The reproductive years provide a window into future risk for Type 2 Diabetes (T2DM); women’s risk is seven to 10 times higher after gestational diabetes (GDM) and two to four times higher after a hypertensive disorder of pregnancy (HDP). Targeting reproductive-aged women at high risk for T2DM could reduce future T2DM incidence. However, little is known about such women’s diabetes risk perceptions, or their knowledge or barriers/motivators of lifestyle change–information essential to understanding how to engage these at-risk women in tailored prevention programs promoting long-term health. This study’s aims include: among reproductive-aged women at high risk for T2DM, what is/are 1) personal health-risk awareness, 2) lifestyle-change interest, and 3) barriers/motivators of participation in lifestyle-change programs?Women aged 18 to 48 were eligible if they had one of the following health risks: 1) GDM or HDP during pregnancy, 2) prediabetes diagnosis, or 3) BMI classified as obese. Three Zoom focus groups, organized by risk group, were conducted with a total of 20 participants. Qualitative content and thematic analysis were used for the focus group transcriptions.Women’s personal health-risk awareness was limited and generalized  and rarely reflected awareness connected to their personal health history . Participants reported that healthcare providers did not adequately follow or address their health risks. All women expressed interest in making healthy lifestyle changes, including engagement in formal programs, but they shared multiple barriers to healthy behavior change related to being “busy moms.” Women emphasized the need for social support and realistic solutions that accounted for the dynamics of motherhood and family life. Common motivators included the desire to maintain health for their families and to set a good example for their children.Participants lacked knowledge and were eager for information. Healthcare improvement opportunities include better coordination of care between primary and specialty-care providers, and more frequent communication and education on diabetes-related health risks and long-term health. Formal lifestyle programs should tailor content by providing multiple formats and flexibility of scheduling while leveraging peer support for sustained engagement. However, DPP enrollment rates are extremely low among reproductive-aged women13 despite the fact that DPP participation and related weight loss may result in a substantial reduction in their T2DM risk as they age,14 and may also have a positive impact on their pregnancy outcomes and the health of their children.15 Thus, there is a critical need to understand more about the perspectives of reproductive-aged women at high risk for diabetes in order to effectively inform them, and to motivate them to engage in diabetes-prevention activities.Engagement in formal lifestyle-change programs can impact long-term health trajectories.16 Such knowledge is needed to learn how women who are at risk for T2DM may be encouraged to participate in programs designed to improve their health during their childbearing years. Therefore, the aim of this study was to use focus groups with reproductive-aged women at high risk for T2DM in order to learn about 1) their awareness of personal health risk, 2) their interest in lifestyle changes, including participation in formal lifestyle-change programs such as the DPP and 3) barriers and motivators to participation in a formal lifestyle-change program. Additionally, focus group questions addressed participant perspectives about the optimal timing for risk notification , and the preferred methods for notification .To better understand the experiences and health-risk perceptions of reproductive-aged women, there is a need for qualitative data from individuals who 1) have had a complication during pregnancy , 2) have already been diagnosed with prediabetes, or 3) are individuals with obesity.Individuals were considered eligible for the study if they were a person who had given birth (referred to as women in this report), were aged 18 to 48 and had one of the following three health risks: 1) a complication during pregnancy , 2) a diagnosis of prediabetes, or 3) a BMI classified as obese.17Focus group participants were recruited by the University of Utah’s Center for Clinical and Translational Science Community Collaboration & Engagement Team (CCET), using fliers sent to eligible individuals within the CCET’s network of contacts. The CCET supports community-engaged research that addresses investigator- and community-identified priorities with the goal of promoting community health needs. Three focus groups, organized by risk group, were conducted online via Zoom in collaboration with the CCET. The format of focus groups, rather than individual interviews, was selected in order to facilitate a broad understanding of women’s knowledge and feelings about the topic. Specifically, the focus group setting was selected to promote social interactions and conversation so that key themes relating to the topic could be identified.A qualitative descriptive approach was used to facilitate an understanding of women’s personal health risk, interest in formal lifestyle-change engagement, and barriers and motivators to lifestyle change. Following qualitative-descriptive methodology, the aim was to stay close to the data, using language that closely reflected the verbiage used by participants.What do you think/know about the relationship between  and your risk for diabetes and heart disease, reproductive health outcomes such as fertility or complications in future pregnancies, and the health of your current or future children and family?What is your experience talking about these risks with doctors or other healthcare providers?How would you want to be notified about these risks?What barriers prevent you from making lifestyle changes? What barriers prevent you from participating in a lifestyle-change or weight-loss program?What would encourage you to make lifestyle changes? What would encourage you to participate in a lifestyle-change program or weight-loss program? How should women be notified about these programs?Data collection included audio-recording the one-hour-long focus group discussions, which took place between February and April of 2022. Questions were provided to participants prior to the Zoom meetings and were discussed during the focus group engagement sessions. These questions were:Prompts were used by the focus group interviewer in order to encourage participants to provide additional details about their perspectives and experiences. Additionally, the interviewer noted commonalities and differences between participant perspectives and experiences in order to encourage additional participant insight regarding these similarities and divergences. Audio recordings of the focus groups were transcribed by a study research assistant and verified for linguistic accuracy by additional members of the research team.19 to examine the data, and thematic saturation23 was reached during analysis of the focus group discussions. Deductive codes were developed based on concepts related to the research question  and interview question content. Deductive codes were used during the initial coding of the first transcript. A codebook was developed with identified definitions and was used to code the remaining transcripts. Additionally, inductive codes emerged during the coding process, representing novel insights shared by participants, and these were added to the codebook. After coding was completed, codes were organized into categories and themes. Authors A.A.B., J.K.M., and S.S. engaged in the initial coding of the transcripts. A fourth member of the research team (S.S.C.) performed an audit of the group’s notes and coding to assess for consistency and accuracy of coding. Disagreements regarding coding were discussed until consensus was reached among the group.Qualitative content and thematic analysis were used24 including weekly coding meetings with authors , during which the authors discussed nuances in the data to ensure consistency and reach consensus in the application of codes. The authors compared observations of coding across transcripts to assess