The research project that will help people stay on the wagon


Have you ever made a lifestyle change and then at some point you “fell of the wagon”?

If you have we need your help. By completing the form below you will be taking part in very important research that will over time show why people get to the point where they discontinue doing something that is ultimately good for them. 

Please take 5 minutes to complete the research questionnaire and by doing so you will be helping many others.

When we have collated the data from this research project we will be publishing the results right here.


Thank you for taking the time to come and visit this page. The purpose of this survey is to give the Diabetic Health Clinic some very clear insights as to why it is that some people do not continue with a lifestyle change.

If you are complaint with your lifestyle change please do not complete this questionnaire.

Often while undergoing a lifestyle change, people loose masses of weight, feel unbelievable and even reverse diseases like type 2 diabetes. Even changes in how they look can be amazing. Even with successful changes sometimes people revert to what they were doing before they embarked on a lifestyle change, this can be very frustrating. Even more frustrating is when people embark on a lifestyle change and don't achieve any results.

This survey is available to anyone, you don't have to have completed the Diabetic Health Clinic Lifestyle program. We just simply want to understand what it is that drives people to leave what is so good for them and go back to a lifestyle which they know means poor health outcomes in the future.

By completing this survey you will be a part of important research that in the future shape how the Diabetic Health Clinic supports program attendees in the long term. Our aim is to provide an environment where people will not be able to fall of the wagon.

This research survey will take around 5 minutes to complete.

We would like to thank you for your participation in advance and we are looking forward to implementing into our program what we have learnt from your responses. 

Please also note that any data collected will never be shared with a commercial party but it may be shared with researchers for research purposes. 

The Diabetic Clinic Research Team.

PLEASE NOTE: When completing the form please ensure that you have made a section in every field. If you leave a field with the "Please Select" entry we will not be able to use the data.

Optional - Personal Details

This is purely an optional section. You can complete as little or as much as you like.

I would like to receive a notification when the research results are published. (To be notified you must provide us with your email address in the field above).

Required Personal Information

I live in: *
Sex: *
Select your age: *

My Lifestyle Change

I completed: *
The year I began my lifestyle change: *
I did the following: *
I made these changes believing they would be permanent: *
My main reason for making changes: *

My Reason For Discontinuing

I was successful with my lifestyle change for: *
Pick the one predominant reason why you discontinued:
I would like to restart my healthy lifestyle: *

The One Thing That Would Have Helped Me Stay On Track

Pick the one predominant thing that would have ensured you stayed on track: *
The one thing that would have ensured I stayed on track:


Your IP Address is

 More information on the “Falling Off The Wagon” research project.

  • The research project will initially run until there are 100 responders.
  • When 100 responses have been received the results will be written up as the initial research project results and published in the Diabetic Health Clinic Research Institute.
  • From the date when the project receives the initial 100 responses, additional responses will be collected and written up at 12 month intervals. This will reflect trend changes over time. A minimum of 100 responders will be required for each 12 month period. If less than 100 people respond in a 12 month period the results will be delayed until 100 responses have been received. At this time a new 12 month period will commence. 
  • Questions over time may be modified at reporting intervals to achieve more valuable insights. Changes to questions and the reasons for these changes will be clearly documented.
  • Everyone in the community will be encouraged to participate. This will be done via newsletters, social media or any other means that are available.