Perceived Barriers and Facilitators to Engagement and Behavioral Enactment in Weight Management Interventions Among Racial and Ethnic Minorities.

Background: The prevalence of obesity, a risk factor for other chronic illnesses, in the US continues to rise and disproportionately affects racial/ethnic minorities. Several weight management interventions are now being delivered remotely to address this disparity, but little is known about whether this has increased access and efficacy of treatment among racial/ethnic minorities, especially from participants' perspectives. We qualitatively explored perceived barriers and facilitators to engagement and behavioral enactment during weight management interventions among a nationally decentralized sample of racial/ethnic minorities in the US. Methods: Thirty-eight self-identified racial/ethnic minority participants who completed the active intervention phase of the parent EVO trial were invited to participate in interviews. Interviews were conducted via Zoom using a guide with open-ended questions. Transcripts were analyzed using NVivo, codebook was developed a priori, but was updated with inductive codes emerging from analysis. Themes were categorized using an adapted version of the Social Determinants of Health and further subgrouped as barriers or facilitators. Results: Twenty-six participants completed interviews between April and August 2024. Participants were mostly female (88.5%), non-Hispanic (76.9%), and Black/African American (53.8%), with a mean (SD) age of 50.3 (10.1) years. Participants identified cultural, environmental, social, personal, and study-related factors as important to successful engagement in the intervention. Some participants' unique identities, such as being immigrants, impacted the ease of engaging with study components, including diet self-monitoring. Some factors perceived as barriers by some participants were perceived as facilitators by others. Conclusions: Perceived barriers and facilitators to successful engagement in weight management interventions are complex and are likely impacted by personal needs and contexts of participants. This underscores the need for multifaceted interventions.