Using the Health Belief Model to Explore Factors of Suboptimal Weight Management in Elderly Type 2 Diabetes Patients: Qualitative Research

Using the Health Belief Model to Explore Factors of Suboptimal Weight Management in Elderly Type 2 Diabetes Patients: Qualitative Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Using the Health Belief Model to Explore Factors of Suboptimal Weight Management in Elderly Type 2 Diabetes Patients: Qualitative Research Yingbin Zhang, Xinyi Chen, Sitian Xiong, Nan Xu, Honghui Rong, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9357275/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Weight management is one of the most effective approaches for managing type 2 diabetes mellitus (T2DM). However, in China, the weight management status of more than 50% of elderly individuals with T2DM remains suboptimal. A partial explanation for this phenomenon may lie in insufficient knowledge levels, while the evolution of social media could exert a potential influence on their knowledge acquisition. Identifying the determinants of inadequate weight management can facilitate the development of targeted health education strategies. Methods This research adopted a qualitative method that complies with the Consolidated Criteria for Reporting Qualitative Research. Participants were recruited from overweight and obese T2DM patients who had enrolled in family physician services across three communities in Chongqing, China, and semistructured interviews were administered. The interview guidelines were designed on the basis of the health belief model. Interview data were analyzed using a theory-driven thematic analysis approach to elicit structured themes. Results In our study, the main reasons for poor weight management among elderly T2DM can be summarized into four themes: (1) poor physical and mental health; (2) the influence of cognition; (3) interpersonal relationships; and (4) behaviors related to weight management. In this context, insufficient sleep, comorbidities, and challenges in dietary control contribute to perceived barriers. A lack of relevant knowledge leads to inadequate perceived susceptibility and severity of overweight and obesity. Interpersonal relationships exert multidimensional influences on individuals' weight management behaviors. Conclusions Suboptimal weight management among elderly T2DM patients in our study is attributed primarily to perceived barriers, and reducing barriers may facilitate weight management. Inadequate relevant knowledge diminishes perceived susceptibility and severity of overweight or obesity. Interpersonal relationships exert a multidimensional influence on patients' behaviors, and individuals in patients' social environment should be considered concurrently. type 2 diabetes mellitus health belief model weight management aged influence factors qualitative research elderly Chinese Figures Figure 1 Figure 2 Figure 3 Figure 4 Background In 2025, individuals aged ≥ 65 years accounted for 23.0% of the national population, more than 20 million new chronic diseases occur in China each year, and aging is the major contributing factor[ 1 ]. Given the aging of the population, China has the largest number of elderly individuals living with diabetes globally, and this number is increasing year by year[ 2 , 3 ]. Diabetes can lead to a variety of microvascular and macrovascular complications, such as diabetic retinopathy, and diabetic nephropathy, which is the leading cause of end-stage renal disease (ESRD)[ 3 ]. At present, the burden of diabetes disease in China is substantial[ 2 , 4 ]. Weight loss is a key strategy for controlling diabetes and reducing the risk of complications[ 1 , 7 ]. Multiple clinical studies have shown that controlling weight helps control blood sugar[ 5 , 6 ]. On the basis of existing research findings, the recommended body mass index (BMI) for people aged 60-80 years in China is 18.0‐24.0 kg/m², and for those over 80 years, it is 22.0‐26.9 kg/m². Keeping the BMI within these ranges can effectively reduce all-cause mortality among elderly individuals[ 8 ]. However, more than half of elderly T2DM in China are overweight or obese[ 9 – 11 ]. At present, the rates of overweight and obesity among people aged 60 years and above in China are 36.6% and 13.6%, respectively, and only 60.2% understand the basic knowledge of weight management[ 1 ]. In response to this situation, the National Health Commission of China launched the Weight Management Year Initiative with the intention of reversing it[ 12 ]. In China, the suboptimal weight management among elderly T2DM, whose underlying causes remain unclear, compromises the overall management of their diabetes. One of the reasons for this phenomenon might be the lack of relevant knowledge, which affects their diabetes management, including weight management[ 11 , 13 ]. Meanwhile, with the advancement of the Internet and social media, their potential in knowledge dissemination has gradually come to the fore[ 14 , 15 ]. Popular science communication via social media may exert potential impacts on the cognitive processes and behavioral decision making of older adults. Identifying the underlying reasons behind this phenomenon will help formulate plans to assist them in improving their weight management and reducing the burden of diabetes. This study represents the first application of the Health Belief Model (HBM) to explore the notification management issues among elderly T2DM in the community. The aim was to identify the obstacles they encounter in weight management and the factors that might help improve their weight status. Methods Design In this qualitative study, we applied a theme-driven content analysis approach to analyse the data collected through semistructured interviews and observations. The research complies with Consolidated Criteria for Reporting Qualitative Research. The research team has a background in preventive medicine and considers solution strategies from the perspective of health education. Interview guideline After the relevant literature was read, expert consultation was conducted, followed by a presurvey, and the interview guidelines were adjusted according to the actual situation. Community health workers co-designed interview questions to ensure cultural relevance. The interview guidelines focused on the understanding of T2DM patients regarding their own weight and the importance of weight management, among other issues. The interview guidelines are detailed in additional file 1. The HBM is one of the most widely used conceptual frameworks in health behavior research; it can explain changes in and maintenance of health-related behaviors and serve as a guiding framework for intervention measures. HBM includes six key constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action[ 16 ]. Participant In this study, purposive sampling was utilized, and family physicians from three community health service centers (Lianfang, Shengquan, and Daqingcun) in Chongqing were contacted to facilitate the recruitment of eligible elderly T2DM patients. The inclusion criteria included meeting the diabetes diagnostic criteria, being over 60 years of age, having suboptimal weight management, and having good expression and communication skills[ 7 ]. The exclusion criterion was the presence of cognitive-related diseases. Suboptimal weight management refers to individuals aged 60–80 years with a BMI ≥ 24.0 kg/m² or over 80 years with a BMI ≥ 27.0 kg/m², where exceeding these thresholds increases the risk of chronic diseases[ 8 ]. Sampling follows the principle of maximum variation to ensure diversity in sex, age, weight condition and disease duration[ 17 ]. Data saturation is determined on the basis of the coding saturation criterion[ 18 ]. When no new codes are generated three consecutive times, the data saturation of the respective center is considered to have been reached. Saturation was achieved at Lianfang in the 15th case, at Shengquan in the 23rd case, and at Daqingcun in the 35th case. Data collection Data collection was conducted between March 2025 and June 2025. Prior to the interviews, all the participants were invited to review the interview guidelines to familiarize themselves with the research objectives. The participants’ voluntary provision of personal information was deemed informed consent to participants in the study. The interviews were conducted in a meeting room or ward (patient receiving intravenous infusion) in the community health service center and lasted 15–40 minutes each. The researchers asked the patients questions following interview guidelines, listened carefully during the interview and recorded the entire process via a tape recorder. The participants who were unwilling to be recorded could take notes instead. Data analysis Our research adopted a theory-driven thematic analysis method based on HBM, which included six steps: data familiarization, generation of initial codes, search for themes, review of themes, definition and naming of themes, and writing of the manuscript[ 19 ]. Two researchers independently reviewed the transcripts multiple times to identify meaningful units, categorize keywords and phrases, and used an iterative approach to constantly modify and refine the code throughout the analysis process. Any differences in the encoding process were addressed through discussions with a third researcher to ensure that broader levels and emerging subthemes were thoroughly captured. These themes are categorized by physical, cognitive, interpersonal, and behavioral dimensions. The emerging subthemes are driven by categorical data based on the initial code within the same theme. Finally, all identified themes and subthemes were reviewed on the basis of the initially encoded and transcribed text. To enhance credibility, member checking was conducted by returning preliminary findings to participants for confirmation. Results The interviews were terminated when no new themes emerged across the 35 cases. The participants had an average age of 70.4 years, and their demographic and other basic information is summarized in Table 1 . Table 1 Basic characteristics of interviewed elderly patients with T2DM (n = 35). Variables Number(n) Proportion(%) Gender male 15 42.86 female 20 57.14 Age range(years) 60–70 14 40.00 70–80 19 54.29 80+ 2 5.71 Weight Condition overweight a 14 40.00 obesity b 21 60.00 Diagnosis duration(years) duration < 5 13 37.14 5 ≤ duration < 10 10 28.57 duration ≥ 10 12 34.29 a : Overweight