similarities and differences between participant experiences not only as women who had given birth per se, but also as women with differences in health risks. A group memo document was maintained and reviewed during weekly meetings.To address rigor, trustworthiness criteria outlined by Lincoln and Guba (1985) were used,Prior to the study’s initiation, the study received a waiver-of-consent documentation from the University of Utah Institutional Review Board, due to the low-risk nature of the focus group sessions. Participants did receive a letter containing information about the study’s purpose and potential risks associated with participation. The voluntary nature of participation was also discussed with participants as a group at the beginning of each session. Participants received a $75 gift card in gratitude for their time and their contribution to the study.Focus group participants were women who were mothers (n = 20) and who 1) had a complication during pregnancy ; 2) had been diagnosed with prediabetes (n = 8); or 3) were individuals with obesity (n = 5). Participants were predominantly white (75%), non-Hispanic (85%), married or living with a partner (75%), and had a bachelor’s degree or higher (75%). The majority (60%) had no prior experience with a formal lifestyle-change program. Women’s knowledge and understanding of their health risk, 2) improving healthcare for mothers at risk for cardiometabolic disease, and 3) Healthy lifestyle-change barriers and motivators.In response to the focus group questions, women across the risk groups shared similar experiences with their healthcare providers, personal knowledge of their current and long-term risk, and ability to engage in healthy-lifestyle behaviors. The main themes identified through analysis were 1) Women’s personal health-risk awareness was often only a general awareness, such as that extra body weight might lead to other health risks. Women often explained their risk awareness through anecdotal experiences, such as witnessing family members’ struggles with health issues. For example, one woman shared how her understanding of diabetes was shaped by her father’s health experience with Type 1 Diabetes:The majority of my knowledge, to be honest, has to do with just personal experience. … with what my dad went through with Type 1 Diabetes. He actually passed away at the age of 54 from complications to his diabetes. He had early onset dementia that started at 52, and ultimately passed away from renal failure of the kidneys. … He was scheduled for dialysis, but hadn’t started it yet, when he passed away. And also ended up with some heart complications, and a couple of mini strokes. … neuropathy, the whole … it was a pretty bad situation for him. So, I feel like, I’ve seen kind of some of the worst that can happen. Or … really the worst that can happen from it. This participant expressed her view that these experiences subsequently led her to prioritize diabetes prevention for herself. Another woman learned the full weight of the potential implications of her GDM while applying for health insurance after the birth of her child:After my first pregnancy, I applied for life insurance. You know, just a new baby–life insurance. And I found it very interesting that although I had been diagnosed with prediabetes, the fact that I had had gestational diabetes … put me higher on the life-insurance risk category than even the prediabetes. The gestational diabetes was considered by the actuaries a higher risk. … That was kind of sobering to just realize that fact. And I know that the likelihood of developing Type 2 Diabetes is much, much higher because of my experience with gestational diabetes. Additionally, women expressed interest in addressing their knowledge gaps and learning about how their personal health risks might inform future health outcomes. One woman with an obese BMI was unaware that her challenges with fertility and becoming pregnant could be connected to her personal health profile:When I read the question … “Do you know about the relationship between these health conditions and health risks?” For example, “fertility and complications in future pregnancies,” … I was like, Oh! Maybe that is going to be something that I am going to have to take into consideration with future pregnancies if I am so fortunate to have, but my other thought was, I am being seen for infertility and I was for my little guy, too. We went and did IUI in order for me to get pregnant. … My husband and I are both unexplained infertility and so now I guess I am wondering if, like, maybe that has anything to do with it. I don’t know. And so, I guess just more than anything, I don’t have a lot to contribute as far as what I know, but it really just makes me like want the information. improving healthcare for mothers at risk for cardiometabolic disease.Expression of this type of wish for additional education was a common comment among the focus group discussions, and the expressed need for education was an issue that connected to the next theme, Healthcare inadequacies, and 2) Suggestions for healthcare improvement.Broadly, participants frequently reported their belief that healthcare providers did not adequately follow and address their health risks. Additionally, participants made numerous comments about and provided suggestions for how reproductive women’s healthcare could be improved in order to address their long-term health. Two subthemes were created to explicate these findings: 1) Across risk groups, the focus group participants detailed an overall description of their healthcare  as lacking key qualities essential to their long-term health. Women attributed their lack of risk-related knowledge to care that was often perceived as dismissive and characterized by poor communication and education about their risk factors. For example, one woman, who was diagnosed with prediabetes by her primary-care provider, felt it necessary to obtain specialist care in order to address her new diagnosis. She stated that after her primary provider delivered the diagnosis, the doctorKind of left it at that. I remember they talked about, like, it was reversible. But they didn’t really give me any strategies. And it’s been my experience with managing it, I had to seek out a specialist on my own. And luckily, I was able to find a specialist who … he sits down with you for 30 to 60 minutes in an appointment. Whereas I feel like when I go to the primary-care physician or most doctors at most clinics, they only see you for five to 10 minutes. In addition to perceiving their care as often dismissive and lacking the thoroughness they desired, women also believed this type of care put them at increased risk for poorer long-term health outcomes: “I felt like they made it more about just statistics, you’re statistically overweight that’s great and they just kind of glanced over me as a person. (laugh) Um, and which put me more at risk.” The issue of weight was raised frequently in relation to healthcare and ongoing health issues. Participants believed providers should address weight with sensitivity and not oversimplify weight’s relationship to health. Several participants stated that providers minimized ongoing health issues due to weight bias, putting them at risk for poor outcomes. Additionally, women said providers should understand that discussing weight and weight gain can be stressful and addressing weight or obesity should be a collaborative process, where providers work to connect women with the resources they need to begin to make healthy-lifestyle changes . One woman described the complexity of addressing weight sensitively and in the context of her overall health:I think that it can be very tricky because so often, it is related to weight. And weight loss. And I think how the providers approach that subject can be tricky, because … you can feel a little bit of shame about it, like, “oh, just 15 pounds, you know, could make such a difference in my health journey.” … Just in the hospital, a couple days ago, a doctor said, “well just stay skinny, and that’s all you have to do.” And while that is helpful, it’s not at the same time. … It’s complicated. There’s a lot of factors and you need a provider … that understands