This is a methodological consensus study conducted in two sequential phases between March 2020 and May 2021 in Colombia. The first phase comprised the expert consensus validation of the NOC Self Management: Diabetes (1619) and NOC Social Support (1504) ⁽¹¹ and their respective indicators, along with conceptual, operational and the magnitude. The second phase involved designing and obtaining expert consensus validation for the adult social support intervention for DM2 self-management.

Nine experts participated in the first phase of the study meeting the following criteria: being a nursing professional with over two years of experience in the area of chronic noncommunicable diseases, having scientific production on nursing process and standardized language systems, and having research and/or academic experience in the area. The number of experts was determined by convenience based on previous studies^{13), (14}.

For the second phase of the study, the sample was composed of eight experts and delimited according to previous studies and fulfilling the following inclusion criteria^{15), (16}: being a health professional with over two years of experience in the management of chronic noncommunicable diseases and having scientific production on or research and/or academic experience in the management of health interventions.

Nursing professionals were recruited through email invitations and recommendations from the participants themselves, with this phase being conducted entirely online. The first phase contemplated the characterization of the population, general guidelines to facilitate its development, information on the NOC outcome labels “Self-management: diabetes” (1619) and “Social support” (1504)¹¹, and their respective indicators, with "selected and not selected" response options, and an additional space for comments.

Once the outcomes and indicators were selected by the experts, the researchers proceeded to construct the conceptual and operational definitions for each indicator and its magnitude, with the above being based on the literature^{17), (18} and experience of the researchers. Next, the material was sent, where the experts had three response options for the validation of the information: agree, agree with modifications, or disagree. With this part, the first phase was completed.

The second phase of the study comprised the design and validation by consensus of specialists of an adult social support intervention for self-management of DM2, which was developed based on the results of phase I and under the guidelines of Sidani and Braden¹⁹. This includes: a) a clear and complete understanding of the problem, describing the nature, manifestations, level of severity, causal factors, and consequences of the problem; b) an elaboration of the intervention delimited by the scientific literature and the medium-range nursing theory; c) the development ofthe intervention based on the results of phase I and under the guidelines of Sidani and Braden^{19), (22} and the mid-range nursing theory called "Individual and Family Self-Management Theory" by Ryan⁷.

From these aspects, the researchers developed the preliminary version of the intervention, which led to the validation by expert consensus of the intervention content, allowing correspondence between elements of the intervention.

The content of the intervention was sent by means of an instrument that included informed consent, characterization of the participants, guidelines for the validation of the content of the intervention, and a link that allowed them to access the intervention in its entirety.

Participants assessed the correspondence between the active principles, components, activities, and actions of the intervention through the consistency and completeness of the components and their relationship to the active ingredients of the intervention, an analysis of the appropriateness of activities to operationalize the components, examining the accuracy and relevance of point and non-specific actions in the delivery of the intervention activities; determining any omissions of components, activities, and actions; and suggesting ways to revise the intervention elements to improve the correspondence between them¹⁹.

This validation of the intervention ended with two rounds, using three criteria: agree, agree with modifications, and disagree, plus a box for comments.

A Content Validity Index (CVI) > 0.80 was defined for the study of each of the two phases²³. The Survey Monkey Audience program was used for data collection, and the synthesis of the content was standardized using the Windows Excel program. The database was stored in Mendeley Data²⁴.

The study was approved by the Research Ethics Committee of the institution involved (CEI-FE 2020 04). All participants approved the informed consent online.

For the first phase of the study of the 9 experts who participated in the validation of the labels, there was a predominance of the female gender (n= 8, 89%), with an average age of 44 years. Regarding the level of education, 8 were identified as having a master's degree (89.00%), and 1 expert with a doctoral degree (11.00%). Regarding professional experience, this group of experts has more than 20 years in the area of study.

In the second phase of the 8 experts, the majority were female, with an average age of 42 years; 100% nursing professionals, 75.00% (n= 6) with master's degrees and 25.00% (n= 2) with a doctoral degree; with work experience in the context of the study of more than 20 years.

