Community and behavior maintenance: the association of community factors with behavior maintenance outcomes in people with type 2 diabetes participating in a group-based walking intervention

Community factors may play a key role in facilitating effective diabetes self-management and sustained behavior change. We investigated whether community factors are related to behavior maintenance outcomes in people with type 2 diabetes participating in a group-based walking intervention. We examined if changes in walking behavior, diabetes self-management and health outcomes are related to perceived social support and diabetes self-efficacy, and if social support is related to behavior maintenance. A longitudinal study was conducted among 528 people with type 2 diabetes participating in a 20-week group-based walking intervention with measurements at baseline, post-intervention, and three months follow-up. Multilevel linear regression and multinomial logistic regression models showed that community factors and social support were positively associated with behavior maintenance outcomes, namely intervention engagement, intention to continue walking after the intervention, and maintenance of physical activity behavior three months following the intervention. Perceived social support and diabetes self-efficacy were positively associated with changes in diabetes self-management and emotional well-being, with those experiencing initial low social support and self-efficacy benefitting most from the intervention. The results emphasize the critical role of integrating community factors and social support components in behavior change interventions in order to promote sustained engagement and behavior maintenance after the intervention.