that there’s a lot to your health, in addition to trying to lose weight … So, I think somehow finding a way to address it without minimizing the struggle; that is, weight loss, and your whole health picture. Because I don’t think any of us don’t know that losing weight is good for us. I think it’s just that it can be complicated. In addition to reports of dismissive and inadequate care for ongoing health concerns, women also described experiences with poorly coordinated care between providers. Participants reported that poorly coordinated care resulted in their health issues falling between the cracks of obstetrics and other care providers:But I honestly, … I did not get the education from any of my physicians, and I saw a number of physicians over the years. Primary care, my OBGYN, etc. No one ever referred me to an endocrinologist. And that was something that I think in hindsight would have been really beneficial for me. Knowing that someone has polycystic ovarian syndrome … that has to do with insulin. More than likely, they will end up prediabetic or even diabetic. This concern about poorly coordinated care between providers is especially germane when connected to a lack of handoff from OBGYN care to primary care, and when considering a lack of tailored health recommendations, as in the example of the following woman:this, now what’s that mean for me in five years, or 10 years, or down a long road? I have family history of diabetes. So, um, how worried should I be about this or things like that that I don’t think always get looped back around or sometimes discussed when they give you information that kind of is like, “Oh, checked the box. Gave her the … My Chart handout or the pamphlet or … mentioned exercising.” And though I never exercise… “See you next year.” It feels like, after that six-week appointment, it’s … kind of hard to know how to process, … so I had Women indicated their preferences for the optimal timing during the postpartum period to learn about their health risks and implications for their long-term health, as well as their preferred ways of learning this information. Due to the establishment of routines and a returned ability to mentally focus on health, participants suggested that the postpartum six-month or one-year mark would be an optimal time in which to revisit and prioritize, with their providers, health issues that require follow-up. Women agreed that the traditional six-week postpartum visit is not a conducive time to elaborate these details, as they are preoccupied with readjusting to life with a new babyI think like six months after I have my baby, I’m a little more mentally stable. I don’t quite have the right words, but I’m not so emotional and more settled into, like, these are our routines. This is what we’re doing. Things have kind of gotten more back to normal. I can. I have the mental space to think about myself and these issues that we’re talking about. To fit the needs of different learning styles, women expressed the need for educational materials to be available in multiple formats . Overwhelmingly, however, they agreed that the information should also be available through a digital resource, such as their electronic health-record app, so that the information could be retrieved at their convenience:Hand me everything digital because I can go back and look at it and reread it multiple times because I feel like it takes me a couple times to read it before I fully understand it. Especially with medical things. The terminology is hard, and so I read something, like, “I don’t even know what that’s saying” and so I need to look at it again and again, and so it’s nice if I have … it digitally, so that way, I can just keep going back to it and I won’t lose it. Women expressed a need for education that is “bite-sized information,” and that accounts for their role as busy moms. This abbreviated format could be incorporated into their daily routines, such as reviewing an educational video while washing dishes. Importantly, these types of resources could help to support an additional priority among participants-that this education be treated as an “ongoing conversation” designed to reinforce women’s learning over time. Women conveyed a desire for the avoidance of “one and done” education, sometimes referred to as providers “checking a box.” This need for brief educational resources that support ongoing learning exposes an additional appeal by the participants-the need for vetted and reputable sources of online information:I spend a lot of time on social media. So, if … a doctor, or some credible source was giving out information, like, just like a helpful tip each day, or like a reel or something, that’s going to spark my interest. It’s going to be something I can go back to. And it’s something that I can share with other people, that I could do on my own, or with friends, and so I think social media would be a good platform, too. To summarize the participants’ suggestions for the improvement of women’s reproductive healthcare, women expressed a desire for 1) healthcare that is coordinated between providers ; 2) revisiting health risks between six-months to one-year postpartum; 3) educational materials that are available in multiple formats; and 4) education that can be treated as an ongoing conversation.All women expressed interest in making healthy lifestyle changes, including engagement in formal programs, but they shared multiple barriers to healthy behavior change related to being “busy moms.” Women emphasized the need for social support and realistic solutions that accounted for the dynamics of motherhood and family life. Common motivators included the desire to maintain health for their families and to set a good example for their children. The research team sorted all codes into barriers and motivators categories, as listed in Barriers that have been discussed in previous sections of this paper include dismissive care from health providers and inadequate healthcare coordination between obstetrics and primary-care providers. In addition, multiple women highlighted a general lack of education as a barrier to engaging in healthy-lifestyle programs. One participant stated: “So, I think the biggest issue is a lack of education. It’s not a lack of doctors caring, but it’s a lack of time to teach, and follow-up regarding lifestyle changes.” .Participants shared unique insights on the difficulty of prioritizing one’s own health and wellness while planning for future pregnancies. Fatalism was noted as a barrier for one participant, who shared:You have a baby, and then three years later you’re in good shape, and then you get pregnant again and you start all over again (laugh). So, part of me is like just whip them out now… be unhealthy for six years, and then, now I can actually get in shape and stay in shape. Self-sacrifice was a common barrier noted by multiple participants, with one noting, “I was focused on how to keep my baby safe, not [myself] 10 years from now… Like I don’t really care about that right now, I care about keeping my baby safe.” .The postpartum period, in particular, was noted as a difficult time for women to receive health information and recommendations for wellness and lifestyle-change programs, as mothers are often struggling with the challenges of postpartum depression, mental ‘fuzziness,’ and feelings of being overwhelmed. One woman shared:There’s already so much to do, as a mom, especially as a new mom, that, um…when you have a break…I feel like, for me, it was very much like, “I don’t want to do anything, I don’t wanna have to do one more thing.” Exercise was just one more thing … on my plate, and I couldn’t handle what was on it already. Cost was consistently mentioned as a key barrier to engagement in lifestyle-change programs. Participants noted the challenges of balancing the costs of parenting–including childcare–with the increased expense and time costs of buying and preparing healthy meals. One participant discussed her challenges as follows:Meal prep and programs that deliver homemade meals to your door … that would be so helpful. But those cost, like, hundreds of dollars a month, and it’s just not something I would be able to afford. So, I kind of have to go cheap which