What motivates people with type 2 diabetes to maintain lifestyle changes and what challenges do they experience? A qualitative evidence synthesis
Bibliographic record
Abstract
BACKGROUND: People with type 2 diabetes often find recommended lifestyle changes difficult to achieve and can find it particularly difficult to maintain these changes. It is therefore useful to explore their views and experiences about what influences them when attempting to achieve these goals. OBJECTIVES: To identify, appraise and synthesise qualitative studies that explore what motivates people with type 2 diabetes to maintain lifestyle changes over time and the challenges they experience. METHODS: We included qualitative studies and mixed methods studies with a qualitative component, in any language, of adults who had type 2 diabetes and who had maintained lifestyle changes for a minimum of twelve months. We searched MEDLINE, CINAHL, PsycINFO and EMBASE from inception to 4th November 2024. We extracted data using a pre-designed form and assessed methodological limitations using predefined criteria. We used a thematic synthesis approach to analyse the data. We assessed our confidence in the review findings using the GRADE-CERQual approach. Finally, we used our findings to develop a model using the locus of control theory and to develop implications for practice. RESULTS: We included twelve studies from Europe, USA, Canada, South-Africa, Australia and New Zealand. Participants described several factors that motivated them to maintain lifestyle changes, including getting support from others, seeing results from their lifestyle changes, walking as an activity, being physically active with others, fearing the consequences of type 2 diabetes, and taking control. Factors that they viewed as challenging included mental, physical, practical, and social challenges around exercise, and lack of follow-up from healthcare professionals. CONCLUSIONS: Our review identified several factors that may influence maintenance of lifestyle changes in type 2 diabetes. Based on these findings, we have developed a series of questions to help people with type 2 diabetes and their healthcare providers think about how best to maintain lifestyle choices over time.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.076 | 0.113 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.011 | 0.014 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.003 | 0.007 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".