Table 2 Extracted information from all included studies (n = 35)
Study | Participants | Aim | Study design | Key themes | CASP scorea |
|---|---|---|---|---|---|
Diet interventions | |||||
Abbott et al. 2010 [27] Australia | n = 23 adults (83% female) aged 19 to 72 years (mean 48.0 years) who self-identified as aboriginal | To explore the experiences of Aboriginal peoples who had attended cooking classes | Individual semi-structured interviews | Facilitators: New chronic health diagnosis, improve future health, family, be a role model for family, culturally appropriate foods, group learning, credible diet teachers Barriers: Food cravings, poor oral health, depression, moving around/travel, caring for others, cooking for others, social isolation caused by eating certain foods, lack of family support (“sabotage”), cost of healthier food | 6.5 |
Astbury et al. 2020 [28] United Kingdom | n = 12 adults (75% female) aged 40–75 (mean 56.1 years) living in a larger body | To determine the clinical effectiveness, feasibility and acceptability of referral to a commercial low-energy total diet replacement program compared with usual weight management interventions in primary care | Individual semi-structured interviews | Facilitators: Health professionals, interventionist, feeling accountable to the research team, one-on-one dietary counselling, support for transition back to solid foods Barriers: Eating with other people, holidays, cooking for others, restriction of solid foods | 8.5 |
Burke et al. 2009 [29] United States | n = 15 adults (80% female) aged 38–56 years (mean 48 years) | To explore participants’ reflections on their feelings, attitudes, and behaviors while using a paper diary to self-monitor their diet | Individual semi-structured interviews | Facilitators: Weight loss, gaining dietary knowledge, optimism towards changes, interest, commitment to intervention goals, other participants, accountability towards the research team, meal planning, self-monitoring, group learning, forming habits Barriers: Just didn’t want to, emotional eating, food cravings, fatigue, lack of time, housework, work, not interested or fun, forgetting, feeling overwhelmed by changes being asked | 6.5 |
Dasgupta et al. 2014 [30] Canada | n = 29 adults (83% female) > 18 years (mean 58.9 years) living with type 2 diabetes | To explore effective elements of the strategy from participants’ perspectives after attending a nutrition education/meal training program | Focus groups | Facilitators: Weight loss, blood sugar control, gaining dietary knowledge, increased self-efficacy, reduced medicine intake, other participants, friends, being a role model for family, interactive programs, grocery store tours, incorporation of technology, self-monitoring, interactions with dietitians or chefs, monitoring activity with a pedometer | 7.5 |
Hammarstrom et al. 2014 [31] Sweden | n = 12 women aged 49–71 years (mean 60 years) living in a larger body | To explore barriers and facilitators to weight-loss experienced by participants in a diet intervention | Individual structured interviews | Facilitators: Weight loss, commitment to intervention goals, other participants, family, friends, health professionals, interventionists, clear intervention goals/guidelines Barriers: Just didn’t do it, emotional eating, food cravings, lack of time, health issues (injury, dietary restrictions), travel/moving around, injury, stress with life changes, lack of motivation, previous failure managing health behaviors, coffee dates with friends, cooking with other people, lack of friend support, co-workers, family (“sabotage”), cost of healthier food, food accessibility, no health coach, transport to program locations, lack of food variety, no group cooking sessions | 7.5 |
Maston et al. 2021 [32] Australia | n = 20 adults (60% female, mean age 51.2 years) living in a larger body | To explore facilitators and barriers to dietary adherence and program attrition in a specialized weight loss clinic | Individual semi-structured interviews | Facilitators: Weight loss, gaining dietary knowledge, other participants, health professionals/ interventionists, clear intervention goals/guidelines, stigma free spaces, self-monitoring Barriers: Emotional eating, unrealistic weight loss expectations, transportation to program, lack of food variety | 9 |
Mendonca et al. 2019 [33] Brazil | n = 45 adults (58% female) \(\ge\) 20 years (84.5% \(\ge\) 40 years) | To investigate the barriers and facilitators for the adherence of participants in a 7-month nutritional intervention for promoting the consumption of fruits and vegetables | Individual semi-structured interviews | Facilitators: Gaining dietary knowledge, increased self-efficacy, interest, improve future health, commitment to intervention goals, other participants, family, health professionals/ interventionists, interactive design, clear intervention goals/ guidelines, nearby program locations, habit formation, length of meetings Barriers: Lack of time, housework, work, no weight loss, caring for others | 8.5 |
