Adults’ perceived health promotion needs in the prediabetes stage: a meta-synthesis study


Needs Assessment
Health Promotion
systematic review


Introduction: One of the methods to promote pre-diabetic patients’ adherence to preventive behaviors and improving their lifestyle is to pay attention to their needs in the designed educational programs. Therefore, this study was conducted with the aim of identifying the needs of individuals with prediabetes.


Three databases, including ISI/Web of Sciences, PubMed, Scopus were searched without time limitation until August 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines and to achieve the research goal, Sandelowski and Barroso's seven-step meta-synthesis method (2007) was used. Thematic synthesis was used to analyses the data.


Results: Out of the 1934 studies obtained, 34 studies were finally examined and 805 codes were recorded based on the extracted data. Through synthesizing and analyzing the primary studies, 8 main themes were extracted regarding individuals’ needs in the prediabetes stage: Information needs, Cultural needs, Psychological needs, Social support needs, Education needs, Financial needs, Service needs and Skill needs.

Discussion and Conclusion: In addition to paying attention to the needs mentioned in other studies regarding activity, nutrition, social support, stress and emotions management, and monitoring the prediabetes condition, the present study examines the other aspects of the needs of individuals with prediabetes such as educational, service, skill, and cultural needs. Moreover, it also explains the perceived needs and their types in each of the dimensions in detail. It can be a proper guide for designing educational programs and various interventions to control the prediabetes condition, leading to a reduction in the prevalence of type 2 diabetes in the society.


Kong AP, Luk AO, Chan JC. Detecting people at high risk of type 2 diabetes-How do we find them and who should be treated? Best Practice & Research Clinical Endocrinology & Metabolism. 2016;30(3):345-355.

Hostalek U. Global epidemiology of prediabetes-present and future perspectives. Clinical diabetes and endocrinology. 2019;5(1):5.

Katibeh M, Hosseini S, Soleimanizad R, et al. Prevalence and risk factors of diabetes mellitus in a central district in Islamic Republic of Iran: a population-based study on adults aged 40-80 years. EMHJ-Eastern Mediterranean Health Journal. 2015;21(6):412-419.

Zand A, Ibrahim K, Patham B. Prediabetes: why should we care? Methodist DeBakey cardiovascular journal. 2018;14(4):289.

Ogurtsova K, da Rocha Fernandes J, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice. 2017;128:40-50.

Barry E, Roberts S, Oke J, Vijayaraghavan S, Normansell R, Greenhalgh T. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. bmj. 2017;356

Griauzde D, Kullgren JT, Liestenfeltz B, et al. A mobile phone-based program to promote healthy behaviors among adults with prediabetes who declined participation in free diabetes prevention programs: mixed-methods pilot randomized controlled trial. JMIR mHealth and uHealth. 2019;7(1):e11267.

Messina J, Campbell S, Morris R, Eyles E, Sanders C. A narrative systematic review of factors affecting diabetes prevention in primary care settings. PLoS One. 2017;12(5):e0177699.

O’Brien MJ, Moran MR, Tang JW, et al. Patient perceptions about prediabetes and preferences for diabetes prevention. The Diabetes Educator. 2016;42(6):667-677.

Timm L, Daivadanam M, Lager A, Forsberg B, Östenson C-G, Mölsted Alvesson H. “I did not believe you could get better”—reversal of diabetes risk through dietary changes in older persons with prediabetes in region Stockholm. Nutrients. 2019;11(11):2658.

Lawrence H, Reynolds AN, Venn BJ. Perceptions of the healthfulness of foods of New Zealand adults living with prediabetes and type 2 diabetes: A pilot study. Journal of nutrition education and behavior. 2017;49(4):339-345. e1.

Paterson BL. “It looks great but how do I know if it fits?”: An introduction to meta‐synthesis research. Synthesizing qualitative research: Choosing the right approach. 2011:1-20.

Sandelowski M, Barroso J. Handbook for synthesizing qualitative research. springer publishing company; 2006.

