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Perceptions, experiences and barriers to lifestyle modifications in first-generation Middle Eastern immigrants to Sweden: a qualitative study
  1. Patricia Olaya-Contreras1,
  2. Katarina Balcker-Lundgren2,
  3. Faiza Siddiqui2,3,
  4. Louise Bennet2,3
  1. 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenborg, Sweden
  2. 2 Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden
  3. 3 Department of Clinical Sciences, Lund University, Malmö, Sweden
  1. Correspondence to Dr Patricia Olaya-Contreras; patricia.olaya-contreras{at}


Objective The prevalence of type 2 diabetes (T2D) among Iraqi immigrants to Sweden is high and partly related to sedentary physical activity and calorie dense food. The aim of the present study was to explore perceptions, experiences and barriers concerning lifestyle modifications (LSM) in Iraqi immigrants to Sweden at risk for T2D.

Design A qualitative thematic analysis was conducted on data collected from gender-specific focus group interviews which took place during a culturally adapted randomised controlled intervention study addressing motivation to lifestyle change, self-empowerment, behavioural modifications and sociocultural barriers to LSM. Seven focus groups were held, with an interval of 1–4 weeks between January and May of 2015; each session lasted approximately 1.5 hours.

Setting The city of Malmö, Sweden.

Participants Out of 27 women and 23 men assigned to the intervention group, 19 women and 14 men who attended at least one focus group session were included in the study.

Results Participants expressed awareness of the content of healthy lifestyle practices. They also expressed numerous social and cultural barriers to LSM connected to irregular meals, overeating, food and drinking preferences and family expectations. Overeating was described as a consequence of social and cultural norms and expectations and of poor mental well-being. Facilitators for reaching successful LSM were connected to family involvement and support.

Conclusion Our study reports that facilitators for LSM are connected to presence of family support. Preventive actions addressing family involvement may benefit Middle Eastern immigrants at high risk for T2D to consider healthier lifestyles practices. Identification of sociocultural barriers and facilitators for LSM are crucial for successful health promotion in minority populations at risk for T2D.

Trial registration Trial registration number: NCT01420198 for the MEDIM-study; Pre-results.

  • lifestyle modifications
  • Middle East
  • minority populations
  • obesity
  • prevention
  • qualitative thematic analysis
  • type 2 diabetes

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  • Contributors PO-C: Wrote and revised the manuscript, analysed and interpreted the data, translated the material coming from the group discussions from Swedish to English. KB-L: Participated in conducting the group sessions; participated in data acquisition, reviewing the translated data transcripts and notes from Sweden to English for data analyses and data assessment; contributed with interpretation of the data and participated in writing and revising the manuscript. FS: Participated in the design of the study and in conducting the group sessions; participated in assessing data and interpretation of the data interpretation and contributed to writing the manuscript. LB: Designed and conducted the original study, contributed data acquisition, reviewing the translated data transcripts and notes from Sweden to English for data analyses and interpretation, data assessment and interpretation of the data; contributed to writing and revised the manuscript.

  • Funding This work was supported by grants from Lund University (ALF grants Dnr 20101641, 20101837 and 162641), Region Skåne (Dnr 226661 and 121811), the Swedish Society of Medicine (Dnr 97081 and 176831), the Crafoord Foundation (Dnr 20110719), the Swedish Research Council Linné grant to LUDC (Dnr 349-2006-237 and Dnr 349-2008-6589), Strategic Research area Exodiab (Dnr 2009-1039), Swedish Foundation for Strategic Research (Dnr IRC15-0067) and ANDIS (Dnr 825-2010-5983).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethical Review Board of Lund University, Sweden approved the study (approval no. 2011/88).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data can be made available upon request from the corresponding author.

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