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

Introduction: 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. Methods: Semi-structured interviews were conducted with 18 participants (men, n = 11, women, n = 7, prediabetes, n = 5, Type 2 diabetes, n = 13, median age 68.5 years) who completed a two-year multi-component (n = 7), single-component (n = 6) intervention or served as controls (n = 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 Identifier: NCT02374788. Results: 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 Conclusion: 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：身体活动（physical activity, PA）支持是糖尿病照护的核心内容。索菲亚步数研究（Sophia Step Study）为一项三臂随机对照试验（randomised controlled trial），旨在评估针对糖尿病前期及2型糖尿病（Type 2 diabetes）患者提升身体活动水平的不同层级支持方案。本文旨在从受试者视角揭示研究方案的构成要素与中介影响因素，报告完成两年研究随访的依从性受试者的质性探索结果。 方法：本研究于瑞典斯德哥尔摩的一家初级医疗中心开展，对18名受试者开展半结构化访谈。受试者基线特征为：男性11例、女性7例，糖尿病前期5例、2型糖尿病13例，年龄中位数为68.5岁；所有受试者均完成了为期两年的研究干预或随访，其中7人接受多组分干预、6人接受单组分干预，另有5人为对照受试者。访谈资料采用归纳式内容分析法进行编码分析。索菲亚步数研究已在ClinicalTrials.gov注册，注册号为NCT02374788。 结果：受试者反馈，频繁的研究评估可为其提供健康结局反馈、正向强化支持，同时带来哨兵式健康监测感知与个性化照护体验。受试者认为，小组交流会、计步器（pedometers）与健康体检可作为提升身体活动认知与动机、建立新日常行为习惯以及掌控自身健康的有效资源。研究周期较长这一特点，有助于受试者维持身体活动相关的认知与日常行为习惯。 结论：无论是接受基于理论的干预方案组，还是对照组的依从性受试者，均明确了支持身体活动的关键中介因素。在身体活动自我管理中，应纳入结果反馈、个性化鼓励、情绪支持与自我监测等环节，以优化受试者的活动动机与健康结局。