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Panulo M, Chidziwisano K, Beattie TK, Tilley E, Kambala C, Morse T. Process Evaluation of “The Hygienic Family” Intervention: A Community-Based Water, Sanitation, and Hygiene Project in Rural Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116771. [PMID: 35682353 PMCID: PMC9180059 DOI: 10.3390/ijerph19116771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 12/07/2022]
Abstract
Process evaluations of environmental health interventions are often under-reported and under-utilized in the development of future programs. The “Hygienic Family” intervention targeted improvements in hygiene behaviors of caregivers with under five-year-old children in rural Malawi. Delivered through a combination of open days, cluster meetings, household visits, and prompts, data were collected from two intervention areas for ten months. A process evaluation framework provided indicators that were measured through intervention implementation and expenditure reports, focus groups discussions, interviews, and household surveys. The collected data assessed the intervention fidelity, dose, reach, acceptability, impact, and cost. Results indicated that all planned hygiene promotion messages were delivered, and study participants were better reached primarily through household visits (78% attended over 75% of the intervention) than cluster meetings (57% attended over 75% of the intervention). However, regression found that the number of household visits or cluster meetings had no discernible effect on the presence of some household hygiene proxy indicators. Intervention implementation cost per household was USD 31.00. The intervention delivery model provided good fidelity, dose, and reach and could be used to strengthen the scope of child health and wellbeing content. The intensive face-to-face method has proven to be effective but would need to be adequately resourced through financial support for community coordinator remuneration.
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Affiliation(s)
- Mindy Panulo
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi; (K.C.); (T.M.)
- Correspondence: ; Tel.: +265-99-966-0417
| | - Kondwani Chidziwisano
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi; (K.C.); (T.M.)
- Department of Environmental Health, Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi;
- Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, Glasgow G1 1XQ, UK;
| | - Tara K. Beattie
- Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, Glasgow G1 1XQ, UK;
| | - Elizabeth Tilley
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland;
| | - Christabel Kambala
- Department of Environmental Health, Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi;
| | - Tracy Morse
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi; (K.C.); (T.M.)
- Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, Glasgow G1 1XQ, UK;
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Duijzer G, Bukman AJ, Meints-Groenveld A, Haveman-Nies A, Jansen SC, Heinrich J, Hiddink GJ, Feskens EJM, de Wit GA. Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial. BMC Health Serv Res 2019; 19:824. [PMID: 31711499 PMCID: PMC6849241 DOI: 10.1186/s12913-019-4529-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. Trial registration The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.
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Affiliation(s)
- Geerke Duijzer
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands. .,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.
| | - Andrea J Bukman
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Aafke Meints-Groenveld
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands.,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.,Wageningen University, Consumption and Healthy Lifestyles, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Sophia C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Judith Heinrich
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Gerrit J Hiddink
- Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, Wageningen University, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Edith J M Feskens
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Julius Centrum, PO Box 85500, STR 6.131, 3508 GA, Utrecht, the Netherlands.,Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
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3
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Kim S, Ko YH, Song Y, Kang MJ, Lee H, Kim SH, Jeon JY, Cho YU, Yi G, Han J. Development of an exercise adherence program for breast cancer survivors with cancer-related fatigue-an intervention mapping approach. Support Care Cancer 2019; 27:4745-4752. [PMID: 30972643 DOI: 10.1007/s00520-019-04785-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors (BCS), with severe impact on quality of life. CRF can be reduced through exercise, but conversely, is also a barrier to exercising. The aim of this article was to apply the intervention mapping protocol (IMP) to develop an exercise adherence intervention for BCS with CRF. METHOD The program was developed using the IMP, which consists of six steps. Based on the data from focus group interviews and literature review, we produced a logic model of change. RESULTS Two performance objectives (survivors adopt and maintain exercise and survivors cope with fatigue) and 17 change objectives were generated. Also, we designed theory-based methods of change, and strategies for practical application. A structured program plan that includes intervention content and methods, ranges, and program data was proposed. Finally, an implementation and evaluation plan was developed. CONCLUSION The IMP provided a useful framework to systematically plan an exercise adherence program. This study resulted in a theory and practice-based exercise adherence program, based on behavioral change theories, and practice-based knowledge that fits the needs of BCS with CRF.
