Open Access Research article

Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM)

Jennifer J Infanti1, Angela O’Dea1*, Irene Gibson2, Brian E McGuire3, John Newell4, Liam G Glynn5, Ciaran O’Neill6, Susan B Connolly7 and Fidelma P Dunne1

Author Affiliations

1 School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland

2 Croí–The West of Ireland Cardiac Foundation, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland

3 School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland

4 HRB Clinical Research Facility, National University of Ireland Galway, University Road, Galway, Ireland

5 Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland

6 J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland

7 Division of Cardiology Cardiothoracic and Thoracic Surgery, Imperial College Healthcare NHS Trust, London, UK

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BMC Medical Research Methodology 2014, 14:13  doi:10.1186/1471-2288-14-13

Published: 24 January 2014



Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions.


We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation.


Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention.


Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population.

Trial registration

Current Controlled Trials ISRCTN41202110

Gestational diabetes mellitus; Prevention of type 2 diabetes; Barriers to participation in lifestyle intervention; Risk factor modification; Randomised controlled trial