Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study

Chantal M. Hulshof; Nuria E.J. Jansen; Priya Gharbaran; Dieuwke Schiphof; Pauwke P.L. Berkers; Marienke van Middelkoop

doi:10.1136/bmjopen-2025-112032

Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study

Chantal M. Hulshof^*
, Nuria E.J. Jansen
, Priya Gharbaran
, Dieuwke Schiphof
, Pauwke P.L. Berkers
, Marienke van Middelkoop

^*Corresponding author for this work

Erasmus University Rotterdam

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objectives:

Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progressfdesion. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity.

Design:

Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains.

Setting:

HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024.

Participants:

16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported.

Results:

HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.

Conclusions:

Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity.

Trial registration number:

Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20.

Original language	English
Journal	BMJ open
Volume	16
Issue number	5
DOIs	https://doi.org/10.1136/bmjopen-2025-112032
Publication status	E-pub ahead of print - 12 May 2026

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Hulshof, C. M., Jansen, N. E. J., Gharbaran, P., Schiphof, D., Berkers, P. P. L., & van Middelkoop, M. (2026). Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study. BMJ open, 16(5). Advance online publication. https://doi.org/10.1136/bmjopen-2025-112032

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abstract = "Objectives: Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progressfdesion. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity. Design: Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains. Setting: HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024. Participants: 16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported. Results: HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.Conclusions: Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity. Trial registration number: Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20.",

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note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.",

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Hulshof, CM, Jansen, NEJ, Gharbaran, P, Schiphof, D , Berkers, PPL & van Middelkoop, M 2026, 'Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study', BMJ open, vol. 16, no. 5. https://doi.org/10.1136/bmjopen-2025-112032

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity

T2 - perspectives of healthcare professionals and patients in a qualitative study

AU - Hulshof, Chantal M.

AU - Jansen, Nuria E.J.

AU - Gharbaran, Priya

AU - Schiphof, Dieuwke

AU - Berkers, Pauwke P.L.

AU - van Middelkoop, Marienke

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

PY - 2026/5/12

Y1 - 2026/5/12

N2 - Objectives: Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progressfdesion. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity. Design: Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains. Setting: HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024. Participants: 16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported. Results: HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.Conclusions: Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity. Trial registration number: Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20.

AB - Objectives: Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progressfdesion. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity. Design: Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains. Setting: HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024. Participants: 16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported. Results: HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.Conclusions: Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity. Trial registration number: Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20.

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DO - 10.1136/bmjopen-2025-112032

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C2 - 42130000

AN - SCOPUS:105038657461

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Hulshof CM, Jansen NEJ, Gharbaran P, Schiphof D , Berkers PPL , van Middelkoop M. Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study. BMJ open. 2026 May 12;16(5). Epub 2026 May 12. doi: 10.1136/bmjopen-2025-112032

Gender-related facilitators and barriers in implementing combined lifestyle interventions for individuals with knee osteoarthritis and overweight or obesity: perspectives of healthcare professionals and patients in a qualitative study

Abstract

Bibliographical note

UN SDGs

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Cite this