Patient experiences of behaviour change and service engagement in pre-diabetes programmes in Wales: a qualitative study
Year: 2026
Type: preprint
Abstract: Background The global burden of diabetes is increasing, necessitating improved surveillance and prevention efforts. Evidence supports identifying high-risk individuals and implementing intervention programmes. Until recently, Wales lacked a nationwide, standardised support programme for individuals with pre-diabetes. Clinical data from a Welsh diabetes prevention pilot programme, implemented in 2022, indicated a reduction in average blood glucose levels (HbA1c) at 12-month follow-up. However, limited qualitative evaluation has been conducted to understand the lived experiences of individuals identified with pre-diabetes and how programme components may support behaviour change. This study aimed to undertake a formative evaluation by exploring the views and experiences of adults enrolled in the two diabetes prevention programmes currently delivered within a Welsh health board. Methods This qualitative study, informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model, investigated the lived experiences of service users of the diabetes prevention programmes. In total 28 participants took part in one of the five focus groups or a telephone interview from January to March 2024. Thematic analysis with a hybrid inductive-deductive approach was used to analyse the data. Different dimensions of experience including access to service, interactions with healthcare support workers (HCSWs) and behaviour change were explored and mapped around perceived capability, opportunity, motivation and behaviour change. Results Service-related and personal determinants of programme engagement and lifestyle change were identified and mapped onto the COM-B components of psychological and physical capability, social and physical opportunity, and automatic and reflective motivation. Key elements included prior knowledge, supportive staff, health checks, personalised guidance, risk awareness, and personal responsibility. The findings revealed a complex interplay of factors affecting participant engagement and behaviour change. Conclusions Based on our findings, we summarised a set of recommendations that might improve the current services being offered within the Welsh Diabetes Prevention Pilot Programmes, such as increased flexibility in delivery (out-of-hours), and availability (resources to be made available online out of hours), more frequent contact (e.g. monthly for the first 6 months), and regular health checks (e.g. HbA1c every 6 months), could improve initial uptake, sustained engagement and behaviour change in the programmes.
Source: Research Square
Authors: Zsofia Szekeres, Tahir Touray, Jane EA Lewis
Institution: Cardiff Metropolitan University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225749789