Enhancing Diabetes Medication Adherence Clinics Service Delivery: A Pre-Delivery Framework based on the Double Diamond Model

Diabetes medication therapy adherence clinics (DMTAC) in Malaysia are crucial for managing type 2 diabetes but encounter significant operational challenges, including high rates of patient non-attendance, program dropout and variability in service delivery, which collectively undermine their effectiveness. Guided by the first three phases of the Double Diamond design-thinking model (discover, define, develop), this study aimed to create an evidence-based pre-delivery framework to systematically address these gaps. Evidence was triangulated from (i) a retrospective cohort study of 198 patients that quantified clinical outcomes and attrition risk factors; (ii) semi-structured interviews with 32 patients that illuminated barriers, facilitators and service preferences; and (iii) a comprehensive scoping review of 61 randomised controlled trials on pharmacist-led diabetes interventions. Design requirements extracted from these sources were mapped to the Transtheoretical Model (TTM), Health Action Process Approach (HAPA) and the communication models of Motivational Interviewing (MI) and Shared Decision-Making (SDM). The resulting framework comprised three sequential domains: (i) Pre-Service: stage-matched assessment of patient readiness and barrier screening; (iii) Within-Service: modular, patient-centred interventions delivered via MI or SDM with explicit action- and coping-planning rooted in HAPA; and (iii) Post-Service: flexible follow-up modalities, tailored self-management aids and automated appointment reminders. This pre-delivery framework offers clinicians and service managers an actionable, theory-informed guide to enhance engagement, medication adherence and clinical outcomes across Malaysian DMTAC settings.