doesn’t always mean a calorie deficit. It usually means I have to either do fast food or something that’s quick and easy. So yeah, there are childcare barriers, financial barriers, and definitely time. Time is a big one. While participants highlighted the barriers of childcare and family responsibilities in engaging in healthy lifestyle programs, multiple women expressed that their children also serve as a motivator to improve their health and wellness. One noted that she wants to improve her relationship with exercise to better her health for her family: “I don’t want to be in the background, not be able to do something with [my kids] because I didn’t put in the effort to keep myself healthy.” .This study provides important qualitative information to guide and improve the care of reproductive-aged women at risk for T2DM. Reproductive-aged women with cardiometabolic complications of pregnancy are at elevated risk for T2DM but are under-represented in lifestyle-change programs and prevention efforts. Participants highlighted a lack of continuity in care between their obstetric and primary-care providers, and voiced concerns regarding dismissive and/or perfunctory healthcare that minimized and poorly communicated their future health risks. Multiple barriers to T2DM-prevention efforts were highlighted, most notably lack of time, family and domestic labor commitments, and inadequate social and structured healthcare support during the postpartum period. Despite the concerns voiced by participants regarding their healthcare experiences, women reported that parenting and pregnancy were motivators for lifestyle changes and endorsed the need for improved efforts at T2DM-prevention programs for this patient population.25 In addition to a six-fold increase in risk for developing T2DM, having a HDP increases a woman’s risk for cardiovascular mortality by 40%, contributing to the United States’ already significant burden of pregnancy-related morbidity or mortality.26 Such care could provide a means of supporting long-term health by formalizing the follow-up plan for pregnancy-associated cardiometabolic risk. Optimally, fourth-trimester care would be home-based and would leverage telehealth so as to minimize common barriers to postpartum care. Additionally, this care would include tailored guidance on postpartum health behaviors25 and could serve to educate women on the associations between pregnancy outcomes and their long-term health risks.Fourth-trimester care is defined as postpartum maternal healthcare that occurs during the year following pregnancy. Although not routine in the United States, fourth-trimester care has been identified as an ideal opportunity for comprehensive cardiometabolic evaluation and handoff of care from obstetrics to primary and specialty providers.27 These findings were mirrored in a Norwegian-based qualitative study with women who had had GDM or preeclampsia, where participants described feelings of being left on their own to decipher the implications of their pregnancy complications and how to care for their health going forward.28 As a result, several participants reported mental-health struggles as they processed their diagnosis, need for self-advocacy, and complex motherhood transitions.We learned from the participants of our study that their personal health-risk awareness was limited and superficial . Most women reported little understanding of their current health status and cardiometabolic risks, and rarely reflected awareness of their obstetric health complications and their impact on current health status . Additionally, participants reported that healthcare providers did not adequately follow up on and/or address their health risks, and they believed they lacked education and knowledge about their personal health risks. Similarly, a United Kingdom-based longitudinal qualitative study exploring women’s experiences of their postpartum care following HDP found women lacked tailored education from providers and educational materials about their health risk. Moreover, women were unaware of the implications of their personal risk profile for future pregnancies and for their long-term health.29 Combined, these studies underscore the importance of healthcare providers effectively conveying long-term health risks associated with reproductive-aged women’s personal health profiles. In a report by Wilkinson et al., an Australian-based qualitative study with postpartum women who had had GDM or overweight/obesity, women said they desired a tailored and supportive lifestyle program offered by trusted professionals and women with lived experience that would account for the “new normal” of motherhood while also providing methods of accountability.30 The lack of time and energy that mothers face must be central to healthy behavior-change recommendations and to the design of lifestyle programs.28 These reported lifestyle-program priorities are similar to the priorities identified by women in the present study. Additionally, as in the present study, free or low-cost programs were identified as a priority of postpartum women.31 Having to pay for a healthy-lifestyle program was a barrier for this study’s participants, who cited a number of competing financial responsibilities.These findings are concerning as greater risk perception among women has been associated with engagement in a formal postpartum lifestyle-change program.This study has several strengths, including the participation of mothers with various cardiometabolic risk factors and a wide range of obstetric and medical diagnoses. Additionally, the study’s collaboration with the University of Utah’s CCET contributed to best-practices in qualitative and community-based research, including the use of the same interview guide and moderator for all three focus groups. Study limitations include the fact that the study population was majority white/non-Hispanic. Additionally, the experiences of women from a single intermountain region may be different from those living in different geographic regions. These women were savvy healthcare consumers, many of whom had participated in other studies with the CCET. Therefore, findings for women with less research experience may reveal even greater knowledge gaps and barriers to lifestyle-change program participation. Despite these limitations, this study provides helpful information about the knowledge and experiences of reproductive-aged women with cardiometabolic risk factors.Understanding reproductive-aged women’s views regarding their health status and risk for T2DM represents a key component in designing effective lifestyle programs. In our study, women demonstrated limited knowledge regarding the connection between pregnancy health and long-term health outcomes, such as potential diabetes-related health risks. Moreover, women identified numerous barriers to participation in lifestyle programs, yet reported being eager to receive further education. Overall, women were able to identify practical, real-world strategies supportive of their ability to participate in lifestyle programs. Nonetheless, further research is needed to understand diverse women’s experiences and identify potential barriers and facilitators.


