STUDY PROTOCOL article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1591205
Influence of Social Determinants on Lifestyle Modification Adherence in People with Prediabetes: A Sequential Explanatory Mixed-Methods Study Protocol
Provisionally accepted
Ana Carvalho-Azevedo1
Manuela Abbate1*
Sergio Fresneda1
María Arias-Fernández1
Marina Torres-Carballo2
Aina Maria Yañez1Cristina Moreno-Mulet1
Miquel Bennasar-Veny1- 1Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- 2Balearic Public Health Service, Palma, Spain
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Aim: Social determinants (SD) such as age, gender, ethnicity, postal code, or socioeconomic status, as well as health beliefs strongly impact health outcomes. This study aims to analyze the influence of SD on adherence to healthy lifestyle recommendations among individuals with prediabetes.Design: This sequential explanatory mixed-methods study will include an initial crosssectional analysis of quantitative data, followed by a qualitative ethnomethodological study using critical discourse analysis.The quantitative analysis will use data from 103 participants with prediabetes included in the intervention arm of the PREDIPHONE trial. The relationship between adherence to the lifestyle modification intervention (diet and physical activity) and sociodemographic characteristics will be explored by multivariable linear regression. The qualitative study will explore how gender, social class, and other factors (such as social and family support, knowledge about one's health condition, health beliefs, and patientprofessional relationship) can influence adherence to lifestyle changes in a selected subgroup of individuals. Data generation techniques will include semi-structured interviews, discussion groups, support network mapping, and the researcher's field diary.The rigor strategies that will be applied include triangulation, data saturation, and reflexivity.: Prediabetes exhibits an uneven distribution, disproportionately affecting individuals from underprivileged social classes, directly impacting on adherence behaviors. Our study can guide the development of health interventions tailored to individuals with prediabetes, focusing on addressing social disparities in lifestyle modification. Patient or Public Contribution: Participants will contribute through semi-structured interviews and discussion groups, providing insights into their experiences on adherence to lifestyle changes. Trial Registration: NCT06488677 (ClinicalTrials.gov identifier)
Keywords: therapeutic adherence and compliance, social determinants of health, Prediabetic State, Healthy lifestyle, Social Class, Gender role
Received: 10 Mar 2025; Accepted: 18 Jun 2025.
Copyright: © 2025 Carvalho-Azevedo, Abbate, Fresneda, Arias-Fernández, Torres-Carballo, Yañez, Moreno-Mulet and Bennasar-Veny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Manuela Abbate, Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
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