Experiences of making lifestyle changes among people with prediabetes attending Diabetes Prevention Education Program (DiPEP): A qualitative study in Nepal

Background Development of diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called ‘Diabetes Prevention Education Program’ (DiPEP) was tested recently in Nepal. The present qualitative study aimed to explore the experiences of making lifestyle changes among people with prediabetes who participated in the DiPEP. Method A qualitative study with semi-structured interviews of 20 participants was conducted four to seven months following DiPEP intervention. DiPEP was developed considering the local and cultural context of Nepali users and was delivered in Nepali language. It was a 6-month lifestyle intervention with a group-based physical or digital educational sessions for the four weeks of the first month and next five months with either group-based weekly physical follow-up or individual biweekly telephone follow-up calls, and a group-based monthly physical or digital meetings. Four topics in the educational sessions were introduction to diabetes and prediabetes, healthy eating & physical activity, stress management and management of social cues. The monthly meetings included revision of the four topics, practical exercise sessions followed by a question-answer session. The data was analysed thematically. Results The findings were categorized into four themes, i) understanding that diabetes could be prevented, ii) lifestyle changes made, iii) hurdles to overcome, and iv) experiencing benefits leading to sustained change. Some participants said that it was a relief to have learned that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet like reducing carbohydrate intake and in physical activity like starting exercises. Some obstacles faced by participants were lack of motivation and time, lack of family support and lack of space to do exercises. Having experienced benefits from lifestyle changes such as weight loss and reduced level of blood sugar were reported to lead them to maintain the changes they had made. Conclusion Understanding that diabetes could be prevented was a key motivator for implementing changes after the DiPEP intervention. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings. Key words Benefits, Hurdles, Lifestyle changes, Prediabetes, Understanding