care were recruited through snowball sampling. Data were collected between August and November 2025. Data were analysed using qualitative content analysis according to Graneheim and Lundman. Four themes and 12 subthemes described how specialist nurses applied patient-centered strategies, considered gendered and multicultural influences, encountered clinical and motivational challenges, and expressed a need for enhanced organizational and educational support. Nurses emphasized empathy, small-step goal setting, and person-centered communication. However, limited consultation time, low patient motivation, socioeconomic constraints, and cultural complexity hindered effective counselling. Participants highlighted the need for cultural competence training, accessible and updated resources, and stronger organizational support. Effective dietary prevention requires that specialist nurses have sufficient time, appropriate tools, and organizational support to tailor advice to patients' everyday lives. Despite strong commitment, structural, cultural, and motivational barriers limit the effectiveness of prevention efforts. Strengthening organizational structures, improving access to culturally adapted resources, and adopting collaborative care models may enhance diabetes prevention in clinical practice.