is defined as a BMI ranging from 24.0-27.9 kg/m² for people aged 60‐80 years and from 27.0‐27.9 kg/m² for those over 80 years. b : Obesity is defined as a BMI of 28.0 kg/m² or above. Theme 1: Physical and mental health barriers The physical and mental health barriers of elderly individuals are significant obstacles to their weight management. Physical reasons prevent them from having enough ability and confidence to complete their weight management plans. A comparison of the subthemes and HBM dimensions is shown in Table 2 . Table 2 Poor physical and mental health hinders weight management. Subtheme Including categories HBM dimension Poor sleep quality Insufficient sleep time. Perceived barriers Irregular sleep patterns. Nocturia reduces sleep quality. Comorbidities Joint diseases impede movement. Perceived barriers Cardiovascular diseases reduce exercise capacity. Metabolic diseases affect confidence in weight loss. Individual constitution A body type prone to weight gain can undermine confidence in weight loss. Self-efficacy Family history raises patients' vigilance levels. Perceived susceptibility We observed that elderly individuals exhibited poor sleep quality, which led them to perceive barriers and consequently hindered their completion of the weight management program. Elderly individuals tend to spend more time in bed at night than their actual sleep duration does, indicating that their sleep may be insufficient. P21 "I hit the hay between 10:30 and 11 PM, latest by 11. I usually wake up approximately 4 or 5 times in the morning, then get up after 5 times. I wake up like twice at night, then drift off again after a bit and fall asleep." Some respondents reported having irregular sleep patterns. P24 "Sometimes I sleep for three or four hours, and sometimes for four or five. Once I wake up, I cannot fall asleep again and can only watch TV. My sleep schedule is all messed." The most prominent problem is frequent nocturia. Nocturia forces their sleep to be disrupted, and it is often accompanied by difficulty falling asleep after nocturia. P14 "I think my kidneys are not in good condition. I always get up to urinate at night, which affects the quality of my sleep." Subtheme 2: Comorbidities Some participants reported having other underlying health conditions, which led them to perceived barriers, thereby hindering their exercise and weight management efforts. Among these conditions, some are preexisting, precluding them from initiating exercise; others are acute onset, compelling them to discontinue their original exercise regimens. Joint diseases prevent patients from exercising regularly, as they experience pain. P13 "I have been using prednisone for years because I have rheumatoid arthritis, and both of my joints have been replaced. Every time I walk, my joints hurt. I also have hemorrhoids, and movement makes me uncomfortable." After cardiovascular disease occurs, the patient's body becomes vulnerable, and the amount of exercise load they can bear decreases significantly. P14 suffered from coronary heart disease. He said, "My legs cannot walk anymore, and I have to sit down and rest after walking for a while." Some metabolic disorders can make weight management difficult without a doctor's treatment and proper advice. P8 "I had hyperthyroidism and was afraid it would recur, so I did not dare to exercise." Subtheme 3: Individual constitution If participants believe that they have a tendency to gain weight easily, they usually have a lower level of self-efficacy. P16 "I think it is mainly a matter of constitution. I gain weight even if I drink only water." Having a family history of obesity makes it easier for participants to perceived susceptibility. P23 "I have a family history... These are all a bit overweight in our family, and because they are all overweight, they ended up with diabetes." Theme 2: Influence of cognition Insufficient knowledge results in a low level of perceived threat among participants, thereby diminishing their willingness to engage in weight management. Science communication via social media can not only increase knowledge levels but also act as a behavioral cue, thereby increasing self-efficacy. The relationships among the subthemes are shown in Fig. 1 . [Insert Fig. 1 here] Subtheme 1: Lack of diabetes related knowledge First, the participants held misconceptions regarding the pathogenesis and clinical manifestations of diabetes mellitus. This state of affairs leads to their underestimation of perceived severity, thereby diminishing their motivation for weight management. P12"I think I do not need to lose weight. I can control my blood sugar by taking medicine." Second, some patients have been exposed to relevant knowledge but fail to act in accordance with it. P33 "I looked at the materials and said that people with diabetes should not eat many kinds of things. However, I think it does not truly matter if I eat less of these things. If I do not eat at all, my body may not be able to keep up with nutrition, and it will not be very balanced." Third, some other patients' diet control is "light", a concept in traditional Chinese medicine that suggests that foods with less oil, salt and seasoning can help improve health. This dietary control approach differs from dietary therapy for individuals with diabetes and does not align with the dietary strategy for maintaining a healthy body weight. P35 “I eat light food. I just have some noodles, no oil, some soy sauce, some vinegar. Some chili peppers and no oil were added." In addition, little is known about the risk of complications from diabetes. P16 "I do not know exactly what kind of disease I will get... I feel numbness in my hand; is it caused by diabetes?" Subtheme 2: Lack of scientific weight related knowledge In the present study, we further identified gaps in participants’ knowledge regarding healthy weight. First, they did not know what their appropriate weight range was, which diminished their perceived susceptibility level and consequently reduced their willingness to engage in weight management. P30 "I do not want to lose my weight. I think I should be a little fatter." Second, another contributing factor is the participants’ insufficient knowledge of evidence-based weight management approaches, which leads to perceived barriers and consequently hinders their ability to maintain weight within the ideal range. P21"I have tried many methods to control my weight, but I have always maintained this weight and cannot continue to lose more. I do not know what methods I can use, such as medication or something else." Additionally, some participants purchased overstated products due to a lack of relevant knowledge, which not only resulted in financial losses but also disrupted their weight management plans. P29 "After watching the TV commercial, I bought weight-loss tea. However, it did not work well and was very expensive, so I eventually gave up. I drank it for about half a year and bought two large boxes, spending over 1,000 CNY. They claimed it was very effective, but it was completely useless... Finally, I was found that it only had a food approval number but no drug approval number." Subtheme 3: The impact of social media Given the prevalence of mobile phones and the internet, an increasing number of people have access to the internet, which makes it possible to use the internet and social media for popular science. Popular science on social media can improve their perceived severity, make them aware of the dangers of various chronic diseases that have no symptoms for the time being, and thereby promote weight management. P11 "I mainly learn about diabetes through health courses on various online platforms. Sometimes I also purchase medicines as needed." Successful cases on social media can also serve as cues for their actions and help enhance their self-efficacy. P26 "Seeing that someone on Douyin has successfully lost weight, I also want to lose weight too." However, exaggerated descriptions on social media can also undermine participants' self-efficacy. P6 "However, I have been a little less confident recently, and I learned from my phone that Diabetes is incurable! Problems appear again if you are not careful." Theme 3: Interpersonal relationships The various interpersonal relationships around the participants had a significant effect on them; they influence participants' behaviors via multiple dimensions of the HBM. The influence of interpersonal relationships is shown in Fig. 2 . [Insert Fig. 2 here] Subtheme 1: The influence of families Relatives have a multidimensional and double edged influence on patients. Relatives are the people closest to participants and significantly influence the patient's behavior. First, encouragement from relatives is an important cue to action. P21 "I know I have diabetes. The brochures suggest that moderate exercise helps control blood sugar. My daughter-in-law is a doctor—she told me to watch my diet and exercise more." P35 "My son told me not to eat too much at night, so I did not eat too much and gradually got used to it." Family support can enhance patients' self-efficacy, whereas insufficient family support may also reduce patients' self-efficacy. P6 "My wife makes me a variety of cereals every day, my family follows me in eating cereals, they do the housework, they urge me to take medicine, exercise, have check-ups, and my son bought me a sports watch." P14 "My daughter-in-law and son are both at work. How can they take care of me? My husband has also passed away." Family members can also serve as a source of knowledge, passing it on to diabetic patients in the family. P22 "Additionally, our family has experience in this disease. With those sisters, I can exchange ideas with them." However, family members can also mislead patients. P33 "I do not have a particular control diet either. My daughter told me, 'You have reached this age; it is fine to have slightly more occasionally.' She said that at my age, if I were a little thinner, my body might breakdown, and there was no need to control my weight and diet at this age." Subtheme 2: Multiple roles of doctors Doctors, especially family physicians, play a crucial role in the health management of patients. They are disseminators of health knowledge and initiators and supervisors of healthy behaviors. Doctors' health education is an important cue to patients' actions. P21"The doctor is talking about controlling weight, controlling blood sugar, and strengthening exercise. Well, also