Barriers and facilitators to participate in a combined lifestyle intervention – a qualitative study

Abstract Background Combined lifestyle interventions (CLI) have been shown to be effective on metabolic and cardiovascular outcomes, weight reduction, and quality of life improvement. However, dropout rates in these programs are relatively high in the Netherlands, ranging from 40 to 50% of those who start. This study aimed to identify facilitating and inhibiting factors influencing participation in CLI's. Methods Data were collected through individual interviews with 68 participants (including those who had completed the two-year program, those currently participating, and those who had withdrawn before completion), and 5 focus groups consisting of 23 healthcare professionals (e.g. lifestyle coaches, GP's, and occupational physicians). Data were transcribed verbatim and analyzed using thematic analysis. Data were coded both inductively and deductively, using the WHO Multidimensional Adherence Model, complemented by the COM-B model for behavior change. Results Barriers and facilitators were identified in all domains of the two frameworks. Barriers included the perception of a lack of commitment to the CLI, poor rapport with the lifestyle coach, a perceived unpleasant group dynamic, lack of physical activity elements in the CLI, conflicting external responsibilities in work or private settings, and little to no perceived outcomes. Facilitators included a source of extrinsic motivation, a sense of acquiring new knowledge, receiving practical advice, a personalized approach, increased interaction with others and the lifestyle coach, and the use of interactive learning formats. Conclusions To promote a successful/improved participation to the CLI, it is recommended to incorporate strategies to overcome these barriers and better use facilitators. For example, detailed information and advice should be provided based on personal needs and interactive elements should be incorporated to provide participants with practical advices. Key messages • Key barriers and facilitators concern (lack of) motivation, practical advice, personalization, and interaction. • Tailoring CLI to individual needs and using interactive formats may reduce dropout.