Skip to main content

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

  • Alison O. Booth (a1), Carole Lowis (a2), Moira Dean (a3), Steven J. Hunter (a4) and Michelle C. McKinley (a5)...

To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs).


Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients’ views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education.


Focus groups were held with patients recently diagnosed with type 2 diabetes (n = 16, 38% female, aged 45–73 years). In-depth semi-structured interviews were conducted with HPs (n = 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data.


Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the ‘new’ or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals
      Available formats
Corresponding author
Correspondence to: Dr Alison O. Booth, Institute of Clinical Science, Nutrition and Metabolism Research Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Block B (1st Floor), Grosvenor Road, Belfast BT12 6BJ, UK. Email:
Hide All
Barbour R.S.Kitzinger J. 1999: Developing focus group research: politics, theory, and practice. London; Thousand Oaks, CA, USA: Sage Publications.
Carbone E.T., Rosal M.C., Torres M.I., Goins K.V.Bermudez O.I. 2007: Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Education and Counseling 66, 202210.
Devlin H., Roberts M., Okaya A.Xiong Y.M. 2006: Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes. Health Promotion Practice 7, 4755.
Diabetes UK. 2010: Diabetes in the UK 2010: key statistics on diabetes. London: Diabetes UK.
Dutton G.R., Johnson J., Whitehead D., Bodenlos J.S.Brantley P.J. 2005: Barriers to physical activity among predominantly low-income African-American patients with type 2 diabetes. Diabetes Care 28, 12091210.
Dye C.J., Haley-Zitlin V.Willoughby D. 2003: Insights from older adults with type 2 diabetes: making dietary and exercise changes. Diabetes Education 29, 116127.
El-Kebbi I.M., Bacha G.A., Ziemer D.C., Musey V.C., Gallina D.L., Dunbar V.Phillips L.S. 1996: Diabetes in urban African Americans. V. Use of discussion groups to identify barriers to dietary therapy among low-income individuals with non-insulin-dependent diabetes mellitus. Diabetes Education 22, 488492.
Gregory S. 2010: Narrative approaches to healthcare research. Journal of Therapy and Rehabilitation 17, 630636.
Hayes C., Herbert M., Marrero D., Martins C.L.Muchnick S. 2008: Diabetes and exercise. Diabetes Education 34, 3740.
Hsu M.Y.McCormack B. 2012: Using narrative inquiry with older people to inform practice and service developments. Journal of Clinical Nursing 21, 841849.
Hwang S.W.Bugeja A.L. 2000: Barriers to appropriate diabetes management among homeless people in Toronto. Canadian Medical Association Journal 163, 161165.
Kieffer E.C., Willis S.K., Odoms-Young A.M., Guzmaz J.R., Allen A.J., Two Feathers J.Loveluck J. 2004: Reducing disparities in diabetes among African-American and Latino residents of Detroit: the essential role of community planning focus groups. Ethnicity and Disease 14, (Suppl 1), S27S37.
Krueger R.A.Casey M.A. 2000: Focus groups: a practical guide for applied research, third edition. Thousand Oaks, CA, USA: Sage Publications.
Kulkarni K. 2006: Diets do not fail: the success of medical nutrition therapy in patients with diabetes. Endocrine Practice 12, (Suppl 1), 121123.
Lawton J., Ahmad N., Hanna L., Douglas M.Hallowell N. 2006: ‘I can't do any serious exercise’: barriers to physical activity amongst people of Pakistani and Indian origin with Type 2 diabetes. Health Education Research 21, 4354.
Lawton J., Parry O., Peel E.Douglas M. 2005: Diabetes service provision: a qualitative study of newly diagnosed Type 2 diabetes patients’ experiences and views. Diabetic Medicine 22, 12461251.
Maillet N.A., D'Eramo Melkus G.Spollett G. 1996: Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes. Diabetes Education 22, 3946.
Nagelkerk J., Reick K.Meengs L. 2006: Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing 54, 151158.
National Institute for Health and Clinical Excellence (NICE) 2008: Type 2 diabetes: the management of type 2 diabetes (update). London: NICE.
Nthangeni G., Steyn N.P., Alberts M., Steyn K., Levitt N.S., Laubscher R., Bourne L., Dick J.Temple N. 2002: Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services. Public Health Nutrition 5, 329338.
Pendleton L., House W.C.Parker L.E. 1987: Physicians’ and patients’ views of problems of compliance with diabetes regimens. Public Health Reports 102, 2126.
Peyrot M., Rubin R.R., Lauritzen T., Snoek F.J., Matthews D.R.Skovlund S.E. 2005: Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Medicine 22, 13791385.
Quatromoni P.A., Milbauer M., Posner B.M., Carballeira N.P., Brunt M.Chipkin S.R. 1994: Use of focus groups to explore nutrition practices and health beliefs of urban Caribbean Latinos with diabetes. Diabetes Care 17, 869873.
Savoca M.Miller C. 2001: Food selection and eating patterns: themes found among people with type 2 diabetes mellitus. Journal of Nutrition Education 33, 224233.
Shultz J.A., Sprague M.A., Branen L.J.Lambeth S. 2001: A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise. Journal of Health Communication 6, 99115.
Simmons D., Lillis S., Swan J.Haar J. 2007: Discordance in perceptions of barriers to diabetes care between patients and primary care and secondary care. Diabetes Care 30, 490495.
Sullivan E.D.Joseph D.H. 1998: Struggling with behavior changes: a special case for clients with diabetes. Diabetes Education 24, 7277.
Thomas N., Alder E.Leese G.P. 2004: Barriers to physical activity in patients with diabetes. Postgraduate Medical Journal 80, 287291.
Vickers K.S., Nies M.A., Patten C.A., Dierkhising R.Smith S.A. 2006: Patients with diabetes and depression may need additional support for exercise. American Journal of Health Behaviour 30, 353362.
Vijan S., Stuart N.S., Fitzgerald J.T., Ronis D.L., Hayward R.A., Slater S.Hofer T.P. 2005: Barriers to following dietary recommendations in type 2 diabetes. Diabetic Medicine 22, 3238.
Wang C.Y., Abbott L., Goodbody A.K., Hui W.T.Rausch C. 1999: Development of a community-based diabetes management program for Pacific Islanders. Diabetes Education 25, 738746.
Wdowik M.J., Kendall P.A.Harris M.A. 1997: College students with diabetes: using focus groups and interviews to determine psychosocial issues and barriers to control. Diabetes Education 23, 558562.
West C.McDowell J. 2002: The distress experienced by people with type 2 diabetes. British Journal of Community Nursing 7, 606613.
Woodcock A.Kinmonth A.L. 2001: Patient concerns in their first year with type 2 diabetes: patient and practice nurse views. Patient Education Counseling 42, 257270.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 105
Total number of PDF views: 1067 *
Loading metrics...

Abstract views

Total abstract views: 1364 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.