| Sumario: | Background: Early diabetes detection can enhance metabolic outcomes, reducing future risks and complications. Effective diabetes screening remains crucial in the post cystic fibrosis (CF) modulator therapy era whereby treatment with Elexacaftor/Tezacaftor/Ivacaftor (ETI) will lead to an aging CF population. Therefore, adults living with CF will be at increased risk of metabolic complications, specifically diabetes. The oral glucose tolerance test (OGTT) remains a key validated diagnostic tool for diabetes in this population; however, uptake has been historically low. Aim: This study aimed to evaluate and address barriers to the uptake of OGTT screening for CF-related diabetes from a clinician and service perspective. Method: This single center mixed methods study comprised a survey, solution mapping workshops, and database-driven analytics, incorporating both qualitative and quantitative analyses. The study was conducted in a hospital in Brisbane, Australia from 2017 to 2023. We hybridized the Theoretical Domains Framework and the Capability, Opportunity, Motivation, and Behaviour (COM-B) change model to identify clinician- and service-level barriers to OGTT uptake. OGTT uptake was assessed at three time-points: T0 (2018–2019) Baseline/Pre-implementation, T1 (2020–2021) Post-implementation, and T2 (2022–2023) Post-implementation and ETI. Results: Three barriers to OGTT uptake were identified: (1) clinician capacity, (2) systematic processes, and (3) consumer engagement. Provider knowledge gaps on diabetes diagnostic criteria were addressed through education. A CF-related diabetes clinical pathway was developed and integrated into service procedures and clinical databases. Consumer engagement initiatives were implemented. In our cohort, OGTT screening significantly increased from 12.7% at T0 to 38.5% at T1 (p < 0.001), stabilizing at 33.5% at T2 (p < 0.001). Conclusions: OGTT screening significantly improved following the implementation of behavior-based solutions. Our findings indicate that addressing key barriers at a service level using a multifaceted interventional approach can change end-user perspectives and behavior. http://links.lww.com/IJEBH/A405
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