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Affiliation(s)
- Sue Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Yun Hee Ko
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Yoonkyung Song
- Department of Sports Industry Studies, Yonsei University, Seoul, South Korea
| | - Min Jae Kang
- Department of Sports Industry Studies, Yonsei University, Seoul, South Korea
| | - Hyojin Lee
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Sung Hae Kim
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Justin Y Jeon
- Department of Sports Industry Studies, Yonsei University, Seoul, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
| | - Young Up Cho
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Gihong Yi
- Department of Sociology, Hallym University, Chuncheon, South Korea
| | - Jeehee Han
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
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Mateo KF, Berner NB, Ricci NL, Seekaew P, Sikerwar S, Tenner C, Dognin J, Sherman SE, Kalet A, Jay M. Development of a 5As-based technology-assisted weight management intervention for veterans in primary care. BMC Health Serv Res 2018; 18:47. [PMID: 29378584 PMCID: PMC5789563 DOI: 10.1186/s12913-018-2834-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams. Methods Thematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session open-ended interview. Results Three main themes emerged from usability data analyses: participants’ emotional responses, tool language, and health literacy. Findings from both rounds of usability testing, pilot testing, as well as the open-ended interview data, were used to finalize protocols for the full intervention in the clinic setting to be conducted with Version 3 of the GEM tool. Conclusions The use of qualitative research methods and user-centered design approaches enabled timely detection of salient issues to make iterative improvements to the intervention. Future studies will determine whether this intervention can increase enrollment in intensive weight management programs and promote clinically meaningful weight loss in both Veterans and in other patient populations and health systems.
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Affiliation(s)
- Katrina F Mateo
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie B Berner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie L Ricci
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Pich Seekaew
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Sandeep Sikerwar
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Craig Tenner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Joanna Dognin
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Scott E Sherman
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA.,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Adina Kalet
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Melanie Jay
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA. .,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
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Bukman AJ, Duijzer G, Haveman-Nies A, Jansen SC, Ter Beek J, Hiddink GJ, Feskens EJM. Is the success of the SLIMMER diabetes prevention intervention modified by socioeconomic status? A randomised controlled trial. Diabetes Res Clin Pract 2017; 129:160-168. [PMID: 28528077 DOI: 10.1016/j.diabres.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/11/2017] [Accepted: 05/04/2017] [Indexed: 11/20/2022]
Abstract
AIM To explore the role of socioeconomic status (SES) in participation, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out, and effectiveness in the SLIMMER diabetes prevention intervention. METHODS SLIMMER was a randomised controlled intervention, carried out in a real-world setting, targeting 40- to 70-year-old adults at increased risk of developing type 2 diabetes (n=316). The intervention group participated in a 10-month combined dietary and physical activity programme. Measurements were carried out at baseline, 12months, and 18months. Effectiveness was determined for fasting insulin, HbA1c, weight, BMI, waist circumference, and waist-to-height-ratio. Differences between the low SES (no, primary, or lower secondary school) and higher SES group were tested using logistic regression and ANCOVA. RESULTS Fifty-two percent of the SLIMMER participants had a low SES. No differences in participation were observed between the low and higher SES group. The most important reason for non-participation in the low SES group was 'lack of interest' (32%), whereas in the higher SES group this was 'I already exercise enough' (31%). Attendance, acceptability, adherence, drop-out, and effectiveness after 12months were similar in the low and higher SES group. After 18months, the low SES group seemed to maintain slightly better effects for fasting insulin, HbA1c, and waist circumference. CONCLUSIONS The current study showed that participation, attendance, acceptability, adherence, drop-out, and effectiveness of the SLIMMER intervention were in general not modified by socioeconomic status. The SLIMMER intervention can contribute to health promotion for individuals in both low and higher socioeconomic groups.
