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

Health interventions for individuals with prediabetes are essential to prevent or delay progression to type 2 diabetes. Adherence to lifestyle modification is complex and influenced by social determinants that act as barriers or facilitators. Gender, social class, social support, and the patient-professional relationship may shape individuals' capacity to adopt and maintain behavioural changes. This study aimed to explore how these factors influence adherence to lifestyle modification among people with prediabetes.

Ethnomethodological study with a critical social perspective. Data were collected through 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).

Women across social classes reported significant barriers, including work overload, caregiving responsibilities, and weaker support networks, whereas men often benefited from stronger family support. Participants from lower socioeconomic backgrounds faced additional challenges, such as financial limitations affecting healthy food choices and lack of time for exercise. Trust-based and supportive relationships with healthcare professionals emerged as important facilitators of sustained lifestyle change.

Gender and social class play a key role in prediabetes management. These findings highlight the importance of personalised, equity-focused interventions that address social determinants to improve prevention strategies.

The research protocol was registered in a clinical trial registry prior to data collection (registration number: NCT06488677 on July 5, 2024).