Facilitators and barriers

Participants identified various facilitators and barriers for a healthy lifestyle in general, most of them observed for both diet and physical activity, but some were specific to each. Usually, facilitators and barriers overlapped. For example, participants identified having more time as an expected facilitator, and lack of time as a barrier (additional file 3). Thus, general factors influencing diet and physical activity as facilitators or barriers are reported first (such as presence or absence of social support; additional file 3). Second, participants described the facilitators and barriers specific to exercise (e.g., having access to an attractive environment to go for a walk as a facilitator) and diet (e.g., having access to unhealthy snacks as a barrier). For a summary and overview, see Table 2.

General barriers and facilitators

Social support and/or network

Participants described social networks as a factor that can act as both a facilitator and a barrier. Specifically, not having a romantic partner or lacking his/her support for engaging in health behaviors emerged as a barrier: “I have been a widow for 5 years and it is true that now it has been difficult for me to go out… before, you always counted on that person” (P11), “I am divorced […] on the contrary, it slowed me down and I always wanted to move forward” (P2). On the other hand, having a partner with whom health-related activities were carried out together was frequently identified as a facilitator “It helps me a lot that it is both of us […] it seems that if you don’t do it, the other one seems to fail. It’s easier to do it between two people than between one” (P6). Furthermore, having a social network beyond romantic relationships, with whom these activities can be shared, was also mentioned as a facilitator “this is what has helped me to go out and sometimes to go to the pool, that is, to count on someone, whoever, a friend, your son, your…” (P11).

Emotional aspects

Participants discussed the role of emotional well-being both as a facilitator and a barrier. On one hand, this was reported as a barrier: when one is emotionally unwell or experiencing concerns that cause emotional distress, engaging in healthy activities becomes a non-priority “obviously it’s good to do so many sit-ups, but if I’m depressed I don’t do any sit-ups because I don’t see the point” (P18), “I do my Tai Chi, but now I haven’t been doing it for a long time because I don’t focus. Also, family things come up and you have to pay a little more attention somewhere else” (P19). On the other hand, feeling well emotionally was identified as a facilitator, acting as a driving force and motivator to engage in health behaviors “If you are emotionally well, you are going to do things with enthusiasm, you are going to take care of yourself with your diet, you are going to go for a walk…” (P13).

Willpower

Participants defined a third component, which they referred to as “willpower”, understood as the ability to regulate one’s behavior, resist temptations, and exert self-control to pursue and achieve goals. In other words, the strength one has to drive their will into doing health behaviors. However, they did not define this term further. They mentioned having willpower as a facilitator, while its absence was seen as a barrier “sometimes you don’t have willpower, I don’t always have the ability to say ‘I shouldn’t eat more than 2 plates of this today’ or 8 chocolates” (P9).

Time

Participants identified lack of time as a barrier, mainly due to high work commitments. In fact, working participants identified it, but not retirees. Additionally, participants said they saw it as an expected facilitator; they said they expected that increased free time would lead to a greater engagement in physical activity or to cooking healthier and more elaborate meals. Participants said they expected the anticipated increase in leisure time upon retirement to be a general facilitator.

Motivation and self-conviction

This facilitator is the idea that, to adopt and maintain a behavior, motivation must come from within, with a strong personal conviction. In this regard, it outlines the importance of being oneself who wants to do the behavior rather than other people or external pressures. “It has to be a self-conviction, because if not, it is useless for you to tell me the properties of this product this is fantastic and such, very well, I don’t care, I do not motivate myself […] I am aware that there were things that I could improve and surely for my physical well-being it would be much healthier, but like what we say, I do not have the motivation now to be so… to give up certain things that now give me pleasure” (P9).

Other general facilitators

In addition to the above domains, participants identified other general facilitators. For example, the facilitator of generativity emerges, which involves being a role model for others.

Participants also identified “attitude” as a facilitator, suggesting that one could engage in the necessary activities with the right attitude.

Participants recognized different facilitators related to initiating and maintaining habit acquisition. For example, they discussed the role of a trigger, such as a doctor, friend, or family member telling them to change, as something that could make one realize the need for a change. However, in terms of maintenance, they identified other facilitators, such as recognizing the rewards of the activity “maybe it has to do with the reward, after seeing that you feel better and you don’t feel bad that you didn’t go” (P15). They also called progression, patience, and flexibility with mistakes facilitators “I don’t want to rush because I don’t think that anything that causes me to have an obligation to go further is going to fail” (P9). Additionally, they identified the retirement transition itself as an expected facilitator. Some participants who had not yet retired placed their expectations on achieving a healthy lifestyle in this upcoming phase.

Barriers and facilitators to physical activity

In addition to the previously mentioned domains, participants identified specific facilitators and barriers to physical activity ranging from walking to specific exercises.

