“I’ve made this my lifestyle now”: a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus
Open accessAbstract
BACKGROUND: Diagnosis with Type 2 Diabetes is an opportunity for individuals to change their physical activity and dietary behaviours. Diabetes treatment guidelines recommend theory-based, patient-centred care and advocate the provision of support for patient motivation but the motivational experiences of people newly diagnosed with diabetes have not been well studied. Framed in self-determination theory, this study aimed to qualitatively explore how this patient group articulate and experience different types of motivation when attempting lifestyle change. METHODS: A secondary analysis of semi-structured interview data collected with 30 (n female = 18, n male = 12) adults who had been newly diagnosed with type two diabetes and were participants in the Early ACTID trial was undertaken. Deductive directed content analysis was performed using NVivo V10 and researcher triangulation to identify and describe patient experiences and narratives that reflected the motivation types outlined in self-determination theory and if/how these changed over time. RESULTS: The findings revealed the diversity in motivation quality both between and within individuals over time and that patients with newly-diagnosed diabetes have multifaceted often competing motivations for lifestyle behaviour change. Applying self-determination theory, we identified that many participants reported relatively dominant controlled motivation to comply with lifestyle recommendations, avoid their non-compliance being "found out" or supress guilt following lapses in behaviour change attempts. Such narratives were accompanied by experiences of frustrating slow behaviour change progress. More autonomous motivation was expressed as something often achieved over time and reflected goals to improve health, quality of life or family time. Motivational internalisation was evident and some participants had integrated their behaviour change to a new way of life which they found resilient to common barriers. CONCLUSIONS: Motivation for lifestyle change following diagnosis with type two diabetes is complex and can be relatively low in self-determination. To achieve the patient empowerment aspirations of current national health care plans, intervention developers, and clinicians would do well to consider the quality not just quantity of their patients' motivation. TRIAL REGISTRATION: ISRCTN ISRCTN92162869 . Retrospectively registered.
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Autonomous motivation is important for regular physical activity and healthy eating practices.
“Autonomous motivation factor is important for regular physical activity and healthy eating practices 50 .”
From Healthy eating among people with type 2 diabetes in the Brazilian Amazon: a qualitative study in primary health care (2026) · cites this paper as [50]
Patients with diabetes who successfully included physical activity in their daily routine often developed an intrinsic drive to be more active and no longer felt it to be a chore.
“Patients with diabetes who successfully included PA in their daily routine often noted that they eventually developed an intrinsic drive to be more active and no longer felt it to be a chore.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [113]
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Seo, K., & Song, Y. (2023) · Nursing Open · doi:10.1002/nop2.1593 · Cited by 3 · see citing works
“In the Sebire et al. (2018)'s study, self- care behaviour was initially repulsive, but as the motive was internalized over time, they rather felt pleasure in the self- care behaviour itself.”
BackgroundInfluentialHale, L. A., Higgs, C., Keen, D., & Smith, C. (2021) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2021.692311 · Cited by 3 · see citing works
“While a diagnosis of T2D in itself can be an initial internal motivator for a lifestyle change, maintaining internal motivation is complex and often slow to develop, and can cause internal conflict, frustration, and a need for continual external prompting and ongoing support (13).”
BackgroundBeyond health: exploring women’s socio-cultural motivations for HPV vaccination
Xu, S., Zhang, W., & Zhang, Y. (2024) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2024.2424494 · Cited by 2 · see citing works
Zeh, P., Young, A., Gholap, N. N., Randeva, H. S., Robbins, T., Johal, K., Patel, S., & O’Hare, J. P. (2023) · Primary care diabetes · doi:10.1016/j.pcd.2023.10.012 · Cited by 2 · see citing works
Bravo, C. G., Sabree, S. A., Dukes, K., Adeagbo, M. J., Edwards, S., Wainwright, K., Schaeffer, S. E., Villa, A. T., Wilks, A. D., & Carvour, M. L. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-081417 · Cited by 2 · see citing works
Pártos, K., Major, D., Dósa, N., Fazekas‐Pongor, V., Tabák, Á. G., Ungvari, Z. I., Horváth, I., Barta, I., Pozsgai, É., Bodnár, T., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1299148 · Cited by 2 · see citing works
McInerney, A. M., & Deschênes, S. S. (2025) · Journal of Health Psychology · doi:10.1177/13591053251334444 · Cited by 2 · see citing works
“Feelings of guilt are associated with lapses in health behaviour upkeep (Sebire et al., 2018) and progression to insulin therapy can be viewed by some people with T2D as a personal failure (Polonsky et al., 2005).”