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Affiliation(s)
- Andrea J Bukman
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
| | - Geerke Duijzer
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
| | - Annemien Haveman-Nies
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands; GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Sophia C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Josien Ter Beek
- GGD Noord- en Oost-Gelderland (Community Health Service), P.O Box 3, 7200 AA Zutphen, The Netherlands.
| | - Gerrit J Hiddink
- Wageningen University, Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, P.O Box 8130, 6700 EW Wageningen, The Netherlands.
| | - Edith J M Feskens
- Wageningen University, Division of Human Nutrition, P.O Box 17, 6700 AA Wageningen, The Netherlands.
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den Braver NR, de Vet E, Duijzer G, Ter Beek J, Jansen SC, Hiddink GJ, Feskens EJM, Haveman-Nies A. Determinants of lifestyle behavior change to prevent type 2 diabetes in high-risk individuals. Int J Behav Nutr Phys Act 2017; 14:78. [PMID: 28606146 PMCID: PMC5468963 DOI: 10.1186/s12966-017-0532-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although there are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses. Methods In total, 240 participants at increased risk of T2DM were included in the analyses over 18 months. The intervention was a combined lifestyle intervention with a dietary and a physical activity (PA) component. The primary and secondary outcomes were change in fasting insulin (pmol/L) and change in body weight (kg) after 18 months, respectively. Firstly, in a multiple mediator model, we investigated whether significant changes in these outcomes were mediated by changes in dietary and PA behavior. Secondly, in multiple single mediator models, we investigated whether changes in dietary and PA behavior were mediated by changes in behavioral determinants and the participants’ psychological profile. The mediation analyses used linear regression models, where significance of indirect effects was calculated with bootstrapping. Results The effect of the intervention on decreased fasting insulin was 40% mediated by change in dietary and PA behavior, where dietary behavior was an independent mediator of the association (34%). The effect of the intervention on decreased body weight was 20% mediated by change in dietary and PA behavior, where PA behavior was an independent mediator (17%). The intervention significantly changed intake of fruit, fat from bread spread, and fiber from bread. Change in fruit intake was mediated by change in action control (combination of consciousness, self-control, and effort), motivation, self-efficacy, intention, and skills. Change in fat intake was mediated by change in action control and psychological profile. No mediators could be identified for change in fiber intake. The change in PA behavior was mediated by change in action control, motivation, and psychological profile. Conclusion The effect of the SLIMMER intervention on fasting insulin and body weight was mediated by changes in dietary and PA behavior, in distinct ways. These results indicate that changing dietary as well as PA behavior is important in T2DM prevention. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0532-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N R den Braver
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands. .,Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - E de Vet
- Strategic Communication Chair group, Wageningen University & Research, Wageningen, The Netherlands
| | - G Duijzer
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands.,GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - J Ter Beek
- GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - S C Jansen
- GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
| | - G J Hiddink
- Strategic Communication Chair group, Wageningen University & Research, Wageningen, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - A Haveman-Nies
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands.,GGD Noord- en Oost-Gelderland, Warnsveld, The Netherlands
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Duijzer G, Haveman-Nies A, Jansen SC, Beek JT, van Bruggen R, Willink MGJ, Hiddink GJ, Feskens EJM. Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial. Nutr Diabetes 2017; 7:e268. [PMID: 28481335 PMCID: PMC5518803 DOI: 10.1038/nutd.2017.21] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/03/2017] [Accepted: 03/24/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES To assess the effectiveness of the SLIMMER combined dietary and physical activity lifestyle intervention on clinical and metabolic risk factors, dietary intake, physical activity, and quality of life after 12 months, and to investigate whether effects sustained six months after the active intervention period ended. SUBJECTS/METHODS SLIMMER was a randomised controlled intervention, implemented in Dutch primary healthcare. In total, 316 subjects aged 40-70 years with increased risk of type 2 diabetes were randomly allocated to the intervention group (10-month dietary and physical activity programme) or the control group (usual healthcare). All subjects underwent an oral glucose tolerance test and physical examination, and filled in questionnaires. Identical examinations were performed at baseline and after 12 and 18 months. Primary outcome was fasting insulin. RESULTS The intervention group showed significantly greater improvements in anthropometry and glucose metabolism. After 12 and 18 months, differences between intervention and control group were -2.7 kg (95% confidence interval (CI): -3.7; -1.7) and -2.5 kg (95% CI: -3.6; -1.4) for weight, and -12.1 pmol l-1 (95% CI: -19.6; -4.6) and -8.0 pmol l-1 (95% CI: -14.7; -0.53) for fasting insulin. Furthermore, dietary intake, physical activity, and quality of life improved significantly more in the intervention group than in the control group. CONCLUSIONS The Dutch SLIMMER lifestyle intervention is effective in the short and long term in improving clinical and metabolic risk factors, dietary intake, physical activity, and quality of life in subjects at high risk of diabetes.