Metzgar et al. 2015 [34] United States | n = 23 women (mean age 38.8 years) living in a larger body | To explore facilitators and barriers to weight loss and weight loss maintenance in women who participated in a primary, 18-week comparative trial that promoted weight loss with an energy-restricted diet | Focus groups | Facilitators: Gaining dietary knowledge, increased self-efficacy, having a routine for activity, feeling ready to change, other participants, family, friends, co-workers, health experts/interventionists, feeling accountable to others, flexibility in food choices, meal planning, group meetings, trusting interventionists, habit formation, monitoring by experts (dietitians), learning about portion control, weekly sessions Barriers: Food cravings, not losing weight, lack of motivation, feeling guilty taking time for oneself, lack of support from friends, co-workers, family (“sabotage’), feeling reliant on the program, no activity information/ components | 8.5 |
Rehackova et al. 2021 [35] United Kingdom | n = 34 adults (53% female) aged 20–65 years (mean 51.0 years) living in a larger body with type 2 diabetes | To understand participant experiences in a clinical weight loss program relying on diet replacement and behavioral support | Individual semi-structured interviews | Facilitators: Weight loss, blood sugar control, increased energy, increased self-efficacy, motivated to change, other participants, modelling for others, feeling accountable to the research team, learning about hydration, trust in the diet information given Barriers: Hunger, fatigue, no weight loss, lack of food variety | 6 |
Rodriguez, et al., 2020 [36] Mexico | n = 10 women aged 30–60 years (mean 47.6 years) with a higher prevalence and risk of living in a larger body | To provide a framework for the motivations of women to engage in and maintain a participation in a physician- dietitian nutritional counselling program | Individual interviews | Facilitators: Motivation change, family, friends, health professionals/ interventionists, wanting to look good, avoid health complications, weight loss, type of platform, gaining knowledge, group sessions Barriers: Food cravings, cost of programs and food, work, eating in social gatherings | 5.5 |
Activity interventions | |||||
Camhi et al. 2021 [37] United Stated | n = 26 women aged 21–78 years (mean 42.5 years) | To explore individual, interpersonal and environmental barriers and facilitators associated with participants adherence to an exercise prescription (ExRx) | Individual semi-structured interview | Facilitators: Feeling ready to change, family, friends, easy access to program location Barriers: Caring for others, program not meeting expectations, cost, no instructor for activity | 6.5 |
Casey et al. 2010 [38] Canada | n = 16 adults (44% female) aged 39–65 years (mean 52.5 years) living with type 2 diabetes | To assess barriers and facilitators of participation in a supervised exercise program, and adherence to exercise after program completion | Focus groups | Facilitators: Stop medication, control blood sugar levels, improve physical well-being, improve mental wellbeing, weight loss, intervention staff, feeling accountable to research team, weather, family, peers, incorporation of walking, interactions in programs with activity experts Barriers: Physical health limitations (e.g., knee pain), lacking motivation, childcare, work, poor weather, transpiration to program, losing trainer, locations for activity after the program ended, strict program times for activity, lack of variety in activity type | 8.5 |
Cooke et al. 2018 [39] Canada | n = 30 adults (47% female) aged 35 years and older (half 50–64 years) living with type 2 diabetes and/or hypertension | To assess participants’ experiences and impressions of an exercise intervention, to understand the perceived barriers and facilitators | Individual semi-structured interview | Facilitators: Improved physical well-being, intervention staff, family, friends, incorporation of walking, wearing a pedometer, doing activity daily, keeping an exercise diary, easy to understand guidelines/ content Barriers: Physical health limitations, work, poor weather, pedometer issues, loosing intervention support | 7.5 |
Gallegos-Carrillo et al. 2020 [40] Mexico | n = 117 adults (68% female) aged 35–70 years (mean 50.4 years) diagnosed with high blood pressure | To explore the factors underlying adherence to a specific 16 weeklong exercise referral scheme (including group exercise sessions) aimed at increasing PA in hypertensive patients | Individual semi-structured interviews | Facilitators: More severe high blood pressure diagnosis, increased self-efficacy, prioritizing activity, less perceived barriers, family, friends Barriers: Concern for blood pressure when exercise, time, work, unwilling to preform activity, cost, lack of family support, transportation to program | 5.5 |