The main barriers participants expressed were boredom associated with the activity, not enjoying it, and the “laziness” they attributed to leaving the house once they were at home. Another barrier participants identified was how the activity is conducted. For example, P10 enjoys playing tennis and competing with younger people, but he does not like it when a teacher corrects him “we have a teacher and sometimes, why do I need him yelling at me? well, yelling in quotation marks, he is correcting me, let’s say, this gentleman, I am not going to be Nadal, I come here to have a good time” (P10).

Regarding specific facilitators of physical activity, the importance of the environment and geographic area was discussed, especially for walking. For example, participants identified living in a city like Madrid – which they described as “spectacular” (P16) or where “There is always life” (P10) –as a facilitator for walking. They also mentioned accessibility and proximity to places that facilitated physical activity such as the gym and workplace activities. Additionally, participants discussed engaging in organized activities as a facilitator because it implied commitment and enhanced adherence.

Another facilitator was recognizing the physical “rewards,” meaning that engaging in sports leads to favorable physical conditions. For example, P3 commented that, while he used to experience muscle soreness when skiing in the past, now that he was older but in better physical condition due to being more physically active, it no longer caused him soreness.

Barriers and facilitators to a healthy diet

The barrier participants mentioned the most to maintaining a healthy diet was increased accessibility to food and time for snacking. Participants reported no difficulty in preparing healthy and balanced main meals. However, throughout the day, they reported that they tended to eat unhealthy snacks such as potato chips and processed meats. They mentioned that having more free time and spending more time at home facilitated access to these snacks. Both working and retired participants reported that they perceived retirement as a moment in which this can happen to a greater extent by both, “fear of what you’re going to do next…. (when you retire) it’s true that when I’m at home, I’m always snacking all day long and so on” (P11), and “One of the problems is that you have a lot of time for snacking, that is, when you are working you have no chance to go to the fridge to get a piece of cheese […] and when you are at home, you go to the fridge 50,000 times” (P3).

Another barrier people mentioned was eating out, as it was more challenging to eat healthily. On the one hand, P10 mentioned the need to eat out for work-related reasons and that he was looking forward to retirement, hoping that by changing this, he could improve his diet. On the other hand, P11 referred to eating out as a social event that hindered following a balanced diet, “What makes the story unbalanced is that we go out with friends, which I like, I have a sweet tooth and we like to go out and alternate” (P11).

Only one participant mentioned as a barrier the difficulty and complexity of ingredients in healthy and sophisticated recipes “There are times when you see some recipe in a magazine, we have avocados, but they put things there and I have to go buy this specifically to make the dish” (P7).

Lastly, related to the emotional domain, eating was identified as a strategy for emotional regulation, which hindered maintaining a healthy diet “There are times, especially when I have family issues, but it’s like I can only do a little bit, I can’t solve them and it’s like suddenly I have to eat chocolate […] because chocolate consoles me quite a bit” (P19).

Participants also referred to strategies that allowed them to better control the foods they consumed. On the one hand, having healthy substitutes in mind for unhealthy snacks. For example, in the case of emotional eating, a healthier cereal with a lower proportion of chocolate instead of chocolate. On the other hand, some participants decided not to buy foods that tempted them but were unhealthy. Lastly, P19 mentioned that keeping a daily record of the amount of chocolate she consumed helped her identify when she exceeded her limits and facilitated behavior self-regulation.

One participant suggested that having time and peace to enjoy cooking facilitated preparing more complex and healthier dishes.

Goals and motivation

As mentioned earlier, this section is based on Self-Determination Theory (Deci & Ryan, 2000). Regarding the type of motivation, participants discussed autonomous motivation to a greater extent (52 participants’ mentions) than controlled motivation (28 mentions). The proportion of controlled and autonomous motivation participants mentioned was similar for general healthy lifestyle and diet, whereas, for physical activity, they identified autonomous motivation more frequently.

The most prevalent identified goal was health management, regulated by controlled and autonomous motivation. Skills development and social affiliation were fully regulated autonomously. Appearance and social recognition were only identified within controlled motivation. Thus, except for health management, intrinsic goals were associated with autonomous motivation and extrinsic ones with controlled motivation (Fig. 2). Specific examples were given for the specific behaviors.

Distribution of goals according to the motivation type

General goals and motivation

Participants pointed out different goals that made them want to have a healthy lifestyle. These goals were regulated by different forms of motivation: autonomous and controlled motivation and their subtypes (see Fig. 1).

Regarding autonomous motivation, participants expressed different subtypes: identified (the behavior was considered something personally relevant), integrated (the behavior was considered necessary and in line with one’s values), and intrinsic (the source of motivation was the enjoyment of the behavior itself). First, participants showed identified and integrated motivation, indicating that pursuing a healthy lifestyle was personally relevant for them and fit within their values. More specifically, they outlined the personal value of independence as a reason to be healthy “I try to live a full life physically and mentally, as well as possible, because if not, I will be a burden for my children, and I am not going to be happy with myself, it is that, first of all, I am not going to be happy with myself” (P4). In addition, participants discussed different goals within this type of motivation. For example, regarding the goal of health management, they outlined the value of being in charge of and owning one’s health as well as experiencing well-being and personal satisfaction as a consequence of their health behaviors “A long time ago they tested my sugar, Type 2 diabetes, and thanks to that I have picked up some habits over the years and the truth is that I feel great. Between the analysis that confirms it and a series of things, little by little you create your own needs and you recognize what really suits you” (P6). Participants also mentioned the goal of skills development in a general way, in which being able to accomplish one’s goals whenever it was challenging led to a self-satisfaction feeling that served as motivation to persevere. Last, participants referred to intrinsic motivation in enjoyment and well-being from doing health behaviors. We give examples in the following sections.