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Affiliation(s)
- G Duijzer
- Division of Human Nutrition, Wageningen University, Academic Collaborative Centre AGORA, Wageningen, The Netherlands
- GGD Noord- en Oost-Gelderland (Community Health Service), Warnsveld, The Netherlands
| | - A Haveman-Nies
- Division of Human Nutrition, Wageningen University, Academic Collaborative Centre AGORA, Wageningen, The Netherlands
- GGD Noord- en Oost-Gelderland (Community Health Service), Warnsveld, The Netherlands
| | - S C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), Warnsveld, The Netherlands
| | - J ter Beek
- GGD Noord- en Oost-Gelderland (Community Health Service), Warnsveld, The Netherlands
| | - R van Bruggen
- Huisartsenzorg Regio Apeldoorn, Apeldoorn, The Netherlands
| | - M G J Willink
- BV Diabeteszorg Oude IJssel, Doetinchem, The Netherlands
| | - G J Hiddink
- Wageningen University, Strategic Communication, Sub-department Communication, Philosophy and Technology, Centre for Integrative Development, Social Sciences, Wageningen, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University, Academic Collaborative Centre AGORA, Wageningen, The Netherlands
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Miller CK, Pawelczyk K, Cheavens JS, Fujita K, Moss S. Development and pilot testing of a novel behavioral intervention for adults with type 2 diabetes using intervention mapping. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2017.1377618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Carla K. Miller
- Department of Human Sciences, Human Nutrition, Ohio State University, Columbus, OH, USA
| | - Katlyn Pawelczyk
- Department of Human Sciences, Human Nutrition, Ohio State University, Columbus, OH, USA
| | | | - Kentaro Fujita
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Sara Moss
- Department of Psychology, Ohio State University, Columbus, OH, USA
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Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study. Public Health Nutr 2016; 19:3027-3038. [PMID: 27256153 DOI: 10.1017/s1368980016001282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. DESIGN A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SETTING SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. SUBJECTS Subjects at increased risk of developing type 2 diabetes were included. RESULTS It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. CONCLUSIONS The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.
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One-Year Results of the BeweegKuur Lifestyle Intervention Implemented in Dutch Primary Healthcare Settings. BIOMED RESEARCH INTERNATIONAL 2015; 2015:484823. [PMID: 26380276 PMCID: PMC4561871 DOI: 10.1155/2015/484823] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/30/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022]
Abstract
Background. Lifestyle interventions focusing on healthy diet and physical activity (PA) are effective in reducing health risks in controlled research settings. The aim of this study was to investigate the one-year results of the BeweegKuur lifestyle intervention implemented nationwide in Netherlands for people with a weight-related health risk. Materials and Methods. Data were requested from all 160 locations participating in the BeweegKuur. In a one group pretest/posttest study, one-year changes in health outcome variables and time spent on physical activity were tested with dependent t-tests. Associations between one-year changes in weight and waist circumference and sociodemographic factors and uptake of the program were analysed with ANOVA. Results. Data for 517 participants from 47 locations were available for analysis. One year after the intervention, weight reduced by 2.9 kg (95% CI -3.3;, -2.5), waist circumference by 4.3 cm (-4.9; -3.7), and blood glucose by 0.5 mmol/L (-0.8; -0.3). Physical activity increased significantly. Higher uptake of the program was associated with a larger decrease in waist circumference. Conclusion. The results of the study suggest that lifestyle interventions implemented in real-life primary healthcare settings with tailor-made supervision can contribute meaningfully to primary prevention.
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