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC medical research methodology. 2012;12(1):1-8.

Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative health research. 2012;22(10):1435-1443.

Unit P. Critical Appraisal Skills Programme (CASP): making sense of evidence-10 questions to help you make sense of qualitative research.[Internet]. Londres: Public Heal Resour Unit. 2006;

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC medical research methodology. 2008;8(1):1-10.

Flemming K, Noyes J. Qualitative evidence synthesis: where are we at? International Journal of Qualitative Methods. 2021;20:1609406921993276.

Ghisi GLdM, Seixas MB, Pereira DS, et al. Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health. 2021;21(1):1236.

Mahmoodabad SSM, Vafa FS, Vaezi A, Karimi H, Fallahzadeh H. Explanation of the perceptions of women with prediabetes affecting physical activity: A qualitative study. International Journal of Ayurvedic Medicine. 2019;10(1):95-104.

Roper KL, Thomas AR, Hieronymus L, Brock A, Keck J. Patient and clinician perceptions of prediabetes: a mixed-methods primary care study. The diabetes educator. 2019;45(3):302-314.

Ledford CJ, Fisher CL, Cafferty LA, Jackson JT, Crawford PF, Seehusen DA. How patients make sense of a diabetes diagnosis: an application of Weick’s model of organizing. Diabetes Research and Clinical Practice. 2020;162:108117.

Twohig H, Hodges V, Hobbis C, Mitchell C. Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study. BJGP open. 2019;3(3)

Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabetic Medicine. 2022;39(4):e14748.

Yoon S, Wee S, Loh DH, Bee YM, Thumboo J. Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes. Frontiers in Endocrinology. 2022;13

Mishra P, Greenfield SM, Harris T, et al. Yoga program for type 2 diabetes prevention (YOGA-DP) among high-risk people: Qualitative study to explore reasons for non-participation in a feasibility randomized controlled trial in India. Frontiers in public health. 2021;9:682203.

Abel S, Whitehead L, Coppell K. Making dietary changes following a diagnosis of prediabetes: a qualitative exploration of barriers and facilitators. Diabetic Medicine. 2018;35(12):1693-1699.

DeJesus RS, Clark MM, Rutten LJF, et al. Wellness coaching to improve lifestyle behaviors among adults with prediabetes: Patients’ experience and perceptions to participation. Journal of Patient Experience. 2018;5(4):314-319.

Brown SA, Perkison WB, García AA, et al. The Starr County border health initiative: Focus groups on diabetes prevention in Mexican Americans. The Diabetes Educator. 2018;44(3):293-306.

Dyer KE, Moreau JL, Finley E, et al. Tailoring an evidence-based lifestyle intervention to meet the needs of women Veterans with prediabetes. Women & health. 2020;60(7):748-762.

Ledford CJ, Fisher CL, Cafferty LA, Jackson JT, Seehusen DA, Crawford PF. Turning points as opportunities to partner with patients living with type 2 diabetes or prediabetes. The Journal of the American Board of Family Medicine. 2020;33(2):211-219.

Abel SL, Whitehead LC, Tipene-Leach DC, Coppell KJ. Proximal and distal influences on dietary change among a diverse group with prediabetes participating in a pragmatic, primary care nurse-led intervention: a qualitative study. Public Health Nutrition. 2021;24(18):6015-6026.

Lim RBT, Wee WK, For WC, et al. Correlates, facilitators and barriers of healthy eating among primary care patients with prediabetes in Singapore—A mixed methods approach. Nutrients. 2019;11(5):1014.

Bean C, Dineen T, Jung ME. “It’sa Life Thing, Not a Few Months Thing”: Profiling Patterns of the Physical Activity Change Process and Associated Strategies of Women With Prediabetes Over 1 Year. Canadian journal of diabetes. 2020;44(8):701-710.