This study explores the experiences of Korean elite judokas during their junior to senior transition (JST), including both male and female participants, to provide empirical evidence for the development of tailored support services or programs for this target population.We recruited 12 elite judokas for our study, comprising eight males and four females, all in their first year of university. Given their preferences and availability at the time of data collection, participants were divided into three focus groups: Focus Group 1 , Focus Group 2 , and Focus Group 3 . Thematic analysis was applied to analyze the data from the focus group interviews.Five main themes were identified: (a) COVID-19-Induced Frustration, (b) From Big Fish in a Small Pond to Small Fish in a Big Pond, (c) Challenges in Academic Commitment, (d) Adapting to Transitions in Living Arrangements, and (e) Recognizing Support Needs for the JST.The findings of this study provide both theoretical and practical implications that could improve judokas’ experiences during the challenging physical and mental phase of JST, as well as inform the establishment of tailored support programs and schemes for successful and smooth JSTs for athletes. The shift, often referred to as the junior-to-senior transition (JST), is regarded as one of the most challenging periods in an athlete’s career . AthleteThe JST typically occurs as athletes advance from junior competitions (under 20 years old) to senior competitions encompassing all ages . The ageResearch has consistently shown that athletes find the JST physically and mentally demanding . PhysicaRecognizing the challenging nature of the JST in sports, there has been a significant increase in research focused on this area, especially within diverse sporting cultures and contexts. The goal of these studies is to provide enhanced support for athletes undergoing this demanding phase . ResearcVarious theories and methodologies, including qualitative approaches, have been employed in research studies to examine the JST in sport. These approaches aim to identify the key elements and factors influencing successful and unsuccessful transitions . PromineIn their systematic review of literature concerning the JST, This insight could be significant in fostering the specific knowledge related to sport, culture, and gender that is required to offer personalized support to athletes transitioning between stages. Drawing from their meta-study findings, 2.2.1.This study adopted a case study design to gain in-depth insight into the experiences of elite Korean judokas transitioning from secondary school to higher education institutions, a process also known as the Junior to Senior Transition JST; . This apTo explore the subjective experiences of the participants, we employed focus group interviews as a means to capture the richness of their experiences . Since t2.2.We recruited 12 participants in our study, eight of whom were males and four were females, all in their first year at university. These participants, all elite judokas with international competition experience, were attending the same sports-friendly university in South Korea. This university, distinguished for its commitment to sports , fostersThe participants typically adhered to a training schedule comprising three distinct sessions per weekday. Although this schedule might vary based on different factors such as upcoming competitions, injuries, off-campus training, or training camps, both the male and female teams generally followed this routine. They began with an early morning session from 6:20 am to 7:30 am, followed by an afternoon session from 2:30 pm to 5:00 pm. First-year students arrived earlier than 2:30 pm to prepare the judo gym for the training session. The day concluded with an evening session from 8:00 pm to 9:30 pm.2.3.After obtaining institutional ethical approval, the second author’s contacts were used to recruit a purposive sample . ConsideTo ensure consistency across interviews, an interview guide was established, drawing from our research questions and existing literature e.g., . The intPrior to participating in the study, each participant was given an information sheet detailing the purpose, methodology, potential risks, and benefits of the research. After going through this information, they were requested to sign a consent form to indicate their agreement to participate. Upon receipt of the signed consent form, we scheduled their participation in the focus group interviews. We provided the participants with the information sheet and secured their consent to ensure they had a comprehensive understanding of the study and their rights as research subjects. This strategy highlighted our commitment to ethical principles in research, which include informed consent and respect for participant autonomy. We believe that these measures contributed to the integrity and credibility of our study. The interviews lasted for approximately 82 (FG1), 76 (FG2), and 83 (FG3) minutes, with an average duration of 80.33 min (SD = 3.09). The interviews were transcribed verbatim, and to ensure confidentiality, participants’ names were replaced with codes, such as Judoka 1, 2, 3, and so forth see .2.4.In our analysis, we followed the six-step thematic analysis technique proposed by Ensuring rigor and trustworthiness stands as a critical component in qualitative studies, despite varying research methods and strategies for implementing and evaluating the data analysis process . To enha3.Five themes were identified from the thematic analysis  for university admissions as elite judokas. Their aim was to join South Korea’s leading sports university, making performance in these events crucial. However, the frequent competition cancelations increased their anxiety. As a result, the participants lost their motivation and goals, leading to feelings of frustration and even depression: “I wanted to have clear information on whether or not there were competitions, so that I can prepare for the next competition” (Judoka 3).The absence of competitions led to uncertainty, causing frustration among participants. They were left uncertain about university applications based on their second-year records. Judoka 5 shared her feelings regarding this challenging period, “Because the dormitory was closed, I had to train separately… I did go to the gym but I wasn’t able to do it properly… If it wasn’t for COVID-19, I could have done better, I could have improved more… I feel like I lost a lot of my senses, it was hard to get back in shape. […] I was so stressed because of university, I heard a lot of talk like, ‘You cannot go to university like this.’ My coach told me that I looked too stressed. It was really hard psychologically. Can I go to university without competing? I just kept working hard. I thought I would have to show them if I ever competed again.”While awaiting confirmation of their eligibility for their target university, Judoka 3 and 6 attempted to prepare for the national university entrance exam because they were uncertain whether their second-year medal records would be sufficient for university admission: “Due to COVID-19, the sudden cancelation of matches left me feeling somewhat lost… I could not seem to get a grip on things. Although I was exercising on my own, it did not feel like I was… In the first semester, I felt anxious, so I did study a bit… but still, I think I was fortunate compared to others, I believe my case turned out well” (Judoka 6).Judoka 2, 9, 10, and 11 encountered difficulties with weight control due to the cancelation of competitions, reduced training loads, and associated stress. These factors not only affected their preparation for competitions but also their transition to university. The following is an excerpt from the FG3 conversation:Judoka 11: I had lost weight but when they said [the competition] was canceled, all the effort to lose weight was in vain.Judoka 12: When the competition was canceled… I first thought “I need to go to university…” […] I did not want to do anything…Judoka 11: I was scared…Judoka 10: After taking some time off, my weight went up from 60 to 78, I even wondered if I was pregnant [laugh]. When a competition was announced, I tried to lose 12 kilograms in 3 weeks, but I got injured and was wondering whether I should compete or not. I was starving and weighed around 71–72 kilograms, I felt like I was going to faint […] I ended up competing and lost up to 17 kilograms.Judoka 9: I also gained 15 kilograms and when I lost all of it, I received a lot of help from [the name of one of Judokas]. Now I have lost all the weight and can keep up with everyone.Faced with challenges due to COVID-19, the judokas adopted various coping strategies. They sought support and guidance from parents, peers, and coaches, remained focused on university admission goals, and maintained a determined mindset, prioritizing training over concerns outside the judo gym: “I think I relied a lot on those around me. I sought a lot of advice from my mother and my teacher. When I said, “I do not know what to do now, please advise me,” my mother comforted me saying, “Do not worry. You may want to go to the university of your choice, but that’s not the only path. Prepare at your own pace, and if you