The NOC Social Support (1504) was validated by experts with 9 indicators from the 12 that compose it, which are listed in Table 1.

Table 1

NOC Label -Social Support (1504)
(150408) Willingness to call on others for assistance
(150412) Assistance offered by others
(150402) Time provided by others
(150403) Refers to tasks performed by others
(150404) Refers to information provided by others
(150405) Refers to emotional support provided by others
(150406) Refers to trust relationships
(150407) Refers to the existence of people who can help you when you need it
(150409) Refers to a social support network

NOC: Nursing Outcomes Classification

The indicators “supportive social contacts” (150410) and “stable social network” (150411) were excluded, since the experts considered that they present similarities between them which could generate a bias at the time of data collection¹⁴. This is due to the fact that the indicator Refers to a social support network (150409) was included, and this also has similarities. Finally, the indicator Refers to economic help from other people (150401) was excluded, as the experts stated that it did not respond to the intervention of a nursing professional, but rather pointed more to a family type of support.

The Nursing Self-Management Outcome: Diabetes (1619) is made up of 44 indicators, 28 indicators were selected and are listed in Table 2.

Tabla 2

NOC Label - Self-management: diabetes (1619)
(161901) Accepts diagnosis
(161902) Seeks information on methods to prevent complications
(161903) Performs preventive foot care practices
(161906) Reports non-healing skin lesions to the primary care practitioner
(161907) Participates in health care decisions
(161908) Participates in prescribed educational program
(161909) Performs treatment regimen as prescribed
(161910) Performs the correct procedure for blood glucose monitoring
(161911) Monitors blood glucose
(161915) Reports symptoms of complications
(161916) Uses a diary to monitor blood glucose over time
(161917) Uses preventive measures to reduce the risk of complications
(161941) Obtains health care if blood glucose fluctuates outside of recommendations
(161920) Follows the recommended diet
NOC Label - Self-management: diabetes (1619)
(161921) Follows recommended activity level
(161922) Monitors body weight
(161923) Uses effective weight control strategies
(161925) Follows the recommendations for alcohol consumption
(161926) Participates in a smoking cessation program
(161929) Uses the correct procedure for insulin administration
(161930) Stores insulin correctly
(161931) Obtains necessary medication
(161932) Uses medication as prescribed
(161933) Monitors medication therapeutic effects
(161934) Rotates injection sites
(161937) Uses health care services congruent with needs
(161939) Keeps appointments with health professional
(161940) Maintains plan for medical emergencies

NOC: Nursing Outcomes Classification

The experts made some considerations regarding the excluded indicators. For instance, Controls glycosuria and ketonuria was excluded because its measurement is complex for the study requiring control by clinical laboratories. Uses only non-prescription medications approved by health professional was considered complex to interpret and may not be easily understood by patients, as self-medication has serious health implications. Obtains the pneumonia vaccine, although relevant in the context of diabetes, requires a shared decision-making discussion with their treating physician to determine the individualized risks and benefits¹⁷. Finally, Monitor for signs and symptoms of depression was analyzed as a parameter that requires interdisciplinary management for patient monitoring and would not apply to the entire study population. A CVI of 0.98 was obtained among the experts.

Once the indicators were selected, we proceeded to develop the conceptual and operational definitions and the magnitude of the nursing outcomes.

The intervention was developed on the basis of the steps proposed by Sidani and Braden¹⁹ which are mentioned below:

A theoretical and an empirical approach was used, which allowed for greater clarity on the nature, manifestations, level of severity, causal factors, and consequences of the problem (see Table 3). At the theoretical level, the referent was the Theory of Individual and Family Self- Control, which considers the individual and their family⁷, as well as their context. This theory defines self-management as the intentional incorporation of health-related behaviors in the daily functioning of an individual, preventing diseases or facilitating the management of complex health regimens, reflecting individual and family values and beliefs in a meaningful way.