control your diet. There are also some health tips from grassroots community hospitals that I often look at." Doctors are important distributors of health knowledge. P22 "Regarding the hazards of diabetes, the doctor will tell us, and I have also searched it online." Doctors are also important supervisors of patients' behaviors. Regular check-ups by family physicians can enhance patients' sense of self-efficacy. P7"After I got diabetes, my family physician called me and came to check my blood pressure and blood sugar every quarter and register for consultation. I participated in this activity, and it gave me a lot of help." Subtheme 3: Peers' insights and experiences Participants can acquire relevant information in their interactions with peers, thereby increasing their knowledge level, which can improve their perceived threat. P2 "I haven not received much education, I do not understand the text, I do not understand the content on the internet, I learn from people around me who have diabetes." Peer experiences can enable participants to gain a concrete and intuitive understanding of the hazards of complications and enhance their perceived severity. ESRD represents the most severe complication of diabetes mellitus, requiring patients to undergo regular dialysis for survival maintenance. P33 “Seriously, I am even not afraid of death. I'm just scared to see those with uremia and kidney failure going to dialysis every day. I worked as a volunteer in a nursing home for a few years before, well, I saw those old people. Like those on dialysis, with a tube in the arm, with a tube in the neck, unable to eat or walk, that is truly pitiful, there's no quality of life.” Theme 4: Weight loss-related behaviors Weight loss-related behavior is a multidimensional act that includes exercise, diet control, and regular weight monitoring. The related behaviors for weight management and their corresponding HBM dimensions are shown in Table 3 . Table 3 Direct influencing factors of weight management related behaviors. Subtheme Including categories HBM dimension Weight monitoring Weight scales promote weight monitoring. Cues to action Difficulties in dietary control The participants have difficulties in controlling the quantities and kinds of food . Perceived barriers Subtheme 1: Weighing scales Weight monitoring constitutes a critical component of weight management, as regular weighing facilitates weight control. Scales in the surrounding environment can serve as cues for action to promote weight monitoring behavior. P32”Downstairs, there is a pharmacy equipped with a weighing scale at its entrance, allowing for weight measurement during my passage. Weigh it whenever you think of it, I just love to check if I'm still gaining weight during this period? Or getting thinner?” Subtheme 2: Challenges in dietary control For overweight individuals with T2DM, dietary control entails avoiding foods with a significant impact on blood glucose and regulating total nutrient intake. While some T2DM are aware of the concept of dietary control and its associated benefits, they still face challenges in adhering to it. Controlling the total amount of food makes patients perceived barriers. P32 “It seems that I get in a bad mood when I do not eat enough. When a person is weak and lacks energy, eating less will make the body even weaker. Eating less can also lead to a lack of vitality and then cause fatigue. However, I do not eat a lot either. Generally, I'm satisfied with eating until I'm about seven or eight-tenths full.” The participants also reported difficulties in controlling the types of food they consumed. P21 “I prefer noodles. Noodling may also be a factor that causes weight gain. In addition, fatty meat, I sometimes want to have a little too, maybe fatty meat is also a factor I cannot control. Is it because I'm not doing well in this respect that I cannot lose weight? I do keep exercising.” Discussion Weight management involves diet control and the formulation of exercise plans, as well as regular weight monitoring, and aged individuals also require improved sleep and mental health maintenance[ 8 ].In our study, the primary factor impeding weight management behaviors among elderly T2DM is their perceived barriers[ 17 , 19 ]. Insufficient knowledge leads to insufficient perceived susceptibility and severity, thereby reducing their willingness to start weight management[ 11 , 13 , 20 ]. Social support from surrounding individuals primarily enhances self-efficacy; additionally, it can facilitate the transmission of relevant information and act as cues to their action[ 21 – 23 ]. Poor sleep quality induces perceived barriers among elderly T2DM, which in turn impairs their weight management efforts. When managing their weight, attention should also be given to their sleep problems at the same time and the correlation between diabetes and sleep is shown in Fig. 3 . In China, sleep disorders are quite common among elderly individuals, with more than one-third of them suffering from such conditions[ 24 ]. There is a significant bidirectional relationship between poor diabetes management and insomnia[ 25 , 26 ]. The frequency of nocturia in diabetic patients is 1.49 times greater than that in nonpatients, and nocturia can lead to poor sleep[ 27 – 30 ]. Low sleep quality may cause obesity by affecting hormone levels, thereby affecting appetite and reducing physical activity[ 31 ]. Overweight and obesity are clear causes of diabetes, which in turn makes diabetes management more difficult[ 6 ]. [Insert Fig. 3 here] When formulating an exercise regimen for weight management, personalized protocols should be developed on the basis of an individual’s physical status to mitigate the level of perceived barriers. The comorbidity rate among elderly individuals in China is 44.1%, and elderly patients with T2DM often suffer from multiple diseases[ 17 , 32 ]. For example, after coronary heart disease occurs, personalized exercise methods should be developed after professional assessment[ 33 ]; after knee replacement surgery, exercise with a high joint load should be reduced[ 34 ]. How underlying diseases directly or indirectly hinder exercise is shown in Fig. 4 . [Insert Fig. 4 here] Currently, there is a substantial knowledge gap regarding T2DM among community-dwelling older adults, with insufficient awareness of diabetes and healthy weight management—both of which contribute to reduced levels of perceived susceptibility and severity[ 17 , 20 ]. In response to this situation, health education should be strengthened to increase their relevant knowledge level. The fact that diabetes cannot be cured reduces patients' self-efficacy[ 17 , 35 ]. In that case, emphasizing health education that diabetes can achieve clinical remission and prevent complications through disease management may represent a more effective strategy. Posting health education and popular science videos on social media to target elderly T2DM might be a solution to fill their knowledge gap, which can help increase their perceived threat level and enhance their self-efficacy, as well as the successful cases on social media can also serve as cues to actions. The popularization of social media science needs to be strengthened in supervision, and science popularization videos need to be evaluated. Science populators on social media tend to produce short videos, although studies have shown that duration is positively correlated with video quality[ 36 ]. The quality ratings of diabetes-related videos on multiple social platforms are mostly poor, and the average patient generally lacks sufficient awareness, motivation and time to evaluate this information[ 37 – 39 ]. A good idea might be to have qualified doctors evaluate these videos and send high-quality educational videos to patients, and platforms should promptly remove low-quality content. Elderly people, rural residents, low-income groups and those with low educational attainment find it more difficult to benefit from the popularization of science on social media[ 23 , 40 , 41 ]. Traditional health education methods, such as lectures, free medical consultations and the distribution of handbooks, should also continue. Similar studies have mentioned that people around patients can influence their behaviors[ 17 , 42 ]. Family support can influence self-efficacy, adequate family support enhances diabetes management outcomes, whereas insufficient family support diminishes such outcomes[ 17 , 22 , 43 ]. Primary health care institutions are important sources of knowledge and cues to action[ 44 ]. Peers can play a supportive role, and peer education and peer counselling are regarded as supplements to professional intervention[ 21 – 23 ]. Mutual aid groups are beneficial for weight management and self-management among people with diabetes[ 24 , 35 ]. Peers can enhance self-efficacy, act as cues to action, and transmit experience. Elderly T2DM usually possess awareness regarding dietary control, yet they may not necessarily implement it appropriately[ 42 ]. Some patients said it was difficult to adhere to a diabetic diet, formulating a diabetes-specific dietary regimen may help mitigate perceived barriers, thereby ameliorating this condition[ 20 ]. Moreover, diabetic patients have varying degrees of dietary misconceptions, which is consistent with previous reports[ 17 , 35 ]. Study had reported that eating is a way to have fun and socialize, which might be the reason why some participants have difficulty controlling their diet[ 22 ]. People who weigh weekly lose weight better than those who do not, and those who weigh daily lose weight more significantly than those who weigh weekly[ 45 ]. Encouraging T2DM to purchase weighing scales or installing weighing scales in communities can serve as a cue to action ,which may facilitate the implementation of weighing behaviors. Policy Implications For elderly individuals with sleep disorders induced by nocturia, interventions including reducing pre-bedtime fluid intake, voiding urine promptly before sleep, and administering sleeping medications may alleviate this issue to a certain extent. Family physicians may formulate personalized exercise regimens tailored to the physical conditions of elderly individuals. Meanwhile, family physicians may curate science popularization videos on social media and deliver high-quality ones to elderly residents in the community in a targeted manner, thereby enhancing their knowledge levels. Institutions such as diabetes