Exploring the Factors Associated with Attrition in a Lifestyle Intervention Trial amongst Women with Polycystic Ovarian Syndrome Desiring Fertility - An Interview based Study.

Background: Previous studies exploring the barriers to weight management have suggested psychological, social and logistical barriers were important reasons for high attrition and non-adherence. Aim: The aim of this study was to assess the possible reasons for high attrition and non-adherence to lifestyle interventions in a trial setting amongst women with polycystic ovarian syndrome (PCOS) who wish to conceive. Setting and Design: The study was conducted in a tertary level hospital and employed a qualitative study paradigm. Materials and Methods: The study was nested within a feasibility study that explored the possibility of conducting lifestyle interventional trials in women with PCOS who wish to conceive. Eligible participants who refused participation in the trial were interviewed under three major categories: refusal before randomisation, refusal after randomisation and non-adherence. Statistical Analysis Used: Thematic analysis was used to analyse textual data. Results: The participants considered PCOS as a 'fairly common' condition and did not perceive the need to address the impact of PCOS on their health. The second recurring theme was the perception of being overweight as 'healthy' and 'normal' and downplaying lifestyle changes to focus only on fertility treatment for achieving pregnancy. Finally, the decision to pursue weight loss or to discontinue it seems to be a shared decision making among family memebers which limits the ability of the clinicians and healthcare practitioners to effectively deliver appropriate advice on lifestyle interventions. Conclusion: The current findings would help in planning and designing adequately powered randomised controlled trials to evaluate the impact of lifestyle intervention in women with PCOS.