have to give up unavoidably, there are other paths, so do not put all your energy into this one.” I really wanted to go to [the name of the university], so I kept looking into it, and seeing that, I think my mother encouraged me and tried hard to ease my mind” (Judoka 3).Other participants also shared their experiences regarding coping strategies, such as: “My father helped me… he said I could go to a good university at my level… There was no special method… I thought about it on my own… No… It wasn’t set in stone… (Judoka 12); “I like eating… So, with food… when there were no matches, I ate a lot… I think my coach consoled me from time to time” (Judoka 11); “Without being influenced by others, just me alone… it was tough, then… it got better… I think it was like that” (Judoka 7). Interestingly, one participant (Judoka 3) noted that he kept a diary as part of his coping strategy during the pandemic, in addition to managing his daily routine: “When I entered high school, I kept a daily diary. I wanted to see how I changed day by day. While the diaries from my first and second years were training logs, in my third year, I wrote down everything I felt during the day. Looking at it, I remember making a resolution that even though yesterday was like that, I should make today more meaningful.”Despite successfully navigating through this difficult period and gaining admission to their desired university, they continued to be affected by the COVID-19 restrictions, such as confinement measures, which led to further frustration: “I do not think it’s so much the difference between high school and university, but in high school, I could come and go freely. After coming to university, I find it hard being confined in the dormitory even on weekends. I cannot go out often and thinking that I’m locked up makes me depressed. I have nowhere to release my stress about exercise” (Judoka 4). Judoka 4’s concerns about strict campus restrictions were echoed by others in FG1. These rules, aimed at pandemic protection, confined them mainly to their dormitory rooms. They occupied themselves with smartphone activities and video calls. Their frustrations persisted when they returned to competitions, now changed significantly—lacking audiences, requiring masks, and prohibiting food and drink, among other adjustments—leading to discomfort and frustration: “The matches proceeded rapidly without breaks, and with nobody in the audience, the atmosphere was quite chaotic. We could not bring in drinks, nothing was allowed inside” (Judoka 7); “After not doing anything during the hiatus and then suddenly having a match, I did not feel real about the match, and my competitive spirit diminished whether I won or lost… In high school, I cried when I lost in a match, but this time, there was none of that, it was weird because it did not feel real” (Judoka 5).The participants navigated pandemic challenges using different coping strategies during what should have been a critical final year of secondary school. This time is typically crucial for enhancing performance and motivation before university transition. However, even after entering university, the pandemic’s effects lingered on their athletic careers and daily lives, posing challenges they were still addressing during data collection.3.2.All participants noted the heightened level of other athletes’ performance and the increased demands of training. However, male and female participants perceived this difference distinctly. While male participants felt daunted and intimidated, female participants viewed it as a significant opportunity to enhance their skills and performance, even enjoying the challenges. The following excerpt is part of the conversation from FG1:Judoka 1: There are a lot of people who are stronger than me, so I had many experiences of being defeated, which was hard. The techniques that I was good at did not work well on people who were better than me, and it was completely different from high school, so I had many experiences of feeling deflated. As a result, I think I got mentally stressed.Judoka 4: Until high school, the sports atmosphere was more about being forced to do things while being mindful of the coach’s gaze rather than encouraging each other. While others were doing it reluctantly, I worked hard on my own, but at university, everyone was working hard together, which was good, but… There were many cases where I felt intimidated because there were many people stronger than me.Judoka 2: When I train here and see others doing well, I do not feel like I’m doing exceptionally well… As a result, I feel like my self-esteem is falling.On the other hand, the female judokas from FG2 appreciated others’ high performance and advanced skills, considering these aspects as catalysts for their own improvement. For instance, Judoka 7 noted, “I feel like I’m working harder here than I did in high school. Everyone here is good, so it’s fun to practice, and I feel like I’m improving because I’m with people who are at a higher level. In high school, I did not have many partners who were at my level. I think it’s great that everyone here is good.”Participants felt a stronger sense of autonomy and responsibility when they started university. This transition also brought about a change in coaching style. Unlike their secondary school days, coaches now provided more autonomy and supportive guidance, and this shift, which focused on acknowledging achievements, was well-received by the participants. Judoka 3 noted, “It feels good to get rewarded for the effort I put in. In high school, it felt like I had to meet the coach’s targets, but at university, it feels even better to achieve my own goals. The coach plays a supportive role.” Judoka 6 also shared the similar view, “In high school, I practiced and competed while being conscious of the coach’s gaze, but at university, I have to manage my own practices, and I think the biggest difference is that the competition is for myself. Well… I feel like… In high school, the coach used to watch from the outside and I just did as instruct without thinking, but at university, I think and do a lot more. I find myself contemplating a lot on how to go about the competitions.”While the participants appreciated the autonomy they were given, some also felt pressure to excel and demonstrate high performance to their peers and coaches, understanding that their skills and performance were now largely up to them. For instance, Judoka 7 highlighted, “To be honest, I think I felt more burdened in some ways. Since high school, I was consistently coming in first place, and I felt a sense of pressure that I had to keep beating the older girls who I had previously defeated. This sense of pressure that I had to keep coming in first, starting from my first year at university… Because of the mental burden, my performance in the matches wasn’t good. In fact, I lost in this competition to an older girl whom I had beaten before…”The participants adopted coping strategies similar to those used during the COVID-19 challenges, which included seeking support from parents, peers, and coaches, maintaining focus on skill improvement, and accepting the situation. Notably, there was a difference in support-seeking behavior between genders. Male participants often turned to senior judokas in their later university years, while female participants typically sought help from peers or tried to handle challenges on their own. One of the male participants, Judoka 11, remarked, “When I first started, I could not adapt well to the training and could barely keep up with the intensity of the training. However, I think I was able to adapt to how to do it during training time as the older boys next to me helped and guided me. Thanks to the seniors around me, I think I was able to focus more on the training. Because they run with me, encourage me… I now have the confidence that I can do it to some extent on my own.”One the other hand, one of the female participants, Judoka 8, noted, “Even when it’s too hard during training and I think, “Ah, I really cannot do this anymore,” I feel better after the workout is over and I relieve stress by talking and playing with my peers. When something does not work, I ask the coach and seem