Influence of Social Determinants of Health on Adherence to Lifestyle Modifications in Individuals With Prediabetes: A Mixed Methods Study.
Ana Carvalho-Azevedo, Manuela Abbate, Sergio Fresneda and 5 others
PMID 41422485WHAT IT FOUND
Older adults and unemployed or retired people adhered more to prediabetes lifestyle advice.
Sex, social class and education did not predict adherence. Women and lower social class participants described more time, money and support barriers.
Key findings
01Unemployed or retired participants were significantly more likely to adhere to lifestyle recommendations than employed participants (p = 0.025).
02Age correlated positively with adherence when treated as a continuous variable (r = 0.321, p = 0.003), while sex, social class, education, marital status and living situation showed no association.
03Qualitative interviews showed women described family and work overload as barriers, while lower social class participants described cost as a barrier to healthy eating.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The quantitative phase analysed only 86 participants who completed the intervention arm, so it could not compare the nurse-led telephone programme with the SMS control group or with people who dropped out. The small sample may have limited power to detect associations with social class, gender and other variables. Findings come from one region and from people with prediabetes and BMI 27 to less than 40 kg/m2, so they may not apply to other groups. Adherence was measured at 9 months and associations do not show what caused higher adherence. The qualitative phase included 20 participants selected from high and low adherence quartiles, so its themes describe experiences, not population rates. The broad mixed-methods design did not allow deep analysis of each determinant such as gender or social class.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Balearic Islands Official College of Nursing and by the Ministry of Economy and Competitiveness, Carlos III Health Institute, grant PI18/012019. The paper states the funding sources had no role in the conceptualization, design, data collection, analysis, interpretation, manuscript preparation or publication decision.
The easy way to misread this
Do not read this as evidence that nurse-led telephone advice improved glycaemic control or caused better adherence. The paper analysed only 86 people who completed the intervention arm, did not include the SMS control group or dropouts, and reported associations with social determinants rather than the trial's primary glucose outcome.