associations and centers for disease control and prevention may formulate diabetes-specific dietary regimen and regularly disseminate them via social media and other platforms, so as to eliminate dietary misconceptions among elderly residents with diabetes. Communities and pharmacies may procure weighing scales for residents to use on a complimentary basis, so as to promote their weight-measuring behaviors. Furthermore, communities may facilitate the establishment of peer support groups for overweight and obese elderly T2DM. Limitation This study has the following limitations. First, all participants were recruited from southwestern China and had contracted with family physicians, most of them were predominantly urban residents, with only one patient from a rural area. The insufficient representativeness of the sample may compromise the generalizability of the findings to rural populations. Second, qualitative research inherently involves a certain degree of subjective bias. Thirdly, participants responded in the local dialect, and the English translation during manuscript preparation was context-dependent, whereas cultural disparities may introduce potential deviations. Conclusions Suboptimal weight management among elderly T2DM patients in our study is attributed primarily to perceived barriers, and reducing barriers may facilitate their weight management. A lack of relevant knowledge can reduce the level of perceived susceptibility and severity of overweight and obesity, which makes them fail to realize that they should manage their weight. Interpersonal relationships have multidimensional impacts on patients' behaviors and should be considered in the process of intervention. Abbreviations T2DM type 2 diabetes mellitus ESRD end-stage renal disease BMI body mass index HBM health belief model Declarations Ethics approval This study was approved by the ethics committee of Army Medical University with approval number 2025-33-02. The subject participants provided written consent. All study procedures were carried out in accordance with 2013 Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence. Consent for publication Not applicable. Conflicts of interest None declared. Funding This study received no specific grant from any funding agency. Author Contribution YBZ conducted the interviews and drafted the manuscript. XYC translated the dialogue according to the context and revised the manuscript. STX and NX participated in the interviews, extracted key words and classified them. When there is a disagreement on the themes summary, JAC and CFZ make the final decision. The remaining participants discussed community elderly care guidelines. Acknowledgement The authors thank all the participants in the study for their involvement and help. Data Availability Some participants were concerned that the recording might be leaked, so they did not allow the recording. For privacy protection reasons, the original data is not publicly available, but full coding framework and theme derivation process were referred to in additional file 2. Interview guide (HBM-adapted) is provided in additional file 1. References Chen X, Giles J, Yao Y, Yip W, Meng Q, Berkman L, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet. 2022;40010367:1967–2006. International Diabetes Federation. 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Assessment of the quality, content, and reliability of YouTube® videos on diabetes mellitus and polycystic ovary syndrome: a systematic review with cross-sectional analysis comparing peer-reviewed videos. Endocr Connections. 2024, 137. Wu M, Yang Y, Chen Y. Evaluation of treatment information quality on hypertension and diabetes on WeChat and TikTok: A cross-sectional content analysis. Health Inf J. 2024;303:14604582241275824. Swire-Thompson B, Lazer D. Public Health and Online Misinformation: Challenges and Recommendations. Annu Rev Public Health. 2020;411:433–51. Report on the Development of Internet Information in China. [ https://www.cnnic.cn/n4/2025/0721/c88-11328.html] (Accessed on 27 Sep. 2025). Liu S, Zhao H, Fu J, Kong D, Zhong Z, Hong Y, et al. Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study. BMC Public Health. 2022;221:996. Huai P, Zhang B, Zhang L, Hou Y, Zhang L, Yang H, et al. Based on the multi-theory model perspective, what are the influencing factors of health behavior change among community-dwelling elderly patients with type 2 diabetes in China? A qualitative study. Diabetes Res Clin Pract. 2025;222:112096. Withidpanyawong U, Lerkiatbundit S, Saengcharoen W. Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial. Patient Educ Couns. 2019;1021:85–92. De la Fuente Coria MC, Cruz-Cobo C, Santi-Cano MJ. Effectiveness of a primary care nurse delivered educational intervention for patients with type 2 diabetes mellitus in promoting metabolic control and compliance with long-term therapeutic targets: Randomised controlled trial. Int J Nurs Stud. 2020;101:103417. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;1111:92–102. Additional Declarations No competing interests reported. Supplementary Files additionalfile1Interviewguideline.docx additionalfile2Codingframework.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 13 Apr, 2026 Editor assigned by journal 12 Apr, 2026 Submission checks completed at journal 12 Apr, 2026 First submitted to journal 08 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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12:54:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9357275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9357275/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108492476,"identity":"99a964ad-181d-491f-98ec-5f05b38a3615","added_by":"auto","created_at":"2026-05-05 09:57:50","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25053,"visible":true,"origin":"","legend":"\u003cp\u003eThe influence of cognitive level and the role of science popularization through social media.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/63f63e2045231f58f67c4d86.jpg"},{"id":108803848,"identity":"9b421bf4-2f29-4171-911d-a09f2acd3b83","added_by":"auto","created_at":"2026-05-08 15:09:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21659,"visible":true,"origin":"","legend":"\u003cp\u003eThe multidimensionalinfluence of interpersonal relationships.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/8976bcce233eaa377a24ff71.jpg"},{"id":108389812,"identity":"613915c5-6b57-49c8-8936-7ea70dccdec3","added_by":"auto","created_at":"2026-05-04 06:52:18","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15358,"visible":true,"origin":"","legend":"\u003cp\u003eDiabetes-induced nocturia leads to poor sleep quality, which affects weight management.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/03639c69aac076918296d47a.jpg"},{"id":108389814,"identity":"61e8c264-261a-4e63-82fb-7bb2472668e4","added_by":"auto","created_at":"2026-05-04 06:52:18","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24644,"visible":true,"origin":"","legend":"\u003cp\u003eUnderlying diseases hinder exercise, leading to overweight and obesity.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/b27231f42f7f7c10165d796a.jpg"},{"id":108809277,"identity":"e87e4df0-870c-4738-8053-7b139cf9e1ea","added_by":"auto","created_at":"2026-05-08 15:51:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":418328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/b5a0ecb0-f768-4a11-aaeb-d0ca9f616e31.pdf"},{"id":108389809,"identity":"81cad072-3123-4894-bf7a-ef229749528a","added_by":"auto","created_at":"2026-05-04 06:52:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18043,"visible":true,"origin":"","legend":"","description":"","filename":"additionalfile1Interviewguideline.docx","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/6e8e28951ea191df2e582304.docx"},{"id":108803614,"identity":"d22f1d07-c97f-47b6-b230-2a307c976ffd","added_by":"auto","created_at":"2026-05-08 15:01:11","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30252,"visible":true,"origin":"","legend":"","description":"","filename":"additionalfile2Codingframework.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9357275/v1/f6fc209ba119843c58a26e6e.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Using the Health Belief Model to Explore Factors of Suboptimal Weight Management in Elderly Type 2 Diabetes Patients: Qualitative Research","fulltext":[{"header":"Background","content":"\u003cp\u003eIn 2025, individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years accounted for 23.0% of the national population, more than 20\u0026nbsp;million new chronic diseases occur in China each year, and aging is the major contributing factor[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Given the aging of the population, China has the largest number of elderly individuals living with diabetes globally, and this number is increasing year by year[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Diabetes can lead to a variety of microvascular and macrovascular complications, such as diabetic retinopathy, and diabetic nephropathy, which is the leading cause of end-stage renal disease (ESRD)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. At present, the burden of diabetes disease in China is substantial[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWeight loss is a key strategy for controlling diabetes and reducing the risk of complications[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Multiple clinical studies have shown that controlling weight helps control blood sugar[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. On the basis of existing research findings, the recommended body mass index (BMI) for people aged 60-80 years in China is 18.0‐24.0 kg/m\u0026sup2;, and for those over 80 years, it is 22.0‐26.9 kg/m\u0026sup2;. Keeping the BMI within these ranges can effectively reduce all-cause mortality among elderly individuals[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, more than half of elderly T2DM in China are overweight or obese[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. At present, the rates of overweight and obesity among people aged 60 years and above in China are 36.6% and 13.6%, respectively, and only 60.2% understand the basic knowledge of weight management[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In response to this situation, the National Health Commission of China launched the Weight Management Year Initiative with the intention of reversing it[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn China, the suboptimal weight management among elderly T2DM, whose underlying causes remain unclear, compromises the overall management of their diabetes. One of the reasons for this phenomenon might be the lack of relevant knowledge, which affects their diabetes management, including weight management[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Meanwhile, with the advancement of the Internet and social media, their potential in knowledge dissemination has gradually come to the fore[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Popular science communication via social media may exert potential impacts on the cognitive processes and behavioral decision making of older adults.