Preventing type 2 diabetes: a qualitative study exploring the complexity of health-related practices in people with prediabetes

BACKGROUND: Despite the introduction of primary care-based diabetes prevention strategies, labelling people with prediabetes and encouraging behaviour change, type 2 diabetes continues to rise, causing significant morbidity and mortality. AIM: To examine how a prediabetes diagnosis influences a person's health-related practices. DESIGN AND SETTING: An in-depth qualitative study with 25 people with prediabetes, recruited via general practices. METHOD: The study included narrative interviews, patient-collected data, and follow-up interviews. Theoretical analysis was informed by Bourdieu's theory of practice. RESULTS: Participants with prediabetes, especially those from low-income and diverse ethnic groups, often had difficulty following prescribed 'lifestyle' recommendations. An individual's habitus - that is, their embodied traits and behaviour patterns that had built up over their life-interacted with life-world influences, including the expectations and health beliefs of people in their immediate social circle (such as partner, children, and work colleagues); norms associated with wider social rituals (such as birthday parties); and structural intersectional influences (especially food availability and cost, influences of advertising, access to green spaces, and precarity, for example, housing insecurity). Going against social norms and expectations may risk an individual's social positioning, cultural belonging, and sometimes job security. This risk was often experienced as more salient and pressing than a hypothetical future risk of diabetes. CONCLUSION: To improve the success of diabetes prevention efforts, interventions should go beyond individual-level behavioural advice to incorporate changes to the physical, economic, social, and cultural worlds that influence behavioural practices. By going against social norms 'healthy' behaviours may represent a personal social risk for some, particularly those from diverse ethnic groups.