McCormack et al. 2019 [41] Canada | n = 23 adults (83% female) aged 24 to 68 years (mean 37.5 years) | To explore individual, social, and physical environment characteristics that hinder or facilitate physical activity among previously “inactive” adults during a 12-week community-based internet-facilitated pedometer intervention | Individual semi-structured interviews | Facilitators: Committed to intervention goals, increased self-efficacy, decreased perceived barriers to activity, gaining knowledge, access to nature, companionship for activity, feeling accountable to research team, Family and friends, family, neighbourhood walkability, active transport, wearing a pedometer, goal setting, form habits Barriers: Poor weather and limited access to grocery stores, and lack of access to green spaces or nature | 8.5 |
Eynon et al. 2018 [42] United Kingdom | n = 9 adults (56% female) aged 41–67 years (mean 49.9 years) | To identify the key psychological factors associated with adherence to an exercise referral scheme | Individual semi-structured interview | Facilitators: Committed to intervention goals, improve future health, increased self-efficacy, self-esteem, body image, prioritizing and enjoying activity, seeing physical improvements in activity abilities, emotional balance, forming an exercise identity, goal setting, monitoring, form habits | 8 |
Huberty et al. 2008 [43] United States | n = 24 women aged 26 to 66 years (mean 46 years) | To qualitatively examine factors related to physical activity adherence to understand why women continue to participate in long-term exercise after completing a structured exercise program (“U Try Active Habits and Fitness” intervention) | Focus groups | Facilitators: Future health benefits, increased self-efficacy, self-esteem, self-worth, improved body image, prioritizing activity, enjoyment, feeling improvements in activity abilities, companionship for activity, intervention staff, family, friends, goal setting, continued interactions with activity experts, form habits Barriers: Time, lack of motivation, family care, self-conscious about body image when exercising, feeling guilty taking time to exercise, not enjoyable, fear of not achieving goals, low self-worth, lack of support from family, no one to be active with, opposing norms related to body size | 9 |
Kinnafick et al. 2018 [44] United Kingdom | n = 12 adults (66.7% female) with a mean age of 39.7 years | To qualitatively evaluate the participant experiences of a workplace high-intensity interval training (HIIT) intervention targeting insufficiently active adults | Focus groups | Facilitators: Increased self-esteem, improved physical well-being, feeling improvements in activity abilities, enjoyment, feeling a sense of accomplishment, other participants, interventionists, neighbourhood walkability, flexible activity sessions times, being with a group with a similar activity level Barriers: Lack of time, belief that HITT is for ‘fit individuals,’ programs expectations not being met, no weight loss, poor weather | 7.5 |
Korkiakangas et al. 2011 [45] Finland | n = 54 adults (55% female, mean age of 49 years) living with type 2 diabetes | To describe the motivators and barriers to physical activity among individuals with high risk of type 2 diabetes who participated in video group counselling sessions | Questionnaires with open-ended questions | Facilitators: Improved physical and mental well-being, weight loss, feeling improvements in activity abilities, enjoyment, forming an exercise identity, access to nature, companionship for activity, work environment, neighbourhood walkability, modeling for others, access to activity equipment, owning a pet Barriers: Physical health limitations, time, too tired, stress, not enjoyable, poor weather, season, | 6.5 |
Lee et al. 2015 [46] South Korea | n = 27 women aged 36–60 years (mean 52.5 years). Migrant workers | To investigate the barriers to performing stretching exercise during a community-based 12-week stretching exercise intervention trial | Individual semi-structured interviews | Barriers: Health limitations (e.g., illness) lacking motivation, lack of time, family care, too tired, feeling incompetent preforming activity, lack of family support, co-worker support, no one to exercise with, travel | 5.5 |
O’Dougherty et al. 2008 [47] United States | n = 80 women aged 25–44 years living in a larger body | To examine factors associated with adherence to a strength training intervention in a randomized controlled intervention trial | Focus groups | Facilitator: Committed to intervention goals, increased self-efficacy, improved body image, enjoyment, feeling a sense of accomplishment, accountability to others, family, friends, group activity sessions Barriers: Changes in schedule (i.e., moving or travel), time, family care, too tired, feeling overwhelmed to make changes, no weight loss, prioritizing social activities that are sedentary first, lack of family or friend support, no one to exercise with, opposing norms on physical appearance (e.g., women as muscular), no longer having group sessions, loosing activity trainer | 8.5 |
Tulloch et al. 2013 [48] Canada | n = 28 adults (29% female) aged 39–70 years (mean 55.7 years) living with type 2 diabetes | To determine the perceived facilitators and barriers to exercise at multiple time points of participants in a randomized exercise trial including aerobic, resistance or combined exercise | Interviews | Facilitators: Future health benefits, control blood sugar, improve mental well-being, weight loss, improvements in activity ability, enjoyment, interventionists, family, interactions with activity experts Barriers: Time, family care, work, too tired, vacations, no interest/ not enjoyable, injury, illness, poor weather | 8 |
Vetrovsky et al. 2019 [49] Czech Republic | n = 10 adults (30% female) aged 30–64 years (mean 43.7 years) | To explore patients’ experiences during a 12-week pedometer-based physical activity intervention in a primary care setting targeting inactive adults | Participant written email messages | Facilitators: Future health benefits, enjoyment, interventionists, family, owning a pet, incorporation of walking, wearing a pedometer, goal setting, self-monitoring, self-reward, forming habits Barriers: Lack of motivation, time, family care, feeling overwhelmed at changes, poor weather | 6.5 |
Viljoen et al. 2015 [50] South Africa | n = 35 postmenopausal women aged 50 to 75 years (mean 58.9 years) | To assess self-reported motivational factors influencing adherence and retention to a resistance training program targeting sedentary women | Focus groups | Facilitators: Get off medication, increased self-worth, improved physical and mental well-being, weight loss, enjoyment, increased knowledge, social support, group activity sessions, flexible timing of activity sessions, form habits Barriers: Vacations, lacking social support | 7 |
Mixed interventions (diet and activity) | |||||
Brandt et al. 2018 [51] Denmark | n = 10 adults (70% female) aged 34–71 years (mean 52 years) living in larger bodies | To identify drivers of importance for long-term personal lifestyle changes from a patient perspective when using a collaborative e-health tool | Individual semi-structured interviews | Facilitators: Positive health changes, weight loss, healthcare/interventionists, family, friend, regular monitoring and communication with a healthcare expert, goals setting, trust in healthcare experts and the information they give Barriers: Lacking self-efficacy, feeling overwhelmed by changes, food cravings, illness, lacking family support, other participants, not feeling connected to interventionists, loosing monitoring by interventionists post program, not trusting information interventionists portray | 9 |
Chan et al. 2009 [52] China | n = 25 adults (84% female) aged 18–62 years (60% \(\ge\) 40 years) living in a larger body | To examine the participants’ experience of a community-based lifestyle modification program | Individual semi-structured interviews | Facilitators: Increased self-efficacy, gaining knowledge, self-control, positive health changes, weight loss, feeling full, healthcare professionals/ interventionists, family, clear guidelines, trust in healthcare experts and information given Barriers: Lack of motivation, self-efficacy, stress, work, time, fear of failing, lack of support from family, friends, colleagues, opposing usual social norms over behaviors, eating out or in social settings, short one-on-one sessions, lacking trust in interventionists or the information given | 8 |
Hardcastle et al. 2011 [53] United States | n = 14 adults (64% female, mean age 57.6 years) living in a larger body | To explore the experiences of patients, following participation in a counselling intervention, to identify the influences on behavior change in relation to physical activity and diet | Individual semi-structured interviews | Facilitators: Increased self-efficacy, self-control, fear of negative health outcomes if don’t change, weight loss, commitment to intervention goals, social support, healthcare experts/ interventionists, feeling accountable to others, regular monitoring and communication with health experts, pedometers, interactions with diet or activity experts, form habits, planning ahead Barriers: No weight loss, lack of support from family (“sabotage”), no connection to interventionists, no one to exercise with, rigid intervention structure/delivery times, support for behavior change, just information on what to change | 9 |
Harrison et al., 2020 [54] United States | n = 29 women aged 18–39 years (mean 30.3 years) living with type II diabetes | To understand barriers and facilitators to engagement in a national Diabetes Prevention Program (year-long, group-based program with lifestyle coaches) for young women at an urban safety-net health care system | Individual semi-structured interviews | Facilitators: Motivated to change lifestyle, avoid chronic disease development, weight loss, healthcare experts/ interventionists, support from other participants Barriers: Work, unclear guidelines, onsite weighting (stigma), transportation to program locations, wide range of age groups in sessions together | 7.5 |
Kleine et al. 2019 [55] United States | n = 61 adults (70% female) aged 31 to 82 years (mean age of 51 and 56 years in two separate cohorts | To identify barriers and facilitators of weight loss and weight loss maintenance among individuals participating in a meal replacement program from lower socio-economic areas | Focus groups | Facilitators: Increased self-efficacy, gaining knowledge, feeling accomplishment, positive changes to health, weight loss, changes in body shape, increased energy, commitment to intervention goals, improved quality of life, increased mobility, support from healthcare experts/ interventionists, family, other participants, clear guidelines, educational hand-outs, form habits, quick choices (food) that can be taken on the go, interactions with diet/ activity expert Barriers: Time, lack of family support, not feeling connected to interventionists, eating out or in social settings, cooking for others, loosing monitoring with others post program, being sick of dietary replacement foods, not talking about activity with a health coach, lacking trust in interventionists or the information they provide | 7.5 |
Leung et al. 2020 [56] China | n = 26 adults (79% female) aged 18–65 years (mean 38.9 years) living in a larger body | To explore the psychological factors of dietary and physical activity adherence 10 months after enrolment in a community-based lifestyle modification program | Individual semi-structured interviews | Facilitators: Increased self-efficacy, gaining knowledge, positive changes to health, weight loss, changes in body shape, healthcare experts/ interventionists, family, friends, monitoring heart rate during activity, interactions with diet or activity experts, paying for the program, form habits Barriers: Forgetting what was taught, no one to exercise with | 9 |
Lieffers et al. 2020 [57] Canada | n = 32 first year university students (72% female) aged 17–30 years | To understand experiences and perception of web-based application that aims to support healthy living by providing resources and self-monitoring tools in a12-week randomized controlled trial | Individual semi-structured interviews | Facilitators: Gaining knowledge, feeling accomplishment, daily reflection, goal setting Barriers: Feeling overwhelmed by changes, cost, rigid intervention structure, lack of culturally inclusive food, no app | 8.5 |
Penn et al. 2013 [58] United Kingdom | n = 15 adults (53% female) aged 40– 65 years (mean 54 years) at elevated risk of type 2 diabetes | To explore participants’ perspectives of their behavioral change and maintenance of new behaviors in physical activity intervention | Individual semi-structured interviews | Facilitators: Increased self-efficacy, gaining knowledge, motivated to change lifestyle, feeling accomplished, avoiding chronic disease development, control diabetes, weight loss, improved body image, feeling good after exercise, friends, health experts/ interventionists, free gym access, filling free time caused by retirement (enjoyment) Barriers: No weight loss, embarrassed performing activity, not wanting to fail a set goal, cost | 6.5 |
Rise et al. 2013 [59] Norway | n = 23 adults (61% female) aged 35–72 (mean 58 years) living with type 2 diabetes | To investigate how participants make and maintain lifestyle changes after participating in group-based type 2 diabetes self-management education | Individual semi-structured interviews | Facilitators: Increased self-efficacy, gaining knowledge, fear health complications if don’t change, diabetes control, positive changes to health, weight loss, increased energy, support from healthcare experts/ interventionists, family, friends, educational handouts, forming habits Barriers: Time, lack of support from family | 8.5 |
Schmidt et al., 2020 [60] Norway | n = 6 adults (50% female) aged 41–74 years (mean 56.5 years) living with type II diabetes | To explore and identify factors that influence motivation for and barriers to adopting and maintaining lifestyle changes following participation in an intensive multiple-lifestyle intervention | Individual semi-structured interviews | Facilitators: Increased self-efficacy, decrease medication, improved fitness ability, support from healthcare experts/ interventionists or other participants, co-participation for activity Barriers: Stress, injury, work, opposing social norms over behaviors, rigid intervention structure, loosing monitoring support when intervention ended | 7.5 |
Wycherley et al. 2012 [61] Australia | n = 30 adults (27% female, mean age 56.7 years) living with type 2 diabetes and a larger body | To document factors reported that enhanced or impeded sustainability of lifestyle behaviors following participation in a 16‐week lifestyle intervention program | Individual semi-structured interviews | Exercide barriers included: reduced access to gyms, equipment or similar exercise programmes (29%) and the expense of public gyms (21%) as impediments Facilitators: Increased self-efficacy, gaining knowledge, feeling accomplished, diabetes control, positive changes to health, weight loss, support from healthcare experts/ interventionists, family, feeling accountable to research team, regular monitoring with interventionists, monitoring heart rate during activity, activity encouraging dietary maintenance, clear guidelines, interactions with experts, portion control, forming habits Barriers: Feeling overwhelmed by changes, start activity, food cravings, travel, cost, lack of access to gyms, rigid intervention structure, restriction of alcohol, loosing monitoring support after an intervention ended, no activity discussion with a health coach | 7 |