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Table 3 Characteristics of the 20 included studies

From: Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies

Author, Country Aim of study Inclusion criteria Sample Methods Theoretical framework Setting and intervention
Abel et al., 2018, New Zealand [34] Exploring the barriers and facilitators of making dietary improvements among participants following a dietary intervention Adults < 70 years with newly diagnosed prediabetes (HbaA1c 41–49 mmol/mol 5.9–6.6%), BMI ≥ 25 kg/m2 and metformin not prescribed n = 20
F = 10 M = 10
Age range: 43–69 years
Semi-structured qualitative interviews, thematic analysis Not described Setting: A six-month primary care nurse-delivered dietary intervention pilot; Prediabetes Intervention Package (PIP)
Area for lifestyle change (intervention): To promote dietary changes
Andersson et al., 2008, Sweden [35] Exploring the experiences of individuals with pre-diabetes and the associated increased risk of type 2 diabetes Prediabetic as described by WHO guidelines of 1998, including IGT/IFG
-6 months after health check
n = 8
F = 5 M = 3
Age range: 30–74 years
Qualitative interviews
Phenomenological hermeneutical approach
Not described Setting: Health examination at the local health centre consisting of two visits, aim being to collect information on the general health and living conditions of the population of Skaraborg. The interviews were conducted after the health examinations
Area for lifestyle change (no intervention): To promote exercise and dietary changes
Coppell et al., 2017, New Zealand [36] Examining the implementation and feasibility of a six-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes Adults aged ≤ 70 years, if women non-pregnant with newly diagnosed prediabetes; HbA1c 41–49 mmol or FGP 6.1–6.9 mmol/L, BMI > 25 kg/m2, and metformin not prescribed n = 20*
F = 10 M = 10
Age range: 49–65 years
*A subsample of patients who had completed at six-months intervention were purposefully selected to ensure a range of demographic profiles and glycaemic outcomes
Mixed methods, convergent design, involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation
Semi-structured qualitative interviews, thematic analysis
Not described Setting: A six-month primary care nursing-led dietary intervention for prediabetes
Area for lifestyle change (intervention): To promote exercise and dietary changes
Dyer et al., 2020, USA [37] Assessing the impact of gender-tailoring and modality choice on a diabetes prevention program (DPP) engagement among women veterans with prediabetes Female veterans with prediabetes (HbA1c 5.7–6.4% in prior 12 months), who were overweight or obese (BMI ≥ 24 kg/m2) n = 15 *
F = 15
Mean age: 55.5
*A subsample of participants from a larger study on diabetes prevention. The subsample participants were selected by random.
Interviews were conducted at early-implementation (in person modality = 6 and online modality = 4) and post-implementation follow-up (in person modality n = 6 and online modality = 6)
Mixed method study, qualitative semi-structured telephone interviews Not described Setting: Tailored diabetes prevention program (DPP) implemented in a large Veteran Affairs (VA) health-care system from 2016 to 2018.
