Social support, self-efficacy and motivation: a qualitative study of the journey through HEALD (Healthy Eating and Active Living for Diabetes)

This study aimed to describe the influence of social support on participants' self-efficacy and motivation to perform physical activity before, during and after the Healthy Eating and Active Living for Diabetes in primary care networks (HEALD) programme. HEALD was a controlled trial of a 24-week primary care-based walking programme for people with type 2 diabetes, proven effective in increasing physical activity. Data used in this qualitative sub-study were derived from semi-structured interviews with purposefully selected HEALD completers (n=13) six months after the programme ended. Qualitative data were analysed using content analysis. Prior to HEALD, participants reported feeling a lack of social support for diabetes management and fear of diabetes consequences. During the programme, they reported feeling supported by exercise specialists and peers in general and specifically to do physical activity; they reported weakening social support after HEALD ended. Accordingly, participants reported having self-efficacy and motivation to increase their physical activity during HEALD, but these did not persist after HEALD ended; many relapsed into former behaviours. Participants recommended a longer programme, with more contacts. Our findings are congruent with Social Cognitive Theory. Participants' reported self-efficacy and motivation to adopt physical activity during HEALD were tied to feeling supported by the exercise specialists who led the programme and peers participating in the programme. However, these perceived improvements were compromised when social support was no longer available through HEALD. Periodic contacts with a health care provider post-programme may promote maintenance of positive behaviour changes following diabetes self-management programmes. Furthermore, an optimal mode of peer support requires study. Copyright (C) 2014 John Wiley & Sons.