Examining the facilitators and barriers to health behaviour change for type 2 diabetes remission in a young population with early diabetes: A qualitative study of participants in the DIADEM ‐I randomised controlled trial

BACKGROUND: This qualitative study explored the motivators, facilitators and barriers to health behaviour change in young individuals recently diagnosed with type 2 diabetes mellitus (T2DM), drawing insights from the DIADEM-I randomised controlled trial examining the impact of an intensive lifestyle intervention (ILI) incorporating total diet replacement and gradual unsupervised physical activity on bodyweight reduction and T2DM remission. METHODS: A subset, enrolled in intensive ILI or best medical care (control) groups of DIADEM-I were invited to participate in a qualitative sub-study employing one-to-one face-to-face interviews after study completion at 12 months. Stratified purposive sampling was used to include men and women of varying ages and participants from both intervention groups. Twenty-eight interviews were conducted, recorded, transcribed and analysed using thematic analysis. RESULTS: Highlighted motivators included the desire for T2DM remission, bodyweight reduction and freedom from medication. Social support and intrinsic factors were pivotal, with successful participants experiencing a paradigm shift toward healthier behaviours. Barriers included health-related issues, dysfunctional relationships with food and environmental challenges. Cultural sensitivity addressing body image perceptions and social norms, and the need for obesity and T2DM public awareness programmes was highlighted. The ILI group valued multidisciplinary support, meal replacements and educational programmes, but highlighted the need for flexibility and ongoing personalised support. CONCLUSIONS: The findings highlight the complexity of health behaviour change initiation and maintenance in the context of T2DM diagnosis and aiming for T2DM remission. The study provides insights for clinicians aiming to motivate individuals toward sustained health behaviour change for T2DM remission and implement service delivery.