\u003c/p\u003e \u003cp\u003eIdentifying the underlying reasons behind this phenomenon will help formulate plans to assist them in improving their weight management and reducing the burden of diabetes. This study represents the first application of the Health Belief Model (HBM) to explore the notification management issues among elderly T2DM in the community. The aim was to identify the obstacles they encounter in weight management and the factors that might help improve their weight status.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eIn this qualitative study, we applied a theme-driven content analysis approach to analyse the data collected through semistructured interviews and observations. The research complies with Consolidated Criteria for Reporting Qualitative Research. The research team has a background in preventive medicine and considers solution strategies from the perspective of health education.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInterview guideline\u003c/h3\u003e\n\u003cp\u003e After the relevant literature was read, expert consultation was conducted, followed by a presurvey, and the interview guidelines were adjusted according to the actual situation. Community health workers co-designed interview questions to ensure cultural relevance. The interview guidelines focused on the understanding of T2DM patients regarding their own weight and the importance of weight management, among other issues. The interview guidelines are detailed in additional file 1.\u003c/p\u003e \u003cp\u003eThe HBM is one of the most widely used conceptual frameworks in health behavior research; it can explain changes in and maintenance of health-related behaviors and serve as a guiding framework for intervention measures. HBM includes six key constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eParticipant\u003c/h3\u003e\n\u003cp\u003eIn this study, purposive sampling was utilized, and family physicians from three community health service centers (Lianfang, Shengquan, and Daqingcun) in Chongqing were contacted to facilitate the recruitment of eligible elderly T2DM patients. The inclusion criteria included meeting the diabetes diagnostic criteria, being over 60 years of age, having suboptimal weight management, and having good expression and communication skills[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The exclusion criterion was the presence of cognitive-related diseases. Suboptimal weight management refers to individuals aged 60\u0026ndash;80 years with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;24.0 kg/m\u0026sup2; or over 80 years with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;27.0 kg/m\u0026sup2;, where exceeding these thresholds increases the risk of chronic diseases[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Sampling follows the principle of maximum variation to ensure diversity in sex, age, weight condition and disease duration[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Data saturation is determined on the basis of the coding saturation criterion[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. When no new codes are generated three consecutive times, the data saturation of the respective center is considered to have been reached. Saturation was achieved at Lianfang in the 15th case, at Shengquan in the 23rd case, and at Daqingcun in the 35th case.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted between March 2025 and June 2025. Prior to the interviews, all the participants were invited to review the interview guidelines to familiarize themselves with the research objectives. The participants\u0026rsquo; voluntary provision of personal information was deemed informed consent to participants in the study. The interviews were conducted in a meeting room or ward (patient receiving intravenous infusion) in the community health service center and lasted 15\u0026ndash;40 minutes each. The researchers asked the patients questions following interview guidelines, listened carefully during the interview and recorded the entire process via a tape recorder. The participants who were unwilling to be recorded could take notes instead.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eOur research adopted a theory-driven thematic analysis method based on HBM, which included six steps: data familiarization, generation of initial codes, search for themes, review of themes, definition and naming of themes, and writing of the manuscript[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Two researchers independently reviewed the transcripts multiple times to identify meaningful units, categorize keywords and phrases, and used an iterative approach to constantly modify and refine the code throughout the analysis process. Any differences in the encoding process were addressed through discussions with a third researcher to ensure that broader levels and emerging subthemes were thoroughly captured. These themes are categorized by physical, cognitive, interpersonal, and behavioral dimensions. The emerging subthemes are driven by categorical data based on the initial code within the same theme. Finally, all identified themes and subthemes were reviewed on the basis of the initially encoded and transcribed text. To enhance credibility, member checking was conducted by returning preliminary findings to participants for confirmation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe interviews were terminated when no new themes emerged across the 35 cases. The participants had an average age of 70.4 years, and their demographic and other basic information is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of interviewed elderly patients with T2DM (n\u0026thinsp;=\u0026thinsp;35).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProportion(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge range(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e80+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight Condition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoverweight\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eobesity\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis duration(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eduration\u0026thinsp;\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;\u0026le;\u0026thinsp;duration\u0026thinsp;\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eduration\u0026thinsp;\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e: Overweight is defined as a BMI ranging from 24.0-27.9 kg/m\u0026sup2; for people aged 60‐80 years and from 27.0‐27.9 kg/m\u0026sup2; for those over 80 years.\u003c/p\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003e: Obesity is defined as a BMI of 28.0 kg/m\u0026sup2; or above.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1: Physical and mental health barriers\u003c/h3\u003e\n\u003cp\u003eThe physical and mental health barriers of elderly individuals are significant obstacles to their weight management. Physical reasons prevent them from having enough ability and confidence to complete their weight management plans. A comparison of the subthemes and HBM dimensions is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePoor physical and mental health hinders weight management.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncluding categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHBM dimension\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePoor sleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient sleep time.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePerceived barriers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIrregular sleep patterns.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNocturia reduces sleep quality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJoint diseases impede movement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePerceived barriers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular diseases reduce exercise capacity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetabolic diseases affect confidence in weight loss.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndividual constitution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA body type prone to weight gain can undermine confidence in weight loss.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily history raises patients' vigilance levels.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived susceptibility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe observed that elderly individuals exhibited poor sleep quality, which led them to perceive barriers and consequently hindered their completion of the weight management program.\u003c/p\u003e \u003cp\u003eElderly individuals tend to spend more time in bed at night than their actual sleep duration does, indicating that their sleep may be insufficient.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP21 \"I hit the hay between 10:30 and 11 PM, latest by 11. I usually wake up approximately 4 or 5 times in the morning, then get up after 5 times. I wake up like twice at night, then drift off again after a bit and fall asleep.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome respondents reported having irregular sleep patterns.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP24 \"Sometimes I sleep for three or four hours, and sometimes for four or five. Once I wake up, I cannot fall asleep again and can only watch TV. My sleep schedule is all messed.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe most prominent problem is frequent nocturia. Nocturia forces their sleep to be disrupted, and it is often accompanied by difficulty falling asleep after nocturia.