AUTHOR=Carvalho-Azevedo Ana , Abbate Manuela , Fresneda Sergio , Arias-Fernández María , Torres-Carballo Marina , Yañez Aina M. , Moreno-Mulet Cristina , Bennasar-Veny Miquel 

TITLE=Influence of social determinants on lifestyle modification adherence in people with prediabetes: a sequential explanatory mixed-methods study protocol

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1591205

DOI=10.3389/fpubh.2025.1591205

ISSN=2296-2565

ABSTRACT=AimSocial 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.DesignThis sequential explanatory mixed-methods study will include an initial cross-sectional analysis of quantitative data, followed by a qualitative ethnomethodological study using critical discourse analysis.MethodsThe 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 patient-professional 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.DiscussionPrediabetes 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 contributionParticipants will contribute through semi-structured interviews and discussion groups, providing insights into their experiences on adherence to lifestyle changes.Clinical trial registrationClinicalTrials.gov, identifier NCT06488677.