Area for lifestyle change (no intervention): To promote exercise and dietary changes
Hansen et al., 2010, Norway [38] Identify factors that could have motivational significance for lifestyle change to facilitate the reduction of impaired glucose tolerance (IGT) and, consequently, the risk of type 2 diabetes People with IGT according to WHO guidelines n = 18
F = 14 M = 4
Age range: 33–69 years
Semi-structured interviews, content analysis method Health Belief Model Setting: An instructed, controlled, physical strength exercise program for four months at a fitness centre (2–3 times per week). Interviews were conducted after the intervention
Area for lifestyle change (intervention): To promote exercise
Jallinoja et al., 2008, Finland [39] Exploring whether the individual is seen as capable of autonomously seeking a healthier lifestyle or is dependent on external control and support Individuals with increased risk of type 2 diabetes but not diagnosed with diabetes n = 30
F = 17 M = 13
Age range: 52–65 years
The focus groups consisted of three weight-reducers’ interview groups (5 women, 10 men) and three weight-gainers’ interview groups (12 women, 3 men)
Focus groups
Discourse analysis
Not described Setting: The participants had 1 ½ years earlier participated in a group-based counselling program: GOAL (Good Aging in Lahti Region), a type 2 diabetes prevention program (8-month duration)
Area for lifestyle change (intervention): To promote exercise and dietary changes
Korkiangas et al., 2011 [40] Describing motivators and barriers of exercise among adults with a high risk of type 2 diabetes Individuals who had either scored 15 points or more or 12 points or more on the diabetes risk test with an increased risk of work disability or elevated FGT or IGT in an oral glucose tolerance test within the last 12 months n = 74
F = 33 M = 41
Mean age: 49 years
Focus groups, inductive content analysis
Video conferences and face-to-face groups (data obtained from taped video conferences only)
Not described Setting: Six-month follow up study on the effectiveness and feasibility of activating counselling methods and video conferences in dietary group counselling
Area for lifestyle change (intervention): To promote exercise
Kullgren et al., 2015, USA [41] Examining the frequency of, facilitators of, and barriers to prevent type 2 diabetes among employees found to have pre-diabetes during a workplace screening Individuals who had FBG measurements of 100 to 125 mg/dl n = 40*
F = 29 M = 11
Age range: 41–57
*A subsample of participants from a larger study on diabetes prevention. The subsample participants were selected by purposive sampling with regard to whether they followed the recommendations or not
Mixed methods observational study
Semi-structured telephone interviews
Not described Setting: Follow up study on university employees (n = 82) who were found to have prediabetes during a workplace screening. After three months two groups were compared: 1) Participants attempting weight loss who have gotten at least 150 min of moderate physical activity since the screening or participating in a DPP or 2) have not carried out any of these recommendations after screening
Area for lifestyle change (no intervention): To promote exercise and dietary changes
Kuo et al., 2013, Taiwan [42] Exploring the experiences of people with prediabetes in relation to their engagement in exercise Adults over 18 years with IFG, experience with exercise n = 20
F = 11 M = 9
Age range: 38–66
Mean age: 52.3
In-depth semi-structured interviews
Grounded theory
Not described Participants were interviewed after health consultations
Area for lifestyle change (no intervention): To promote exercise
Lim et al., 2020, Singapore [43] and 2019 [44] Publication from 2020:Assessing factors associated with meeting the recommendation of at least 150 min of moderate/vigorous physical activity weekly and exploring facilitators and barriers related to the exercise behaviour among primary care patients with prediabetes in Singapore
Publication from 2019: Assessing factors associated with fulfilling the healthy plate recommendation and exploring reasons for the dietary behaviour among primary care patients with prediabetes in Singapore
Community dwelling patients aged 21–79 years with existing prediabetes, diagnosis verified by oral glucose tolerance test (OGTT) and diagnosis code, and currently following up at any of the eight polyclinics n = 48*
F = 24 M = 24
Age range: 21–79 years
*A subsample of participants from a larger study on diabetes prevention. Maximum variation sampling strategy was used to recruit a purposive subsample of participants from diverse backgrounds, based on the criteria of sex and whether they reported meeting the “My healthy Plate” recommendation
Mixed methods
In depth interviews, thematic data analysis (Braun and Clarke)
