Understanding barriers and enablers to maintenance after lifestyle intervention in adults with type 2 diabetes

Background: Lifestyle programs enhance type 2 diabetes (T2D) management; however, short-term barriers and enablers to maintaining changes are unclear.
Purpose: To explore barriers and enablers to maintaining lifestyle changes in adults with T2D who had completed an 8-week lifestyle program, then to map them to the Capability, Opportunity, Motivation – Behaviour (COM-B) model.
Methods: Focus groups were conducted with participants (n=28) at the end-of-program (n=8 groups) and one-month after (n=6 groups) to explore anticipated and experienced barriers and enablers, respectively. Following thematic inductive coding, themes were deductively grouped according to COM-B.
Results: Nine barriers emerged (two anticipated only, one experienced only, six both). Key barriers related to capability (physical health), opportunity (difficulty accessing/using resources; unwillingness to invest in social networks) and motivation (lack of internal drive). Eleven enablers emerged: all across both times. Key enablers related to capability (knowledge), opportunity (access and use of program resources; sense of belonging/safety in the program) and motivation (beliefs/awareness around perceived risk; monitoring of progress; committed to change).
Conclusions: Anticipated and experienced barriers and enablers were mostly aligned, and spanned aspects related to capability, opportunity and motivation.
Practical Implications : Findings suggest T2D management programs should enable ongoing access to resources to build on positive habits and sense of belonging. Investing in mechanisms to scaffold participants into suitable community-based activities may also be beneficial.
Funding: GNH is funded by Australian MRFF Emerging Leadership Fellowship. SRG is partly funded by the HWCRI, which is co-funded by UQ and Health and Wellbeing Queensland.