Mishra P, Harris T, Greenfield SM, et al. Feasibility Trial of Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) among High-Risk People in India: A Qualitative Study to Explore Participants’ Trial-and Intervention-Related Barriers and Facilitators. International journal of environmental research and public health. 2022;19(9):5514.

Baucom KJW, Pershing ML, Dwenger KM, Karasawa M, Cohan JN, Ozanne EM. Barriers and facilitators to enrollment and retention in the national diabetes prevention program: perspectives of women and clinicians within a health system. Women's Health Reports. 2021;2(1):133-141.

Faletau J, Nosa V, Dobson R, Heather M, McCool J. Falling into a deep dark hole: Tongan people’s perceptions of being at risk of developing type 2 diabetes. Health Expectations. 2020;23(4):837-845.

Azzi JL, Azzi S, Lavigne-Robichaud M, et al. Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults. Canadian Journal of Dietetic Practice and Research. 2019;81(2):80-85.

Xia T, Lopes S, Chen L, et al. A feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients. Complementary Therapies in Medicine. 2022;65:102810.

Lim RBT, Wee WK, For WC, et al. Health education and communication needs among primary care patients with prediabetes in Singapore: a mixed methods approach. Primary Care Diabetes. 2020;14(3):254-264.

Signal V, McLeod M, Stanley J, et al. A Mobile-and web-based health intervention program for diabetes and prediabetes self-management (BetaMe/Melon): process evaluation following a randomized controlled trial. Journal of Medical Internet Research. 2020;22(12):e19150.

Chen P, Chai J, Cheng J, et al. A smart web aid for preventing diabetes in rural China: preliminary findings and lessons. Journal of medical Internet research. 2014;16(4):e98.

Saju R, Castellon-Lopez Y, Turk N, et al. Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives. Journal of General Internal Medicine. 2022;37(14):3715-3722.

Thomas T, Samuel-Hodge CD, Porterfield DS, Alva ML, Leeman J. Scaling up diabetes prevention programs in North Carolina: perceptions of demand from potential program recipients and providers. The Diabetes Educator. 2019;45(1):116-124.

Sophia HH, Mei RF, Liu S, Lin Y-K, Chang W-Y. CE: Original Research: Physical activity among Chinese American immigrants with prediabetes or type 2 diabetes. AJN The American Journal of Nursing. 2018;118(2):24-32.

Yeh M-C, Lau W, Chen S, et al. Adaptation of diabetes prevention program for Chinese Americans–a qualitative study. BMC public health. 2022;22(1):1-9.

Fu M, Liu S, Lin Y-K, Chan W-Y. Physical activity of Chinese American immigrants with type 2 diabetes/prediabetes: a mixed method study. The American journal of nursing. 2018;118(2):24.

Kullgren JT, Knaus M, Jenkins KR, Heisler M. Mixed methods study of engagement in behaviors to prevent type 2 diabetes among employees with pre-diabetes. BMJ Open Diabetes Research and Care. 2016;4(1):e000212.

Wadi NM, Asantewa-Ampaduh S, Rivas C, Goff LM. Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness. Public Health Nutrition. 2022;25(2):422-436.

Skoglund G, Nilsson BB, Olsen CF, Bergland A, Hilde G. Facilitators and barriers for lifestyle change in people with prediabetes: A meta-synthesis of qualitative studies. BMC Public Health. 2022;22(1):1-27.

Glechner A, Keuchel L, Affengruber L, et al. Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis. Primary care diabetes. 2018;12(5):393-408.

Bergman M. Inadequacies of current approaches to prediabetes and diabetes prevention. Endocrine. 2013;44:623-633.

Van Rhoon L, Byrne M, Morrissey E, Murphy J, McSharry J. A systematic review of the behaviour change techniques and digital features in technology-driven type 2 diabetes prevention interventions. Digital health. 2020;6:2055207620914427.

Wang Z, Shi Q, Zeng Y, Li Y. Experiences and perceptions of self‐management in people with prediabetes: A qualitative meta‐synthesis. Journal of Clinical Nursing. 2023;