Social ecological model (SEM) framework Setting: Recruited from nine NHG (National Health Care Group) polyclinics in Singapore, health consultations
Area for lifestyle change (no intervention): To promote exercise [43] and dietary changes [44]
Mayega et al., 2014, Uganda/ Sweden [45] Assessing perceptions about type 2 diabetes and lifestyle change among people afflicted with or at high risk of the disease in a low-income setting in Iganga, Uganda Three glycaemic categories:
Suspected diabetes type 2: FPG as ≥ 7.0 mmol/l, suspected prediabetes as an FPG of 6.1–6.9 mmol/l and obesity as BMI > 30 kg/m2
n = 96
F = 47 M = 47
Age 35–60 years
Focus group discussions, content analysis
Ethnographic approach
Not described Setting: The study was conducted in the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in eastern Uganda
Area for lifestyle change (no intervention): To promote exercise and dietary changes
Morrison et al., 2014, Scotland [46] Exploring the reasons for enrolling in, experiences participating in, and reasons for remaining in a family-based, cluster randomized controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes Waist size ≥ 90 cm for men and ≥ 80 cm for women; IGT (i.e., fasting plasma glucose of < 7 mmol/l and, following a standard OGTT, a 2 h plasma glucose of
7.8–11.0 mmol/l)
IFG (i.e., plasma fasting glucose of 6.1–6.9 mmol/l); no previous diagnosis of diabetes
n = 20* F = 7 M = 13
Age not described
*A subsample of participants from a larger study on diabetes prevention. The subsample participants were selected by purposive sampling, ensuring diversity, within the trial population by sex, ethnicity, faith, group, geographical location (Glasgow and Edinburgh) and whether they were allocated to the intervention or control group
Narrative interviews, thematic analysis Not described Setting: A complex dietitian-led dietary-based and physical activity-based intervention for reducing obesity and preventing type 2 diabetes mellitus in people of Indian and Pakistani origin at a high risk of developing diabetes living in Scotland over a three-year period
Area for lifestyle change (intervention): To promote exercise and dietary changes
Penn et al., 2008, England [47] Understanding the experience of participants who maintained behaviour change aiming to inform future interventions. Exploring the dimensions of achieving and maintaining lifestyle change At trial, first recruit: > 40 years, Caucasians with BMI > 25 and IGT diagnosed based on two OGTTs n = 15
F = 7 M = 8
Age range: 47–74
Semi-structured interviews, content analysis, framework approach
Empirical phenomenology approach
Not described Setting: A study nested from the European Diabetes Prevention Study (EDIPS); intervention was individual motivational interviewing (three-month interval) aiming to reduce total food energy and fat intake and increasing activity. Exploring experiences of the participants 3–5 years after
Area for lifestyle change (intervention):
To promote exercise and dietary changes
Strachan et al., 2018, Canada [48] Exploring how people from a small Canadian city diagnosed with prediabetes react emotionally to their diagnosis Between 18 and 65 years old, diagnosed with prediabetes according to the ADA (2016): HbA1c = 5.7%-6.4% (n = 20) or ADA risk-questionnaire indicating increased risk (> 5 = 1) within the past year n = 21*
F = 18 M = 3
Age range: 47–65 years
*A subsample of participants from a larger study on diabetes prevention. The subsample participants were selected by random
Semi-structured interviews, inductive thematic analysis (Braun and Clarke) Not described Setting: The study was part of a larger project where people with prediabetes participated in a 3‐week community‐based lifestyle intervention in Western Canada, “Small Steps for Big Changes Program (SSB)”. Participants were interviewed prior to involvement in the intervention
Area for lifestyle change (intervention): To promote exercise and dietary changes
Bean et al., 2020, Canada [49] Two-fold purpose of the study: a) Profiling patterns of women’s perceived PA journey over one year in those who engaged in Small Steps for Big Changes (SSBC) and b) understanding strategies used to engage in and maintain PA Participants were a) between 18- and 65-years old b) able to read and speak English, c) identify as a woman, d) have prediabetes (glycated haemoglobin 5.7% to 6.4%), and e) have completed SSBC n = 14*
F = 14
Age range: 48–63
Mean age: 60.07
*A subsample of participants from a larger study on diabetes prevention who were female and eligible for SSBC participation, were invited to participate in the qualitative sub study
Qualitative semi-structured interviews, face-to-face and telephone interviews
Trajectory approach coupled with a deductive-inductive thematic analysis (Braun and Clarke)
Not described Setting: The study is a follow-up to a three-week community-based diabetes prevention program in Canada; Small Steps for Big Changes (SSBC)
