Understanding Attrition in the South African Integrated Intervention for Diabetes Risk After Gestational Diabetes (IINDIAGO) Study: A Qualitative Study of Postpartum Lifestyle Intervention Disengagement

ABSTRACT Background and Aims Lifestyle interventions can benefit women with gestational diabetes (GDM) to manage the condition during pregnancy and reduce future health risks including the risk of progression to Type 2 diabetes (T2DM). However, future benefits may only be realised if women engage with the intervention (coaching, educational materials, ongoing risk assessment and monitoring) after the birth of the child. The aim of this study was to explore the factors influencing women's attrition from a lifestyle intervention study (IINDIAGO—Integrated Health System Intervention aimed at reducing Type 2 Diabetes risk in women after Gestational diabetes) in South Africa. Methods This cross‐sectional exploratory descriptive qualitative study was conducted with women recruited from the intervention arm of the IINDIAGO study and living in a low‐income neighbourhood (Soweto). Participants were divided into two groups: Group A ( n = 11 who remained engaged with the study and received ≥ 40% of the intervention) and Group B ( n = 15 who had disengaged from the study and received < 30% of the intervention). Semi‐structured interviews were conducted telephonically, with interviews recorded, transcribed, and analysed using inductive and deductive methods. Results Women who remained engaged (Group A) frequently reported the perceived intervention benefits including health education, reduced diabetes risk, and positive relationships with the study team. In contrast, women in Group B who had disengaged highlighted multiple challenges and competing demands related to their personal situations, including the cost of travel to the study site and the impact of the COVID‐19 pandemic, that hindered their continued participation. Conclusions Successful implementation of postpartum lifestyle interventions for women who experience GDM and are at high risk of converting to T2DM after the pregnancy are critical. However, interventions in the postnatal period must be tailored to the contextual realities of new mothers facing multiple demands with limited resources to facilitate continued access and engagement.