Barriers and facilitators of physical activity and exercise among adults with type 2 diabetes mellitus in Singapore – A mixed-methods sequential explanatory study mapped to the COM-B model, theoretical domains framework and behavioural change wheel

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-06-10 DOI:10.1111/dme.70085

Ying Jie Chee, Huiling Liew, Alvin Wai Kit Tan, Sanchalika Acharyya, Rinkoo Dalan

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引用次数: 0

Abstract

Aims

Exercise is a cornerstone in type 2 diabetes mellitus (T2DM) management. This study investigates physical activity, its barriers, and facilitators among adults with T2DM in Singapore.

Methods

In Phase I of this sequential explanatory mixed-methods study, participants with T2DM were recruited to complete the Physical Activity Stage of Change Questionnaire and were examined for metabolic profiles, physical activity and cardiorespiratory fitness (via a 3-min step test) across different stages of change. In Phase II, 20 participants stratified by their stage of change were interviewed to identify barriers and facilitators to exercise, which were classified using the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the theoretical domains framework (TDF).

Results

Among 100 recruited participants, 83 had complete data and 36 completed the step test. Stages of change assessment identified participants in pre-contemplation(n = 5), contemplation(n = 49), preparation(n = 2), action(n = 3), and maintenance(n = 24) stages. Participants in early stages (pre-contemplation/contemplation) had significantly lower daily step counts (mean ± SD 5983 ± 2788 vs. 7667 ± 3299; p = 0.024) and step test completion rates (29.6% vs. 68.9%; p = 001) than those in the later stages. Qualitative interviews revealed barriers to exercise, including low cardiorespiratory fitness, fear of injuries, lack of opportunities and inadequate motivation. Facilitators included individualized exercise regimens, exercise guidance, goal setting, family support and role modelling.

Conclusions

This study provides insights into barriers and facilitators to exercise among individuals with T2DM in Singapore, systematically analysed using the COM-B model and TDF. Future interventions could target different components of COM-B and leverage the behavioural change wheel framework to enhance personalization and promote sustainable behavioural change to exercise.

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查看原文本刊更多论文

新加坡成人2型糖尿病患者身体活动和锻炼的障碍和促进因素——一项针对COM-B模型、理论域框架和行为改变轮的混合方法序贯解释性研究。

目的：运动是2型糖尿病（T2DM）治疗的基石。本研究调查了新加坡成人2型糖尿病患者的身体活动、障碍和促进因素。方法：在这项顺序解释性混合方法研究的第一阶段，T2DM患者被招募来完成身体活动变化阶段问卷，并在不同的变化阶段检查代谢谱、身体活动和心肺健康（通过3分钟步进测试）。在第二阶段，20名参与者根据他们的变化阶段进行了访谈，以确定运动的障碍和促进因素，并使用能力，机会，动机和行为（COM-B）模型和理论领域框架（TDF）对其进行分类。结果：入选的100名受试者中，83人数据完整，36人完成步进检验。变化评估的阶段确定了参与者在预考虑（n = 5）、考虑（n = 49）、准备（n = 2）、行动（n = 3）和维持（n = 24）阶段。早期阶段（沉思前/沉思）的参与者每日步数显著降低(平均值±SD 5983±2788 vs. 7667±3299；P = 0.024)和步骤测试完成率(29.6% vs. 68.9%；P = 001)。定性访谈揭示了锻炼的障碍，包括心肺功能低下、害怕受伤、缺乏机会和动力不足。促进因素包括个体化运动方案、运动指导、目标设定、家庭支持和角色塑造。结论：本研究利用COM-B模型和TDF系统分析了新加坡T2DM患者运动障碍和促进因素。未来的干预措施可以针对COM-B的不同组成部分，并利用行为改变轮框架来增强个性化，促进可持续的行为改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”