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP14 \"I think my kidneys are not in good condition. I always get up to urinate at night, which affects the quality of my sleep.\"\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eSubtheme 2: Comorbidities\u003c/h3\u003e\n\u003cp\u003eSome participants reported having other underlying health conditions, which led them to perceived barriers, thereby hindering their exercise and weight management efforts. Among these conditions, some are preexisting, precluding them from initiating exercise; others are acute onset, compelling them to discontinue their original exercise regimens.\u003c/p\u003e \u003cp\u003eJoint diseases prevent patients from exercising regularly, as they experience pain.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP13 \"I have been using prednisone for years because I have rheumatoid arthritis, and both of my joints have been replaced. Every time I walk, my joints hurt. I also have hemorrhoids, and movement makes me uncomfortable.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAfter cardiovascular disease occurs, the patient's body becomes vulnerable, and the amount of exercise load they can bear decreases significantly.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP14 suffered from coronary heart disease. He said, \"My legs cannot walk anymore, and I have to sit down and rest after walking for a while.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome metabolic disorders can make weight management difficult without a doctor's treatment and proper advice.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP8 \"I had hyperthyroidism and was afraid it would recur, so I did not dare to exercise.\"\u003c/em\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3: Individual constitution\u003c/h2\u003e \u003cp\u003eIf participants believe that they have a tendency to gain weight easily, they usually have a lower level of self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP16 \"I think it is mainly a matter of constitution. I gain weight even if I drink only water.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHaving a family history of obesity makes it easier for participants to perceived susceptibility.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP23 \"I have a family history... These are all a bit overweight in our family, and because they are all overweight, they ended up with diabetes.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Influence of cognition\u003c/h2\u003e \u003cp\u003eInsufficient knowledge results in a low level of perceived threat among participants, thereby diminishing their willingness to engage in weight management. Science communication via social media can not only increase knowledge levels but also act as a behavioral cue, thereby increasing self-efficacy. The relationships among the subthemes are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1: Lack of diabetes related knowledge\u003c/h2\u003e \u003cp\u003eFirst, the participants held misconceptions regarding the pathogenesis and clinical manifestations of diabetes mellitus. This state of affairs leads to their underestimation of perceived severity, thereby diminishing their motivation for weight management.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP12\"I think I do not need to lose weight. I can control my blood sugar by taking medicine.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSecond, some patients have been exposed to relevant knowledge but fail to act in accordance with it.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP33 \"I looked at the materials and said that people with diabetes should not eat many kinds of things. However, I think it does not truly matter if I eat less of these things. If I do not eat at all, my body may not be able to keep up with nutrition, and it will not be very balanced.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThird, some other patients' diet control is \"light\", a concept in traditional Chinese medicine that suggests that foods with less oil, salt and seasoning can help improve health. This dietary control approach differs from dietary therapy for individuals with diabetes and does not align with the dietary strategy for maintaining a healthy body weight.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP35 \u0026ldquo;I eat light food. I just have some noodles, no oil, some soy sauce, some vinegar. Some chili peppers and no oil were added.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn addition, little is known about the risk of complications from diabetes.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP16 \"I do not know exactly what kind of disease I will get... I feel numbness in my hand; is it caused by diabetes?\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2: Lack of scientific weight related knowledge\u003c/h2\u003e \u003cp\u003eIn the present study, we further identified gaps in participants\u0026rsquo; knowledge regarding healthy weight.\u003c/p\u003e \u003cp\u003eFirst, they did not know what their appropriate weight range was, which diminished their perceived susceptibility level and consequently reduced their willingness to engage in weight management.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP30 \"I do not want to lose my weight. I think I should be a little fatter.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSecond, another contributing factor is the participants\u0026rsquo; insufficient knowledge of evidence-based weight management approaches, which leads to perceived barriers and consequently hinders their ability to maintain weight within the ideal range.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP21\"I have tried many methods to control my weight, but I have always maintained this weight and cannot continue to lose more. I do not know what methods I can use, such as medication or something else.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAdditionally, some participants purchased overstated products due to a lack of relevant knowledge, which not only resulted in financial losses but also disrupted their weight management plans.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP29 \"After watching the TV commercial, I bought weight-loss tea. However, it did not work well and was very expensive, so I eventually gave up. I drank it for about half a year and bought two large boxes, spending over 1,000 CNY. They claimed it was very effective, but it was completely useless... Finally, I was found that it only had a food approval number but no drug approval number.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3: The impact of social media\u003c/h2\u003e \u003cp\u003eGiven the prevalence of mobile phones and the internet, an increasing number of people have access to the internet, which makes it possible to use the internet and social media for popular science.\u003c/p\u003e \u003cp\u003ePopular science on social media can improve their perceived severity, make them aware of the dangers of various chronic diseases that have no symptoms for the time being, and thereby promote weight management.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP11 \"I mainly learn about diabetes through health courses on various online platforms. Sometimes I also purchase medicines as needed.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuccessful cases on social media can also serve as cues for their actions and help enhance their self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP26 \"Seeing that someone on Douyin has successfully lost weight, I also want to lose weight too.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHowever, exaggerated descriptions on social media can also undermine participants' self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP6 \"However, I have been a little less confident recently, and I learned from my phone that Diabetes is incurable! Problems appear again if you are not careful.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Interpersonal relationships\u003c/h2\u003e \u003cp\u003e The various interpersonal relationships around the participants had a significant effect on them; they influence participants' behaviors via multiple dimensions of the HBM. The influence of interpersonal relationships is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1: The influence of families\u003c/h2\u003e \u003cp\u003eRelatives have a multidimensional and double edged influence on patients. Relatives are the people closest to participants and significantly influence the patient's behavior.\u003c/p\u003e \u003cp\u003eFirst, encouragement from relatives is an important cue to action.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP21 \"I know I have diabetes. The brochures suggest that moderate exercise helps control blood sugar. My daughter-in-law is a doctor\u0026mdash;she told me to watch my diet and exercise more.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eP35 \"My son told me not to eat too much at night, so I did not eat too much and gradually got used to it.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFamily support can enhance patients' self-efficacy, whereas insufficient family support may also reduce patients' self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP6 \"My wife makes me a variety of cereals every day, my family follows me in eating cereals, they do the housework, they urge me to take medicine, exercise, have check-ups, and my son bought me a sports watch.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eP14 \"My daughter-in-law and son are both at work. How can they take care of me? My husband has also passed away.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFamily members can also serve as a source of knowledge, passing it on to diabetic patients in the family.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP22 \"Additionally, our family has experience in this disease. With those sisters, I can exchange ideas with them.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHowever, family members can also mislead patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP33 \"I do not have a particular control diet either. My daughter told me, 'You have reached this age; it is fine to have slightly more occasionally.' She said that at my age, if I were a little thinner, my body might breakdown, and there was no need to control my weight and diet at this age.