On the other hand, participants identified introjected motivation within controlled motivation. This referred to the anticipated discomfort when considering being dependent on another person or “hassle my children” (P4), which motivated participants to pursue health behaviors. Focusing on goals that were regulated from controlled motivation, however unclear which subtype, they mentioned the goals of social recognition and appearance. Regarding the former, a participant said she would not like to be seen as dependent or in pain but rather as someone capable of managing everything independently. Focusing on the latter, appearance, participants mentioned the goal of losing weight and looking differently; however, participants did not specify if this was due to external or social pressure (external motivation) or if it was more internalized (introjected motivation).

Goals and motivation mentioned for physical activity

Regarding the type of motivation, participants referred to autonomous motivation, such as intrinsic enjoyment. In this regard, they outlined the enjoyment of a particular physical activity such as Tai Chi, tennis, walking, or Tao Yin, for example, “the slow movements (of Tai Chi) give me such peace of mind” (P19). Participants said they appreciated other outcomes experienced directly from the activity, such as feeling focused, relief of stress (e.g., “I have a lot of work, a certain level of stress and when I get home I would have two options, the days I don’t have tennis and my need to calm that possible stress can be to have a beer with fries, which is not healthy at all” P10).

Specifically for walking, participants discussed the enjoyment of the environment, mentioning that going for a walk in a city like Madrid, which one participant called “full of life,” motivated participants to get to know other areas and neighborhoods.

One participant pointed out the importance of other goals rather than just walking more, like social affiliation “I am interested in seeing new places, spending a day in the countryside. I’m not interested in doing so many steps, I don’t care about that. I’m willing to die of what people die of… because it’s not something that motivates me, but I am motivated by strolling, by being able to see something different, by being with other people, by giving myself a bit of my own choice” (P18). In addition, another participant also referred to social affiliation as a goal in playing tennis, because they enjoyed the social interaction derived from it.

Participants mentioned the goal of health management, also referring to targets such as feeling fit, agile, and in balance through physical activity. Skills development was also a mentioned goal, in which participants valued the improvement at an activity such as tennis or swimming (e.g., “I didn’t know how to swim […] and I overtook my son in level one. I dive headfirst, I swim underwater, I swim all the strokes” P12).

As mentioned earlier, some behaviors seemed to begin from a controlled form of motivation and through an internalization process ended up being autonomously motivated. For example, after developing a healthy habit, it ended up being enjoyed; this would be the case of P10, who started walking due to medical advice after undergoing surgery but maintained this as a habit because of its enjoyment. Similarly, P14 stated “I never liked walking much, but now I walk and if I don’t walk I miss it […] you get dressed, you go to the street, I at least take a walk and I am delighted and I go home happy.”

One participant aiming to lose weight identified the controlled motivation goal related to appearance. Participants also identified health management within controlled motivation for cases with no sign of internalization but rather from the external pressure of avoiding health issues. Participants identified introjected motivation such as feeling guilt whenever not fulfilling their objectives, for example, “The day I don’t exercise, it’s as if I had committed a sin. And besides, I feel bad” (P4). Lastly, they alluded to social recognition in terms of social comparison, appreciating being fitter, more agile, and more balanced than people of their age.

Goals and motivation mentioned for a healthy diet

Regarding the goals explicitly identified for eating healthy and considering the activity of cooking, participants only identified health management and skills development.

Focusing on the type of motivation, participants identified autonomous forms. Starting with intrinsic motivation, participants identified cooking as an activity that generated pleasure, enjoyment, and stress relief. In addition, and relating to the goal of skills development, some participants referred they liked improving at cooking. Some enjoyed the satisfaction they felt when some dishes came out tasty “considering the little I do, sometimes the only thing I say is ‘that came out really tasty.’ Then I get motivated and I say, ‘Damn, and that’s without doing much, if I cooked more, maybe I would…” (P9).

Regarding the goal of health management, the participants’ motivation that regulated these seemed to have gone through internalization and become identified or integrated: “I had a hiatal hernia and…, well, I have a hiatal hernia, so when I was very young I had an ulcer and since then I have monitored my diet a lot […] I eat this way because… for my diet, for my stomach, because why am I going to eat something if it’s going to make me feel bad later?” (P2).

Regarding controlled motivation, health management was also identified here, outlining the goal of avoiding future health issues. This goal has also been externally regulated such as a family member’s pressures to avoid consuming fried products (P10).