Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study

Abstract

The purpose of this study was to explore and identify factors that influence motivation for and barriers to adopting and maintaining lifestyle changes in patients with type 2 diabetes, following participation in an intensive multiple-lifestyle intervention. Participants were recruited from the U-TURN trial, a one-year, intensive lifestyle intervention for type 2 diabetes patients. This study was conducted over time; informants were interviewed twice after the trial ended with a six-month interval between interviews. The qualitative data from these individual interviews were analysed using systematic text condensation with an inductive approach. Five themes emerged: Social support and relatedness, Achievement of results, Support from healthcare professionals, Identification with and acceptance of the new lifestyle and Coping with ongoing challenges. These are all important for maintaining lifestyle changes and diabetes self-management. Changing one’s lifestyle can be a constant, difficult struggle. For sustainable progress after an intensive intervention, the changes must be adopted and endorsed by patients and co-opted into their social setting. Belonging to an exercise group, confidence in managing the lifestyle adjustments and handling of challenges through continual support and professional diabetes treatment are crucial in maintaining and adhering to the new lifestyle.

Barriers and Facilitators for Physical Activity in Adults with Type 2 Diabetes Mellitus: A Scoping Review

“…Regarding the personal component, the key factors identified as facilitators were having information about PA [ 35 , 36 ], higher educational level [ 13 , 33 ], wanting to be healthy [ 36 ], identification with acceptance of lifestyle [ 41 ], and achieving improvements in the control of DM2 [ 37 , 41 ]. Obstacles included poor knowledge and the perception that exercise potentially exacerbates illness [ 40 ], lack of time [ 30 , 33 ], fear of hypoglycemia [ 26 , 33 ], having to do moderate to high intensity exercise and having to overcome the initial challenge of exercising [ 41 ], lack of willpower and not being in the habit of exercising [ 33 ], and the low importance attributed to PA and the feeling of an inability to exercise [ 39 ].…”

“…With regard to the social component, the key factors identified as facilitators were social support from family and health professionals [ 19 , 22 , 31 , 34 , 37 , 39 ] and having a personal trainer [ 34 , 37 ]. Obstacles were the absence of social support [ 18 , 26 , 32 , 34 , 38 ], lack of recommendations or medical information [ 31 , 32 , 33 , 34 ], lack of information given by health professionals regarding the specific types of suitable PA, not knowing how often they should exercise or how to implement a plan for regular PA [ 33 ], having to do PA alone [ 30 , 32 , 33 ], and the lack of parks, gymnasiums, and other facilities nearby for carrying out PA [ 31 , 32 , 33 ].…”

“…Motivation was the factor most frequently identified as a facilitator of physical activity, and lack of motivation was described by several authors as a barrier. Motivation is a key factor in maintaining PA in the long-term [ 37 ]. Neel [ 50 ] described the syndrome of the emergence of genetic homeostasis due to prolonged periods of physical inactivity.…”

Gut microbiota changes after metabolic surgery in adult diabetic patients with mild obesity: a randomised controlled trial

“…On the other hand, after an initial clinical improvement in medical therapy arm, at the final endpoint all participants failed to achieve diabetes remission or improvement. During the first 6 months the patients were observed 4 times (M0, M1, M3 and M6), which might contributed for the initial improvement seen in this arm, as support of healthcare professionals is one of the most important motivators for lifestyle changes and therapeutic adherence [31]. Sustainable progress after an intensive intervention is challenging and a gap of 6 months without clinical visits (between M6 and M12) might contributed for the decline on clinical benefits, which has also been supported by other authors [32,33].…”

Metformin for diabetes prevention: update of the evidence base

“…The PREVENT-DM study, described above, is an interesting example of this approach, in its use of community health workers ("promotoras") to support people with the study interventions in its urban environment, 49 as maintaining adherence to lifestyle change is central to optimising the benefits from it. 110 The use of "Diabetes Prevention Mentors" did not enhance the effectiveness of a community-based diabetes prevention initiative in the UK, however. 111 The nature of a lifestyle intervention is critical to its effectiveness and cost-effectiveness, however.…”