to gain strength from a single word of praise from the coach.” The following excerpt is part of the conversation from FG2:Judoka 7: I try not to be influenced by others and rather than asking for help, I try to struggle and solve problems by myself, and I think things get better that way. Since I have to do it anyway, I just accept it and proceed. When it’s really hard, I analyze my past matches by watching the videos, and that seems to make me forget about the difficulties.Judoka 6: I think… I think… I feel like I’ve lost the sense of burden because I think I have nothing to lose. Thinking that there’s only progress ahead, I just keep overcoming and focusing on training.Judoka 5: I just think I have to do it anyway, and I just do it. Since I have to do it anyway, I think there’s no need to think that it’s hard like this every day… I seem to be encouraging myself.Although all participants faced the same situation of being surrounded by judokas at a higher level, it was interesting to observe the gender differences in their perceptions. The same applied to their coping strategies. Male participants actively sought and received support from their senior judokas, whereas female participants did not mention any support from seniors, instead relying on their peers or managing by themselves.3.3.Most participants, except for Judoka 1, 6, and 7, struggled with academic responsibilities at the university. In South Korea, many elite athletes, like them, are often exempted from rigorous academic work in secondary school to focus on their sport. Thus, they were unprepared for the academic expectations at the university level. However, Judoka 6 and 7, having balanced both academics and sports during their secondary school, were more at ease with the university’s academic demands. Their experiences are reflected in the following conversation excerpts:Judoka 6: When I was in high school, because of COVID, the competitions were canceled, and I wasn’t sure if I could enter university through judo. So, I thought that if it did not work out, I should at least go to university through studying. So, I studied a bit and tried to do the same at university, so I did not find it particularly difficult. I’ve been busily following along with what’s given and accomplishing it, and before I know it, the first semester is almost over. So, I do not think I’ve had any major difficulties so far.Judoka 7: I’m working hard without feeling any particular difficulty. It’s the same as when I was in high school.On the other hand, Judoka 8 in the same focus group as Judoka 6 and 7 noted, “In high school, I only attended morning classes. Even then, since I went to early morning training before class, I ended up falling asleep during the class time. When it came to tests, I mostly just guessed the answers… When I first received an assignment at university, I really did not understand anything… It felt overwhelming. I managed to do it by asking other friends little by little… Now that I’ve adapted, I think it’s okay.” As noted by Judoka 7, and similarly stated by Judoka 5 in the same focus group (FG2), these female participants confirmed that, despite initial struggles, they now manage their academic commitments effectively. However, for the male participants in FG1 and FG3, dealing with academic responsibilities seems to be an ongoing challenge. For instance, Judoka 3 from FG1 mentioned, “Doing assignments is tough. […] If I have to prepare for training in the afternoon, I need to rest in the morning, but due to worrying about assignments, I cannot rest in the morning, which affects the efficiency of my afternoon training. Even if it’s not in the morning, I’ve just finished a tough training session in the afternoon, and I have to do assignments before going for evening training, or if I cannot, I have to do assignments after evening training, which is very hard.”While it is evident that Judoka 3 was still striving to adapt to the new arrangements, interestingly, the male participants from both FG1 and FG3 explicitly mentioned seeking help from Judoka 3. They perceived him to be the most academically adept among them and appreciated his supportive demeanor towards his peers. For instance, Judoka 10 noted, “We get together as a group and try to solve things. Among us, [the name of Judoka 3] studies well and he knows how to write, he’s smart, even among regular students, he’s a smart kid. We ask [the name of Judoka 3] for help and ask him to help us graduate [laughs]. As long as we do not get an F, we can graduate, so we are currently trying to avoid getting Fs. But it’s still very hard.” In this regard, the common coping strategy for all participants was to seek peer support. However, a minor difference emerged between male and female participants: while the male participants also sought help from their senior judokas, who had gone through similar experiences in their 2nd, 3rd, or 4th years, the female participants did not seek support from their female senior judokas at all, preferring to manage amongst themselves instead.3.4.Most participants, except for Judoka 11, had experienced dormitory life during their secondary school years. Transitioning to university dormitories was not a significant challenge for them. However, they did appreciate the improved facilities at the university. They noted the benefits of two-person rooms with private bathrooms and air conditioning, as well as the availability of a sauna. This contrasted with their secondary school accommodation where rooms accommodated more than two people and coaches could enter freely: “Coming to university, the facilities are much better and more comfortable than they were in high school. It’s great not just because the facilities are good, but also because I live in a double room, with air conditioning, a bed, and a balcony. All these things are great. In high school, we had to share a room with several people, and sometimes four or five of us would share a large room, which had many inconveniences. But now that I’m at university, I have my own space, so I can do whatever I want after training, which is just so good” (Judoka 2). In addition to improved facilities and living conditions, the female participants from FG2 discussed having more freedom in their daily lives. Below is an excerpt from the conversation in FG2:Judoka 8: The biggest changes since moving to a university dormitory are that the coach does not take our mobile phones away and we have more time to sleep. When I was in high school, the coach would enter the room without any notice… Because of that, I was always on edge, even when sleeping. Now that’s no longer a problem, I feel really comfortable. It’s improved a lot. The facilities have also gotten better.Judoka 7: [the name of her high school] really has strict rules. We were not even allowed to bring a single piece of candy into the dormitory. We could not even wear slippers inside. There were so many restrictions, but coming to university, all those restrictions are gone, and I feel really comfortable.Judoka 11, who did not have previous experience of staying at a dormitory during his high school, was also satisfied with the facilities and living condition but it took some time for him to adjust himself to the new environment especially his hometown is far away from the university where is situated in Seoul, the capital city of South Korea: “Before entering university, I had never experienced dormitory life. Having my own room and space was nice, but when I went back to [the name of the city where he is from] for a holiday and returned, it took about 1–2 weeks to adjust. I wanted to go back to [the name of the city where he is from]… I missed living with my family.” However, he noted that he eventually adapted well to the new environment and settled down.All participants expressed satisfaction with their dormitory life, but they faced stressors related to certain aspects related to their sport. A notable concern was the daily washing of their thick uniforms. The team’s hierarchy, which allowed fourth-year students to have laundry priority, often left the first-year students, including our participants, waiting late into the night to wash their uniforms. Additional laundry machines for both male