Participants were interviewed at baseline, during and after the intervention
Area for lifestyle change (intervention): To promote exercise and dietary changes
Katangwe et al., 2020, England [50] Exploring factors influencing engagement with the National Health Service (NHS) DPP and the role of community pharmacies (CP) in diabetes prevention Eligible patients for referral: individuals 18 years or over with HbA1c blood test results within the pre-diabetes range (42–47 mmol/mol [6.0–6.4%]) in the last 12 months n = 16*
F = 9 M = 7
Mean age: 68.4
*A subsample of participants from a larger study on diabetes prevention were purposively sampled from the questionnaire respondents for follow-up semi-structured interviews (n = 10) and a focus group (n = 6)
Explanatory sequential mixed method design
Focus groups and semi-structured interviews (telephone)
Thematic analysis (Braun and Clarke)
COM- B approach, theoretical model for identifying key factors influencing desired behaviours Setting: Individuals were invited to participate in the NHS DPP in order to lower their risk of developing T2D. In the interview study sample, three had attended the program, three had completed the program, three were waiting, two had dropped out, and five had declined
Area for lifestyle change (intervention): To promote exercise and dietary changes
Griauzde et al., 2020, USA [51] 1) Estimating weight change from a low-carbohydrate diabetes prevention programme (LC-DPP) and 2) evaluating the feasibility and acceptability of a LC-DPP. General experiences with the intervention as well as specific barriers and facilitators of VLCD adherence were specifically explored (1) Overweight (BMI ≥ 25 kg/m2), (2) haemoglobin A1c (HbA1c) between 5.7% and 6.4% drawn within six months of the study start date, (3) willingness to participate in group-base class, and (4) ability to engage in at least light physical activity n = 14*
F = 8 M = 6
Mean age: 58.7
*A subsample of participants was recruited from the dietary intervention, sampling not described
Mixed methods sequential explanatory study design
Single arm pilot study
Qualitative semi-structured interviews
Not described Setting: Primary care clinic within a large academic medical centre in the USA. An evidence based, low-fat dietary intervention to teach participants to follow a very low carbohydrate diet (VLCD). Participants attended 23 group-based classes over one year. The participants were interviewed at six (n = 13) and 12 months (n = 12)
Area for lifestyle change (intervention): To promote dietary changes
Howells et al., 2021, England [52] Exploring how individuals with prediabetes understand biomedical definitions of risk and the extent to which they resist them, as this reframing of risk could have implications for engagement with the NHS DPP High-risk patients defined as prediabetic via a blood glucose test (HbA1c level 42–47 mmol/mol) and who had received their prediabetes diagnosis within the last 12 months n = 43*
F = 20 M = 23
Mean age: 60
*Seven general practices were purposively selected to recruit participants (based on a range of factors, including deprivation scores, ethnic diversity and their approach to informing their patients about diabetes risk). From these, all eligible at-risk patients were invited to have consultations audio-recorded and to also participate in in-depth interviews
Qualitative mixed methods: observational study (audio recorded consultations), and individual in-depth interviews
Grounded theory approach
Not described Setting: In the context of a national diabetes prevention program, the setting of this study is the primary care consultation where data was drawn from individual interviews and observations
Area for lifestyle change (no intervention): To promote exercise and dietary changes
Wallace et al., 2021, USA [53] Understanding how Latinos with prediabetes attempted to slow T2D progression and how stress affected their engagement in these behaviours (1) 20 years of age or older; (2) born in a Spanish-speaking Latin American or Caribbean country; 3) doctor confirmed prediabetes diagnosis (haemoglobin A1c range 5.7–6.4%) or elevated fasting glucose reading 100–125 mg/dL in past year, and (4) received medical care in the health system in the past year n = 20
F = 14 M = 6
Age range: 22–72
Mean age: 51
Qualitative semi-structured interviews Not described Setting: Participants were interviewed after having been diagnosed with prediabetes, following participants’ medical appointments
Area for lifestyle change (intervention): To promote exercise and dietary changes
  1. * How participants in the qualitative data collection were selected if part of a larger study
  2. IFG Impaired fasting glucose, IGT Impaired glucose tolerance, FPG Fasting plasma glucose, FBG Fasting blood glucose, OGTT Oral glucose tolerance test, BMI Body mass index, T2D Type 2 diabetes and DPP Diabetes prevention program
  3. F Female, M Male