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2: Multiple roles of doctors\u003c/h2\u003e \u003cp\u003eDoctors, especially family physicians, play a crucial role in the health management of patients. They are disseminators of health knowledge and initiators and supervisors of healthy behaviors.\u003c/p\u003e \u003cp\u003eDoctors' health education is an important cue to patients' actions.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP21\"The doctor is talking about controlling weight, controlling blood sugar, and strengthening exercise. Well, also control your diet. There are also some health tips from grassroots community hospitals that I often look at.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDoctors are important distributors of health knowledge.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP22 \"Regarding the hazards of diabetes, the doctor will tell us, and I have also searched it online.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDoctors are also important supervisors of patients' behaviors. Regular check-ups by family physicians can enhance patients' sense of self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP7\"After I got diabetes, my family physician called me and came to check my blood pressure and blood sugar every quarter and register for consultation. I participated in this activity, and it gave me a lot of help.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3: Peers' insights and experiences\u003c/h2\u003e \u003cp\u003eParticipants can acquire relevant information in their interactions with peers, thereby increasing their knowledge level, which can improve their perceived threat.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP2 \"I haven not received much education, I do not understand the text, I do not understand the content on the internet, I learn from people around me who have diabetes.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePeer experiences can enable participants to gain a concrete and intuitive understanding of the hazards of complications and enhance their perceived severity. ESRD represents the most severe complication of diabetes mellitus, requiring patients to undergo regular dialysis for survival maintenance.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP33 \u0026ldquo;Seriously, I am even not afraid of death. I'm just scared to see those with uremia and kidney failure going to dialysis every day. I worked as a volunteer in a nursing home for a few years before, well, I saw those old people. Like those on dialysis, with a tube in the arm, with a tube in the neck, unable to eat or walk, that is truly pitiful, there's no quality of life.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Weight loss-related behaviors\u003c/h2\u003e \u003cp\u003eWeight loss-related behavior is a multidimensional act that includes exercise, diet control, and regular weight monitoring. The related behaviors for weight management and their corresponding HBM dimensions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDirect influencing factors of weight management related behaviors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncluding categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHBM dimension\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeight scales promote weight monitoring.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCues to action\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulties in dietary control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe participants have difficulties in controlling the quantities and kinds of food .\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived barriers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1: Weighing scales\u003c/h2\u003e \u003cp\u003eWeight monitoring constitutes a critical component of weight management, as regular weighing facilitates weight control. Scales in the surrounding environment can serve as cues for action to promote weight monitoring behavior.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP32\u0026rdquo;Downstairs, there is a pharmacy equipped with a weighing scale at its entrance, allowing for weight measurement during my passage. Weigh it whenever you think of it, I just love to check if I'm still gaining weight during this period? Or getting thinner?\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2: Challenges in dietary control\u003c/h2\u003e \u003cp\u003eFor overweight individuals with T2DM, dietary control entails avoiding foods with a significant impact on blood glucose and regulating total nutrient intake. While some T2DM are aware of the concept of dietary control and its associated benefits, they still face challenges in adhering to it.\u003c/p\u003e \u003cp\u003eControlling the total amount of food makes patients perceived barriers.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP32 \u0026ldquo;It seems that I get in a bad mood when I do not eat enough. When a person is weak and lacks energy, eating less will make the body even weaker. Eating less can also lead to a lack of vitality and then cause fatigue. However, I do not eat a lot either. Generally, I'm satisfied with eating until I'm about seven or eight-tenths full.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe participants also reported difficulties in controlling the types of food they consumed.\u003c/p\u003e \u003cp\u003e \u003cem\u003eP21 \u0026ldquo;I prefer noodles. Noodling may also be a factor that causes weight gain. In addition, fatty meat, I sometimes want to have a little too, maybe fatty meat is also a factor I cannot control. Is it because I'm not doing well in this respect that I cannot lose weight? I do keep exercising.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWeight management involves diet control and the formulation of exercise plans, as well as regular weight monitoring, and aged individuals also require improved sleep and mental health maintenance[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].In our study, the primary factor impeding weight management behaviors among elderly T2DM is their perceived barriers[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Insufficient knowledge leads to insufficient perceived susceptibility and severity, thereby reducing their willingness to start weight management[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Social support from surrounding individuals primarily enhances self-efficacy; additionally, it can facilitate the transmission of relevant information and act as cues to their action[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePoor sleep quality induces perceived barriers among elderly T2DM, which in turn impairs their weight management efforts. When managing their weight, attention should also be given to their sleep problems at the same time and the correlation between diabetes and sleep is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In China, sleep disorders are quite common among elderly individuals, with more than one-third of them suffering from such conditions[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. There is a significant bidirectional relationship between poor diabetes management and insomnia[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The frequency of nocturia in diabetic patients is 1.49 times greater than that in nonpatients, and nocturia can lead to poor sleep[\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Low sleep quality may cause obesity by affecting hormone levels, thereby affecting appetite and reducing physical activity[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Overweight and obesity are clear causes of diabetes, which in turn makes diabetes management more difficult[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eWhen formulating an exercise regimen for weight management, personalized protocols should be developed on the basis of an individual\u0026rsquo;s physical status to mitigate the level of perceived barriers. The comorbidity rate among elderly individuals in China is 44.1%, and elderly patients with T2DM often suffer from multiple diseases[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. For example, after coronary heart disease occurs, personalized exercise methods should be developed after professional assessment[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; after knee replacement surgery, exercise with a high joint load should be reduced[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. How underlying diseases directly or indirectly hinder exercise is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eCurrently, there is a substantial knowledge gap regarding T2DM among community-dwelling older adults, with insufficient awareness of diabetes and healthy weight management\u0026mdash;both of which contribute to reduced levels of perceived susceptibility and severity[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In response to this situation, health education should be strengthened to increase their relevant knowledge level. The fact that diabetes cannot be cured reduces patients' self-efficacy[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In that case, emphasizing health education that diabetes can achieve clinical remission and prevent complications through disease management may represent a more effective strategy. Posting health education and popular science videos on social media to target elderly T2DM might be a solution to fill their knowledge gap, which can help increase their perceived threat level and enhance their self-efficacy, as well as the successful cases on social media can also serve as cues to actions.\u003c/p\u003e \u003cp\u003eThe popularization of social media science needs to be strengthened in supervision, and science popularization videos need to be evaluated. Science populators on social media tend to produce short videos, although studies have shown that duration is positively correlated with video quality[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The quality ratings of diabetes-related videos on multiple social platforms are mostly poor, and the average patient generally lacks sufficient awareness, motivation and time to evaluate this information[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A good idea might be to have qualified doctors evaluate these videos and send high-quality educational videos to patients, and platforms should promptly remove low-quality content.