Understanding barriers and facilitators of adherence to lifestyle changes in prediabetes: a qualitative study.

Women across social classes reported significant barriers to lifestyle adherence related to work overload, caregiving responsibilities, and weaker support networks.

• Data were collected through fifteen semi-structured interviews, one focus group, and a support network mapping exercise.
• Women's barriers were identified across social classes, suggesting gender as an independent factor shaping adherence capacity.
• Caregiving responsibilities were specifically highlighted as a barrier unique to or more prominent among women participants.
• The study used an ethnomethodological approach with a critical social perspective to explore these gendered dynamics.

Men with prediabetes often benefited from stronger family support compared to women, facilitating their adherence to lifestyle modifications.

• Family support was identified as differentially distributed by gender, with men more frequently benefiting from this facilitator.
• This finding emerged through thematic content analysis and critical discourse analysis of interview and focus group data.
• The contrast between men's and women's support networks was captured in part through a support network mapping exercise.
• Rigour was ensured through data saturation, investigator triangulation, and reflexivity.

Participants from lower socioeconomic backgrounds faced additional challenges to lifestyle adherence, including financial limitations affecting healthy food choices and lack of time for exercise.

• Financial constraints were specifically identified as affecting the ability to make healthy food choices among lower socioeconomic participants.
• Lack of time for exercise was reported as a distinct barrier among those from lower socioeconomic backgrounds.
• Social class was identified alongside gender as a key social determinant shaping prediabetes management capacity.
• The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure reporting quality.

Trust-based and supportive relationships with healthcare professionals emerged as important facilitators of sustained lifestyle change in prediabetes.

• The patient-professional relationship was identified a priori as a social determinant likely to shape adherence.
• Trust was specifically highlighted as a component of the facilitating healthcare relationship.
• This finding was identified through thematic content analysis and critical discourse analysis of participant narratives.
• The facilitating role of healthcare relationships was identified across the fifteen semi-structured interviews and focus group data.

The study employed an ethnomethodological design with a critical social perspective, using multiple qualitative data collection methods to explore adherence barriers and facilitators.

• Data collection methods included fifteen semi-structured interviews, one focus group, and a support network mapping exercise.
• Analysis combined thematic content analysis and critical discourse analysis.
• Rigour was ensured through data saturation, investigator triangulation, and reflexivity.
• The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) and was registered in a clinical trial registry prior to data collection (NCT06488677, registered July 5, 2024).

Social determinants including gender, social class, social support, and the patient-professional relationship were identified as shaping individuals' capacity to adopt and maintain behavioural changes in prediabetes.

• These four social determinants were the primary focus of the study's inquiry into adherence to lifestyle modification.
• The study framed these determinants as acting as either barriers or facilitators to lifestyle change.
• Findings highlight the importance of personalised, equity-focused interventions that address social determinants to improve prevention strategies.
• Health interventions for prediabetes are framed as essential to prevent or delay progression to type 2 diabetes.