What motivates people with cancer to eat? A qualitative study grounded in self-determination theory
Assunção, M. L., Borges, M. Y., da Silva, D. A., & Japúr, C. C. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102926 · Cited by 2 · see citing works
Morinishi, K., Chikada, A., Ogura, M., Inagaki, N., & Nin, K. (2023) · SAGE Open Nursing · doi:10.1177/23779608231194412 · Cited by 2 · see citing works
“Previous studies have shown that people with newly diagnosed T2DM are mainly motivated to change their lifestyles by external factors, such as feeling restricted (Sebire et al., 2018).”
BackgroundInagaki, S., Kato, K., Abe, K., Takahashi, H., & Matsuda, T. (2023) · ACI Open · doi:10.1055/s-0043-1766113 · Cited by 2 · see citing works
Al-Mehemdi, S. A., Ali, E. H., Mohammed, H. K., & Mohammed, M. A. (2022) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2022.00929 · Cited by 1 · see citing works
Cory, D. M., & Chu, P. (2023) · Essential clinical social work series · doi:10.1007/978-3-031-31650-0_6 · Cited by 1 · see citing works
Breast cancer screening motivation among women: an application of self-determination theory
Dang, C. T., Nguyen, T. T. N., Ho, T. T. T., & Kang, S. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02594-z · Cited by 1 · see citing works
“Compared with the findings of previous studies on the types of motivation to change lifestyles in individuals with newly diagnosed diabetes, the intrinsic motivation reported for this behavior is similar to the results of our study [24].”
ResultKhan, S., Trundle, C., Phillips, T., & Araújo, N. (2026) · BMC Public Health · doi:10.1186/s12889-026-26956-7 · Cited by 1 · see citing works
“This study adds critical ethnographic nuance to a large body of qualitative health literature that has explored patient perspectives on themes such as diabetes distress [61, 62], self-care agency [63–65], coping and resilience [66–69], as well as motivation for lifestyle change [70].”
Patterson, E. (2020) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · Cited by 1 · see citing works
Patient Perspectives on Lifestyle Changes Following a Diabetes Diagnosis
Şahin, A., & Soylu, D. (2024) · KMAN Counseling and Psychology Nexus · doi:10.61838/kman.psychnexus.2.1.9 · Cited by 1 · see citing works
The relationship of stigma level and healthy lifestyle behaviors in individuals with type 2 diabetes
Bakır, E., NEŞE, A., İlter, S. M., & AYDIN, N. (2024) · Adıyaman Üniversitesi Sağlık Bilimleri Dergisi · doi:10.30569/adiyamansaglik.1428351 · Cited by 1 · see citing works
Aljehani, F. (2024) · Cureus · doi:10.7759/cureus.69300 · Cited by 1 · see citing works
“…lifestyle modification for patients with prediabetes was the patient's lack of motivation (79.2%), where this is in line with a range of studies that have identified the lack of motivation as a significant barrier to lifestyle modification for patients with prediabetes and type 2 diabetes [36-38].”
BackgroundInfluentialVich-Pérez, P., Taulero-Escalera, B., García-Espinosa, V., Villanova-Cuadra, L., Regueiro-Toribio, P., Sevilla-Machuca, I., Timoner-Aguilera, J., Martínez-Grandmontagne, M., Abós-Pueyo, T., Álvarez-Hernández-Cañizares, C., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314519 · Cited by 1 · see citing works
Magham, P. (2022) · Indian Journal of Health Studies · doi:10.56490/ijhs.2022.4103 · Cited by 1 · see citing works
Farias, T. A. D. S., Ueno, T. M. R. L., Monteiro, W. F., Campos, H. L. M., & Leon, E. B. D. (2026) · Cadernos de Saúde Pública · doi:10.1590/0102-311xen175125
“Autonomous motivation factor is important for regular physical activity and healthy eating practices 50 .”
