Psychological Factors of Long-Term Dietary and Physical Activity Adherence among Chinese Adults with Overweight and Obesity in a Community-Based Lifestyle Modification Program: A Mixed-Method Study

Abstract

There is a paucity of research on factors influencing long-term adherence to lifestyle modification. We conducted a mixed-method study to explore the psychological factors of dietary and physical activity (PA) adherence among Chinese adults with overweight and obesity at 10 months after enrollment of a community-based lifestyle modification program in Hong Kong. We recruited Chinese adults newly enrolled in a culturally adapted lifestyle modification program and followed them for 10 months. For the quantitative study, primary outcomes were dietary and PA adherence scores while secondary outcomes included knowledge, self-efficacy, motivation and stage of change. For the qualitative study, data were collected using semi-structured interviews and observation. A total of 140 participants completed the 10-month follow-up. They reported moderate level of dietary adherence but low level of PA adherence at 10 months. Multivariable regression analyses revealed that greater improvement in nutrition knowledge and diet stage of change predicted higher dietary adherence while greater improvement in PA self-efficacy and PA stage of change predicted higher PA adherence. Qualitative data on 26 participants suggest that participants’ knowledge and self-efficacy but not motivation were enhanced during the program. The findings of this study enhanced our understanding on factors influencing long-term adherence to lifestyle changes.

Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model

“…As less self-efficacy has been found in NAFLD patients than in other chronic liver diseases [28], this could be a critical factor in understanding the lack of motivation these patients have for their treatment. Many studies have found better performance of physical activity and diet by diabetic and obese patients who have high perceived self-efficacy [29][30][31][32]. Similar results were found by Zelber-Sagi et al in a study with 146 ultrasound-diagnosed NAFLD patients [33]; however, more evidence is necessary to confirm the importance of self-efficacy in these patients.…”

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

“…Fourteen studies exclusively at activity behaviors [37][38][39][40][41][42][43][44][45][46][47][48][49][50] with one reporting only facilitators [42] and one only barriers [46]. Eleven studies reported barriers and facilitators in mixed interventions [51][52][53][54][55][56][57][58][59][60][61].…”

Psychosocial determinants for adherence to a healthy lifestyle and intervention participation in the FINGER trial: an exploratory analysis of a randomised clinical trial

“…In addition, the nonpositive perception was significant predictor of cognitive training participation in the previous report [5], whereas we observed its negative association with participation in several intervention domains. We could not identify other publications that included the study perception, but this concept has been suggested to be used as a surrogate for self-efficacy that has been previously connected to exercise participation [11,12], likewise has a positive attitude [6]. In addition, earlier study focusing on computer-based cognitive training in the FINGER found that positive expectations were associated with joining the programme [28].…”

“…Among psychosocial factors, depressive symptoms have been quite consistently associated with poorer participation in the lifestyle interventions [5][6][7][8], or with greater dropout [9], but they have not always hampered reaching beneficial lifestyle modifications [10]. Positive attitude and self-efficacy have been associated with higher adherence to exercise programmes [6,11,12].…”