Barriers and facilitators to dietary change while aiming to reduce free sugar intakes: framework analysis based on...

This study aimed to identify barriers and facilitators to reducing free sugar intakes while participants were in the process of attempting to do this. Sixty-two adults with free sugar intakes >5% total energy intake; participants in a randomised controlled trial examining the effects of three different dietary recommendations versus control for reducing free sugar intakes were interviewed at either 1, 2, 4, 8, or 12 weeks after receiving their recommendation. Data were analysed using thematic analysis and framework analysis based on recommendation received, time for change, and success in reducing free sugar intakes at 12 weeks. Thematic analysis revealed seven interactive themes leading to dietary change: 'Is it possible?'; 'Power of knowledge'; 'Personal balance and empowerment'; 'Habitual approach'; 'Realities of life'; 'Extensive awareness and viewpoint'; and 'Proof and impact'. Framework analysis revealed greater knowledge, including knowledge related to practical solutions, in intervention groups compared to control; greater intentions and expectations at the start of the process, followed by increasing or decreasing engagement and satisfaction over time, with noticeable physical and subjective proof occurring from 4 weeks; and active engagement, with growing confidence and motivation in those who ended the trial having reduced their free sugar intakes compared to more passive attitudes in those less successful. Our findings demonstrate clear variation in barriers and facilitators to reducing free sugar intakes throughout the process, dependent also on recommendation received and individual orientation. Suggestions for improving free sugar intake reduction can be offered based on these differences.