\u003c/p\u003e \u003cp\u003eElderly people, rural residents, low-income groups and those with low educational attainment find it more difficult to benefit from the popularization of science on social media[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Traditional health education methods, such as lectures, free medical consultations and the distribution of handbooks, should also continue.\u003c/p\u003e \u003cp\u003eSimilar studies have mentioned that people around patients can influence their behaviors[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Family support can influence self-efficacy, adequate family support enhances diabetes management outcomes, whereas insufficient family support diminishes such outcomes[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Primary health care institutions are important sources of knowledge and cues to action[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Peers can play a supportive role, and peer education and peer counselling are regarded as supplements to professional intervention[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Mutual aid groups are beneficial for weight management and self-management among people with diabetes[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Peers can enhance self-efficacy, act as cues to action, and transmit experience.\u003c/p\u003e \u003cp\u003eElderly T2DM usually possess awareness regarding dietary control, yet they may not necessarily implement it appropriately[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Some patients said it was difficult to adhere to a diabetic diet, formulating a diabetes-specific dietary regimen may help mitigate perceived barriers, thereby ameliorating this condition[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, diabetic patients have varying degrees of dietary misconceptions, which is consistent with previous reports[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Study had reported that eating is a way to have fun and socialize, which might be the reason why some participants have difficulty controlling their diet[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeople who weigh weekly lose weight better than those who do not, and those who weigh daily lose weight more significantly than those who weigh weekly[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Encouraging T2DM to purchase weighing scales or installing weighing scales in communities can serve as a cue to action ,which may facilitate the implementation of weighing behaviors.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ePolicy Implications\u003c/h2\u003e \u003cp\u003eFor elderly individuals with sleep disorders induced by nocturia, interventions including reducing pre-bedtime fluid intake, voiding urine promptly before sleep, and administering sleeping medications may alleviate this issue to a certain extent.\u003c/p\u003e \u003cp\u003eFamily physicians may formulate personalized exercise regimens tailored to the physical conditions of elderly individuals. Meanwhile, family physicians may curate science popularization videos on social media and deliver high-quality ones to elderly residents in the community in a targeted manner, thereby enhancing their knowledge levels.\u003c/p\u003e \u003cp\u003eInstitutions such as diabetes associations and centers for disease control and prevention may formulate diabetes-specific dietary regimen and regularly disseminate them via social media and other platforms, so as to eliminate dietary misconceptions among elderly residents with diabetes.\u003c/p\u003e \u003cp\u003eCommunities and pharmacies may procure weighing scales for residents to use on a complimentary basis, so as to promote their weight-measuring behaviors. Furthermore, communities may facilitate the establishment of peer support groups for overweight and obese elderly T2DM.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study has the following limitations. First, all participants were recruited from southwestern China and had contracted with family physicians, most of them were predominantly urban residents, with only one patient from a rural area. The insufficient representativeness of the sample may compromise the generalizability of the findings to rural populations. Second, qualitative research inherently involves a certain degree of subjective bias. Thirdly, participants responded in the local dialect, and the English translation during manuscript preparation was context-dependent, whereas cultural disparities may introduce potential deviations.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSuboptimal weight management among elderly T2DM patients in our study is attributed primarily to perceived barriers, and reducing barriers may facilitate their weight management. A lack of relevant knowledge can reduce the level of perceived susceptibility and severity of overweight and obesity, which makes them fail to realize that they should manage their weight. Interpersonal relationships have multidimensional impacts on patients' behaviors and should be considered in the process of intervention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT2DM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etype 2 diabetes mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eend-stage renal disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehealth belief model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e This study was approved by the ethics committee of Army Medical University with approval number 2025-33-02. The subject participants provided written consent. All study procedures were carried out in accordance with 2013 Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflicts of interest\u003c/h2\u003e \u003cp\u003eNone declared.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received no specific grant from any funding agency.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYBZ conducted the interviews and drafted the manuscript. XYC translated the dialogue according to the context and revised the manuscript. STX and NX participated in the interviews, extracted key words and classified them. When there is a disagreement on the themes summary, JAC and CFZ make the final decision. The remaining participants discussed community elderly care guidelines.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThe authors thank all the participants in the study for their involvement and help.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eSome participants were concerned that the recording might be leaked, so they did not allow the recording. For privacy protection reasons, the original data is not publicly available, but full coding framework and theme derivation process were referred to in additional file 2. Interview guide (HBM-adapted) is provided in additional file 1.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen X, Giles J, Yao Y, Yip W, Meng Q, Berkman L, et al. 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Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;1111:92\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"type 2 diabetes mellitus, health belief model, weight management, aged, influence factors, qualitative research, elderly Chinese","lastPublishedDoi":"10.21203/rs.3.rs-9357275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9357275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWeight management is one of the most effective approaches for managing type 2 diabetes mellitus (T2DM). However, in China, the weight management status of more than 50% of elderly individuals with T2DM remains suboptimal. A partial explanation for this phenomenon may lie in insufficient knowledge levels, while the evolution of social media could exert a potential influence on their knowledge acquisition. Identifying the determinants of inadequate weight management can facilitate the development of targeted health education strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis research adopted a qualitative method that complies with the Consolidated Criteria for Reporting Qualitative Research. Participants were recruited from overweight and obese T2DM patients who had enrolled in family physician services across three communities in Chongqing, China, and semistructured interviews were administered. The interview guidelines were designed on the basis of the health belief model. Interview data were analyzed using a theory-driven thematic analysis approach to elicit structured themes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn our study, the main reasons for poor weight management among elderly T2DM can be summarized into four themes: (1) poor physical and mental health; (2) the influence of cognition; (3) interpersonal relationships; and (4) behaviors related to weight management. In this context, insufficient sleep, comorbidities, and challenges in dietary control contribute to perceived barriers. A lack of relevant knowledge leads to inadequate perceived susceptibility and severity of overweight and obesity. Interpersonal relationships exert multidimensional influences on individuals' weight management behaviors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSuboptimal weight management among elderly T2DM patients in our study is attributed primarily to perceived barriers, and reducing barriers may facilitate weight management. Inadequate relevant knowledge diminishes perceived susceptibility and severity of overweight or obesity. Interpersonal relationships exert a multidimensional influence on patients' behaviors, and individuals in patients' social environment should be considered concurrently.\u003c/p\u003e","manuscriptTitle":"Using the Health Belief Model to Explore Factors of Suboptimal Weight Management in Elderly Type 2 Diabetes Patients: Qualitative Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 06:52:13","doi":"10.21203/rs.3.rs-9357275/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-21T15:02:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-13T11:15:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-12T09:18:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-12T09:18:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-04-08T12:48:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb584de9-9a1e-4c38-9766-1f99813dcfdf","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T06:52:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 06:52:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9357275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9357275","identity":"rs-9357275","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}