Lidin, M., Hellénius, M.-L., Ekblom‐Bak, E., & Karlssön, M. (2019) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515119848967
Jabardo-Camprubí, G., Roig, J. B., Roca, R. D., Martín-Horcajo, M., Puig-Ribera, A. M., & McKenna, J. (2021) · Research Square · doi:10.21203/rs.3.rs-154801/v1
“A number of such frameworks are available today, including COM-B model or Behaviour Change Wheel (16), Self Determination Theory (17) and Social Ecological Theory (18).”
BackgroundWhat Keeps You Going? Modelling Motivation and Lifestyle Changes in Patients with Type 2 Diabetes
Land, K. V., Kuilman, S. K., Laub, S., & Jan Treur, A. (2021)
What Keeps You Going? Modelling Motivation and Lifestyle Change in Patients with Type 2 Diabetes
Land, K. V., Kuilman, S. K., Laub, S., & Jan Treur, A. (2021) · Lecture notes in networks and systems · doi:10.1007/978-3-030-90318-3_73
(2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80071-609-420221011
Matin, H., Sarbakhsh, P., & Shaghaghi, A. (2022) · Research Square · doi:10.21203/rs.3.rs-2108615/v1
Christensen, L. F., Bilberg, R., Andersen, K., Nielsen, B., & Nielsen, A. S. (2023) · International Journal of Nursing and Health Care Research · doi:10.29011/2688-9501.101389
“In accordance with other studies, staff with negative attitudes towards engaging in physical health is an important finding [11,28,29].”
BackgroundResultHerath, L., Kamalsiri, M., Inthuja, P., Gamage, G. P., & Vidanage, D. (2024) · Journal of Diabetology · doi:10.4103/jod.jod_9_24
Vich-Pérez, P., Taulero-Escalera, B., García-Espinosa, V., Villanova-Cuadra, L., Regueiro-Toribio, P., Sevilla-Machuca, I., Timoner-Aguilera, J., Martínez-Grandmontagne, M., Abós-Pueyo, T., Álvarez-Hernández-Cañizares, C., et al. (2024) · medRxiv · doi:10.1101/2024.09.11.24313481
“Studies show that this approach is essential not only for the lifestyle intervention itself, but also for its quality and individualization, because motivation for change after a diagnosis of diabetes mellitus is complex and can be affected by poor self-determination [31,32,33].”
BackgroundCsuka, S. I., Horvát, B., Csordás, G., Lakatos, C., & Martos, T. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1455261
“Those living with diabetes for longer periods were more likely to follow a diet, which suggests more established healthy behavior, and that they may be further in the process of adaptation to diabetes (44).”
Almomani, H. Y., Ayre, H., Powell, R. A., & Armani, K. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06361-2
“The desire to avoid hypoglycaemia and improve insulin injection skills also motivated adherence to the intervention similar to previous comparable studies [31, 32].”