At the empirical level, the scientific literature provided a relevant information on the prevalence, manifestations, level of severity, determinants and factors associated with the study phenomenon, allowing for expanded understanding of the problem^{23), (25}.

Table 3

Nature of the problem	Self-management is conceptualized as the ability of the individual, together with the family, community and health professionals, to manage symptoms, treatments, lifestyle changes, and psychosocial, cultural, and spiritual consequences of health conditions.
Manifestations of the problem	People with DM2 may present alterations in metabolic parameters, persistent symptoms, low therapeutic adherence, complications, frequent hospitalizations, increased costs associated with the use of care, and risk of mortality. Likewise, and in relation to other domains, they may present a lack of knowledge of the disease, a lack of autonomy in health care, a lack of participation and skills in preventive health behaviors, and finally, from the social domain, difficulties in decision- making and problem-solving, lack of motivation to control their disease, alterations in coping, lack of social acceptance, difficulty in processing emotions, and loss of productivity.
Level of severity of the problem	The lack of self-management behaviors contributes to the progression of the disease, leading to health complications, decreased functional capacity, and a lower quality of life.
Causal factors of the problem	-Personal characteristics and lifestyle: knowledge, health, cultural and spiritual beliefs, life patterns, psychological disorder, motivation -Health status: genetics, comorbidity, severity of disease and symptoms. -Resources: financial, psychosocial devices and resources. -Environmental characteristics: environments, home, work and community. -Health care system: access to health services. -Individual and family factors: age, culture, psychosocial characteristics, family functionality
Consequences of the problem	The lack of control over DM2 and insufficient participation in health-promoting lifestyles increases the risk of mortality and lead to serious biological, psychosocial and economic complications for the individual, their family and the healthcare system.

DM2: Type 2 diabetes mellitus.

It was supported based on three assumptions of the Individual and Family Self-ManagementTheory⁷: 1) social support can direct, encourage and support engagement in self-management behaviors and the achievement of outcomes; 2) person-centered interventions are more effective in fostering engagement in self-management behaviors and achieving of outcomes; and 3) individuals actively participate in self-management conditions by collaborating with people in the health care system to achieve personal health goals.

Based on the aspects of the problem identified in the previous steps, strategies were described which in turn form active ingredients of the intervention¹⁹: knowledge of DM2, DM2 self-management skills, and social support.

Steps 4-5: Select the mode of administration and dose of the intervention; specify the elements of the intervention

These steps were constructed taking into account the scientific literature and taking into account the active ingredients of the intervention which are described in general terms in Table 4.

Table 4

Name of intervention	Social support intervention for DM2 self-management.
Dose	-4 sessions
	-Once every 15 days for 2 months -2 follow-up sessions at 1 month and 2 months after the intervention
Duration	40 minutes
Delivery strategies	-Individualized -Face to face -Use of educational material (educational brochure)
Place of delivery	Nursing consultation (outpatient clinic) from a health institution level of care
Receiver	Adults with type 2 diabetes mellitus who meet the inclusion criteria
Provider	Nurse professionally trained in the management of type 2 diabetes mellitus

DM2: Type 2 diabetes mellitus.

Once the intervention had been constructed following Sidani & Braden¹⁹, it was validated by eight experts, obtaining an CVI of 0.90; among the disagreements, one expert recommended that the place of delivery should contemplate not only the nursing office, but also the individual's home; in addition, that the provider should include an interdisciplinary health team, which was not accepted because the intervention focuses on the role of nursing in the care of DM, in the primary health care nursing consultation.

Regarding the precision, feasibility, acceptability of the intervention, coherence and completeness between the components and principles of action, appropriateness of the activities, and precision and relevance of the actions, 100% of the experts agreed with the elements that make up the intervention protocol. However, the experts recommended specifying the actions and establishing specific differences between activities and actions to avoid similarities.

In response to these recommendations, the respective adjustments were made and the protocol was sent for a second round, which did not generate any further recommendations. The CVI achieved was 0.98.