A review of barriers and facilitators to lifestyle intervention uptake and adherence among adults

Abstract Background Healthy behaviours, such as regular physical activity, healthy dietary intake, smoking cessation, and reducing alcohol consumption, are key components in the prevention of noncommunicable diseases (NCDs), improving public health outcomes and reducing healthcare costs. However, lifestyle interventions targeting these behaviours typically have low participation and high drop-out rates. Through a systematic review, we aim to identify the barriers and facilitators associated with the uptake of and adherence to lifestyle interventions among adults. Methods We conducted a systematic review using databases MEDLINE (ALL), Embase, and Web of Science (Core Collection). Study selection was partly assisted by the AI-driven software Active learning for Systematic Reviews (ASReview). A thematic analysis was conducted using the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Study quality was assessed using the Critical Appraisal Skills Programme (CASP). Results We identified 147 studies, 36 of which were eligible for final analysis. Most studies featured qualitative research conducted in Western countries. Preliminary analysis identified barriers and facilitators related to all COM-B constructs. The most frequently reported TDF domains were beliefs about consequences (e.g., health benefits), emotions (e.g., shame, enjoyment), environmental context and resources (e.g., competing responsibilities, flexibility of the intervention), and social influences (e.g., (lack of) social support). After accounting for age, similar results were found in adults aged 18-65 and those over 65. Conclusions This review provides insight into how lifestyle interventions can be tailored to the needs and preferences of adults. This helps healthcare providers and policymakers to adapt or develop interventions that achieve higher rates of uptake and adherence, as well as improve their (cost-)effectiveness and public health outcomes. Key messages • We identified barriers and facilitators to lifestyle intervention uptake and adherence among adults. These insights inform the adaptation and development of more personalised interventions. • Tailoring lifestyle interventions to individual needs and preferences supports higher participation and lower drop-out rates, ultimately improving public health outcomes and reducing healthcare costs.