‘This is why I’m doing a lot of exercise’ — a qualitative study of participant’s experiences of the Sophia Step Study

<b>Introduction:</b> Support for physical activity (PA) is central in diabetes care. The Sophia Step Study is a three-armed randomised controlled trial aiming to evaluate different levels of support for increased PA in prediabetes and Type 2 diabetes. With the purpose to reveal the programme components and the mediating factors from the participants’ perspective this paper aims to report a qualitative exploration of adhering participants’ experiences after two years’ study participation. <b>Methods:</b> Semi-structured interviews were conducted with 18 participants (men, <i>n</i> = 11, women, <i>n</i> = 7, prediabetes, <i>n</i> = 5, Type 2 diabetes, <i>n</i> = 13, median age 68.5 years) who completed a two-year multi-component (<i>n</i> = 7), single-component (<i>n</i> = 6) intervention or served as controls (<i>n</i> = 5) at a primary care center in Stockholm, Sweden. The interviews were analysed using content analysis with an inductive approach. Sophia Step Study is registered at ClinicalTrials.gov with <i>Identifier: NCT02374788</i>. <b>Results:</b> The participants recalled the frequent study assessments as providing feedback of health outcomes; positive reinforcement; a sense of sentinel and a personalised approach. Group meetings, pedometers and health check-ups were valued as resources for increased awareness and motivation of PA; establishment of new routines and control over the own health. The long program duration allowed for maintenance of awareness and routines for PA <b>Conclusion:</b> Adhering participants in theory-based interventions, but also in the control group, identified key mediators to support for PA. Feedback of results, personalised encouragement, emotional support and self-monitoring should be regarded in self-management of PA to optimise patient motivation and outcomes.

**引言**：体力活动（physical activity，PA）支持是糖尿病照护的核心环节。索菲亚步数研究（Sophia Step Study）为一项三臂随机对照试验，旨在评估针对前驱糖尿病与2型糖尿病患者增加PA的不同支持方案。本研究拟从参与者视角揭示项目组成要素与中介影响因素，因此本文将报告对参与研究满两年的留存参与者的体验开展的质性探索结果。

**方法**：对瑞典斯德哥尔摩某基层医疗中心的18名完成两年研究的参与者开展半结构化访谈。该18名参与者中，男性11例、女性7例，前驱糖尿病患者5例、2型糖尿病患者13例，年龄中位数为68.5岁；其中7例接受多组分干预、6例接受单组分干预，剩余5例作为对照组。访谈资料采用归纳式内容分析法进行分析。索菲亚步数研究已在ClinicalTrials.gov注册，注册号为NCT02374788。

**结果**：参与者回忆称，频繁的研究评估可为其提供健康结局反馈、正向强化，使其产生健康哨兵式的警觉意识，并获得个性化干预方案。团队会议、计步器与健康体检被视为提升PA认知与运动动机、建立新日常习惯以及掌控自身健康状况的重要资源。研究项目的长周期设置有助于维持参与者的PA相关认知与日常运动习惯。

**结论**：无论是接受基于理论的干预的留存参与者，还是对照组的留存参与者，均明确了支持PA的关键中介因素。在PA的自我管理中，应纳入结果反馈、个性化鼓励、情感支持与自我监测环节，以优化患者的运动动机与健康结局。