The Acceptability of Lifestyle Medicine Approaches for People in Midlife: A Rapid ReviewPreprint
Black, J., Manger, S., & Carlisle, K. (2025) · Research Square · doi:10.21203/rs.3.rs-7504849/v1
Matin, H., Sarbakhsh, P., & Shaghaghi, A. (2025) · Patient Preference and Adherence · doi:10.2147/ppa.s552530
“8,9,15 Based on the unquestionable importance of self-management competencies in type 2 diabetes patients to control the illness and prevent its debilitating complications, the Treatment Self-Regulation Questionnaire (TSRQ) was introduced by Ryan & Cannell 16 , as a generic tool to assess the…”
Peng, M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-29139-5.00051-3
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021) · Figshare · doi:10.6084/m9.figshare.14880840
Cox, J. S., Searle, A., Thornton, G., Hamilton-Shield, J. P., & Hinton, E. C. (2024) · Figshare · doi:10.6084/m9.figshare.26632549
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021) · Figshare · doi:10.6084/m9.figshare.14880831
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021) · Figshare · doi:10.6084/m9.figshare.14880834
Cross, R., Greaves, C., Withall, J., Kritz, M., & Stathi, A. (2023) · Figshare · doi:10.6084/m9.figshare.22705944
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021) · Figshare · doi:10.6084/m9.figshare.14880837
Cross, R., Greaves, C., Withall, J., Kritz, M., & Stathi, A. (2023) · Figshare · doi:10.6084/m9.figshare.22705941
Cross, R., Greaves, C., Withall, J., Kritz, M., & Stathi, A. (2023) · Figshare · doi:10.6084/m9.figshare.22705938
Matthew, B., & McGrath, N. M. (2025) · Journal of Public Health and Epidemiology · doi:10.5897/jphe2025.1524
“Given that a diagnosis presents an opportunity to discuss, facilitate, and motivate lifestyle change (Sebire et al., 2018), this difference highlights that the large number of individuals with undiagnosed diabetes are at increased risk of continuing to make unhealthy dietary choices.”
Storz, M. A., Huber, R., & Seufert, J. (2026) · Journal of Diabetes Research · doi:10.1155/jdr/8319702
Opoku-Addai, K., Mensah, G. P., Korsah, K. A., Avinu, E. S., Agyei, F. B., & Ahenkorah, E. M. (2026) · BMC Nutrition · doi:10.1186/s40795-026-01386-1
“The findings concur with other studies conducted in England and Denmark among patients with type 2 diabetes mellitus [31, 32].”
Smit, A. K., Oosterman, J. E., Vos, R. C., & Jong, J. C. K. (2026) · TSG - Tijdschrift voor gezondheidswetenschappen · doi:10.1007/s12508-026-00502-7
“Ook het kwalitatieve onderzoek van Sebire et al. toont aan dat gecontroleerde motivatie bij patiënten met DM2 aan-vankelijk gedragsverandering kan opleveren, maar ge-paard gaat met interne conflicten en afhankelijkheid van externe prikkels [32].”
Fan, M., & Qian, W.-P. (2026) · Medicine · doi:10.1097/md.0000000000050291
“[32,33] Simon qualitative study revealed [34] that newly diagnosed patients experienced a significant increase in their perception of disease severity and susceptibility due to immediate health threats, such as uncontrolled blood glucose levels and the risk of acute complications.”
Zaghloul, H. B., Elhadad, S. M., Chagoury, O. L., & Taheri, S. (2026) · Diabetic Medicine · doi:10.1111/dme.70514
- Authors
- Sebire, S. J., Toumpakari, Z., Turner, K. M., Cooper, A. R., Page, A. S., Malpass, A., & Andrews, R. C.
- Affiliations
- University of Bristol (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- University of Exeter (GB)
- Corresponding author
- Sebire, Simon J.
- ORCID
- Venue
- BMC Public Health
- Published
- 2018-01-31
- Volume
- 18
- Issue
- 1
- Pages
- 204-204
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5793401
- OpenAlex
- W2786563095
- Cited by
- 94
- References
- 36
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 15 · 2023: 19 · 2022: 18 · 2021: 14 · 2020: 4 · 2019: 6
- FWCI
- 4.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research
- Diabetes UK (BDA:R04/0002750)
- UK Department of Health
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Social Psychology › Motivation and Self-Concept in Sports
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- type 2 diabetes, newly diagnosed diabetes, lifestyle modification, motivation, self-determination theory, autonomous motivation, controlled motivation, behavior change, patient empowerment, physical activity, dietary behaviour, patient experience, barriers to behavior change
- MeSH terms
- Healthy Lifestyle, Adult, Aged, Diabetes Mellitus, Type 2, Diet, Female, Follow-Up Studies, Humans, Male, Middle Aged, Motivation, Prospective Studies, Exercise, Qualitative Research
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