and female judo teams could help address this challenge: “Laundry! There are only two washing machines, so since we are freshmen, by the time it’s our turn to do laundry it’s already late at night… I wish there were more washing machines. We do need to wash our judo uniforms quite frequently” (Judoka 7). Judoka 9 also shared the view, “There’s nothing particularly difficult about living in the dormitory, but if I had to choose something, it would be that the seniors do their laundry first and we have to do ours later, which can be a bit tiring.” In addition to the issue of laundry machine usage, some of the male participants discussed the need for support with water supply and cleaning supplies. As first-year students, they were responsible for providing water for training sessions and purchasing new cleaning supplies, a burden they suggested could be reduced with additional support: “One inconvenient thing is… we have to buy items like water bottles ourselves. Every time we train, we have to run around carrying 1 liter in each hand, which is quite hard… It would be nice if we had something like a portable ice box to carry around easily, but every time we train, since there are 8 first-year students, we have to carry 16 bottles, 2 bottles each… It feels like we are exhausted and tired even before we start training […] And also things like brooms… we have to buy all those cleaning supplies ourselves. It would be nice if the school could provide us with good stuff… It’s too much trouble to have to keep replacing them as we use them… It’s also a cost” (Judoka 10).While it is positive that all participants were content with their dormitory life and appreciated the high-quality facilities and living conditions, it appears that some minor adjustments and support could further improve their dormitory life. Based on their recommendations, considerations such as providing more laundry machines and carriers for water bottles (considering the sport-specific context) would be beneficial.3.5.The participants discussed some support needed for their JST in order to better adapt to university life: (a) providing an induction session, (b) supplying devices for studying, (c) granting access to psychological/counseling support. As presented in the previous section of “Challenges in Academic Commitment,” to reduce their pressure and overwhelming experience in relation to academic commitment, the participants requested induction sessions at the start of the very first semester. These sessions would provide clear and sufficient information about developing their timetable, expectations for each module, and sources of support : “I wish there had been an opportunity to receive more detailed information about the basics before the semester started, and a chance to ask questions. It would be nice to have a class or session that explains the importance of grades, how to efficiently plan your timetable, how to do assignments well, and other basic things that you need to know” (Judoka 8). During the data collection period, COVID-19 restrictions meant participants attended classes via Zoom. Some highlighted the importance of having reliable devices like laptops or webcams for these virtual lectures. Although most had the required devices, malfunctions led to them borrowing from peers. Given the shift towards online or hybrid teaching, having dependable devices is essential for the learning process.Lastly, while the male participants did not discuss the need or importance of psychological or counseling support, the female participants highlighted this aspect. In particular, Judoka 6 and 7, who attended the same high school, discussed how they greatly benefited from such support at their high school, finding it very helpful for their performance and daily life: “I’m quite open about receiving counseling. In high school, we had a dedicated professional counselor. Since all the students at our school were athletes, I think we all needed some kind of psychological counseling to some extent. We had a good counselor who gave us a lot of counseling. There were also many boys” (Judoka 6); “The counselor listened to us and gave us a lot of good advice. At that time, many boys also received counseling. Although you had to make a reservation, you could still get enough psychological support. When you went and came back, you felt relieved” (Judoka 7). While both mentioned that many male athletes at their high school sought such psychological support, the male participants in the present study did not discuss any such experiences, indicating that they might not have had this opportunity during secondary school. Judoka 5 and 8 recognized the availability of support in high school but did not use it although they stressed its importance for adjusting to university life.4.The aim of the present study was to explore Korean elite judokas’ experiences of junior to senior transition (JST), with the goal of providing empirical evidence to aid in the development of a tailored support service or program for this target population. The findings offer both theoretical and practical implications that can contribute to improving judokas’ experiences during the JST, a period recognized as challenging both physically and mentally . PreviouSince they experienced the COVID-19 pandemic during the last year of their secondary schools, their challenges were not only limited to the JST itself but also associated with the pandemic. The most notable challenges all participants experienced were frustrations resulting from the cancelations of all competitions and qualifiers in their final year of secondary school due to COVID-19. In response to these unique challenges, participants utilized three main coping strategies: seeking support and advice from parents, peers, and coaches; focusing on their goals; and merely carrying on, concentrating on training and putting the issue out of mind when outside the judo gym. These coping mechanisms are akin to those employed by Olympians preparing for the postponed Tokyo Olympic Games, which included commitment to training, setting short-term goals, seeking positive distractions, and securing social support . Armed wAs the participants managed the JST, they strongly perceived an increase in the high performance and competition power of other athletes, as well as increased training demands. Both aspects posed significant physical and mental challenges . InteresMany participants struggled with academic commitment, largely because they did not prioritize it during secondary school. A commonly written response by Korean student-athletes to exam questions they cannot answer is “I am sorry. I am a student-athlete” , a phrasAll participants highlighted the improved facilities and living conditions, which enhanced the quality of their daily life in the dormitory. The female participants also appreciated having more freedom. Increased autonomy and responsibility, along with improved facilities and living conditions, positively impacted their JST experience. This needs to be reflected in the HAC model , althougThe participants expressed a need for specific support mechanisms to facilitate their JST and to adapt more effectively to university life. As noted earlier, the implementation of induction sessions can be a beneficial addition to future support initiatives. The participants suggested that providing suitable devices for academic pursuits would be appreciated and could motivate them to engage more actively in the learning process. Finally, access to psychological or counseling support was recommended by the participants, particularly the female judokas. The significance of such support in an elite sports setting has been underscored in various studies e.g., . As the We demonstrate both theoretical and practical implications of the findings, and we hope they contribute to the existing literature on the JST in a unique cultural context . We alsoThe original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving humans were approved by General University Ethics Panel (GUEP), University of Stirling. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.HH: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing. SH: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing.