title: Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes.
abstract: OBJECTIVE
  To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes.
  
  
  METHODS
  Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed.
  
  
  METHODS
  The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes.
  
  
  METHODS
  We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers).
  
  
  RESULTS
  Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors.
  
  
  CONCLUSIONS
  Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Morrison
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Douglas
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Bhopal
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D044466:Asian People; D003920:Diabetes Mellitus / Q000517:prevention & control*; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D018570:Risk Assessment; D012606:Scotland; D015431:Weight Loss
keywords: Diabetes & Endocrinology; Preventive Medicine; Public Health; Qualitative Research