Understanding experiences of participating in a weight loss lifestyle intervention trial

A qualitative evaluation of South Asians at high risk of diabetes

Zoe Morrison*, Anne Douglas, Raj Bhopal, Aziz Sheikh

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)
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Abstract

Objective: To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes. Design: Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed. Setting: The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes. Participants: We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers). Results: Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors. Conclusions: Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.

Original languageEnglish
Article numbere004736
JournalBMJ Open
Volume4
Issue number6
DOIs
Publication statusPublished - 20 Jun 2014

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Nutritionists
Life Style
Weight Loss
Exercise
Scotland
Interviews
Family Health
Climate
Volunteers
Language
Randomized Controlled Trials
Obesity
Communication
Weights and Measures
Food
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Understanding experiences of participating in a weight loss lifestyle intervention trial : A qualitative evaluation of South Asians at high risk of diabetes. / Morrison, Zoe; Douglas, Anne; Bhopal, Raj; Sheikh, Aziz.

In: BMJ Open, Vol. 4, No. 6, e004736, 20.06.2014.

Research output: Contribution to journalArticle

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abstract = "Objective: To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes. Design: Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed. Setting: The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes. Participants: We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers). Results: Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors. Conclusions: Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.",
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note = "Acknowledgements: The authors have previously thanked and named many individuals who contributed to the trial. (8) The authors further acknowledge the Trial Dietitians (Alyson Hutchison, Anu Sharma, Sunita Wallia and Ruby Bhopal), Nandini Choudhuri, Sujama Roy and Salman Aziz; current Trial Steering Committee (Professor Nigel Unwin (ex-chair), Prof Graham Hitman (chair), Dr Nita Forouhi, Dr Deepak Bhatnagar, Dr Ghada Zoubiane and Mr Iqbal Anwar); the trial Data Monitoring and Ethics Committee (Professor Iain Crombie, Dr Mike Small, Dr Mike Kelly, Professor Kamlesh Khunti); South Asian Community and religious organisations and individuals who contributed to the recruitment efforts; and finally to all the participants who gave their time to take part in this study. Funding: This study was funded by the National Prevention Research Initiative (G0501310), a funding consortium comprising the British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Health & Social Care Research & Development Office for Northern Ireland; Chief Scientist Office, Scottish Government Health Directorate; the Welsh Assembly Government; and World Cancer Research Fund. Additional financial support was provided from NHS Lothian and NHS Greater Glasgow & Clyde R&D, Chief Scientist Office, NHS Health Scotland and NHS National Services Scotland. Open Access: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http:// creativecommons.org/licenses/by/3.0/",
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N1 - Acknowledgements: The authors have previously thanked and named many individuals who contributed to the trial. (8) The authors further acknowledge the Trial Dietitians (Alyson Hutchison, Anu Sharma, Sunita Wallia and Ruby Bhopal), Nandini Choudhuri, Sujama Roy and Salman Aziz; current Trial Steering Committee (Professor Nigel Unwin (ex-chair), Prof Graham Hitman (chair), Dr Nita Forouhi, Dr Deepak Bhatnagar, Dr Ghada Zoubiane and Mr Iqbal Anwar); the trial Data Monitoring and Ethics Committee (Professor Iain Crombie, Dr Mike Small, Dr Mike Kelly, Professor Kamlesh Khunti); South Asian Community and religious organisations and individuals who contributed to the recruitment efforts; and finally to all the participants who gave their time to take part in this study. Funding: This study was funded by the National Prevention Research Initiative (G0501310), a funding consortium comprising the British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Health & Social Care Research & Development Office for Northern Ireland; Chief Scientist Office, Scottish Government Health Directorate; the Welsh Assembly Government; and World Cancer Research Fund. Additional financial support was provided from NHS Lothian and NHS Greater Glasgow & Clyde R&D, Chief Scientist Office, NHS Health Scotland and NHS National Services Scotland. Open Access: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http:// creativecommons.org/licenses/by/3.0/

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N2 - Objective: To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes. Design: Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed. Setting: The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes. Participants: We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers). Results: Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors. Conclusions: Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.

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