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Influence of Social Determinants of Health on Adherence to Lifestyle Modifications in Individuals With Prediabetes: A
Ana Carvalho-Azevedo1,2,3, Manuela Abbate1,2,3, Sergio Fresneda1,2,3
1Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain.
Aim:
To explore the relationship between social determinants of health and adherence to lifestyle recommendations, and how these determinants can help explain contextual and interpersonal factors contributing to adherence among individuals with prediabetes.
Design:
Explanatory sequential mixed methods study integrating a cross-sectional quantitative analysis with an ethnomethodological qualitative approach grounded in critical social paradigm.
Methods:
The quantitative phase used data from the intervention arm (n = 86) of the PREDIPHONE trial, a randomised controlled study evaluating the effectiveness of a nurse-led telephone intervention for lifestyle changes in glycaemic control. Adherence was measured using a composite index, analysed as both a continuous and categorical variable. Correlation analysis examined adherence and age. Chi-square and ANOVA tests were used to analyse differences in participant characteristics across adherence quartiles. The qualitative phase included individual semi-structured interviews and a focus group with participants showing high or low adherence. Thematic content and discourse analysis were employed, ensuring validity through triangulation, reflexivity and discourse saturation.
Results:
Employment status was identified as a significant factor, with unemployed or retired participants showing better adherence. Although no statistical differences in adherence were found by social class or gender, lower social class participants reported financial barriers to healthy eating and time constraints limiting physical activity (PA). Women reported facing greater challenges due to caregiving responsibilities, whereas men benefited from household support.
Conclusions:
Employment status emerged as a determinant of time availability for self-care, alongside social class and gender in adherence to lifestyle modifications. Women, especially those from lower social classes, experienced heightened barriers to adherence, underscoring the need for tailored, gender-sensitive and equity-focused interventions.
Implications:
Addressing social determinants is essential for effective lifestyle advice among individuals with prediabetes.
Impact:
The study highlights the role of social class and gender in adherence.
Reporting Method:
STROBE and COREQ guidelines.
Patient Contribution:
Through interviews and focus group.
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