3
|
Recio-Rodriguez JI, Garcia-Ortiz L, Garcia-Yu IA, Lugones-Sanchez C, Olmo EZD, Bolibar B, Casajuana-Closas M, Lopez-Jimenez T, Llobera J, Ramos R, Pombo H, Motrico E, Gil-Girbau M, Lopez-Mendez F, Represas-Carrera F, Maderuelo-Fernandez JA. Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial. BMC Public Health 2022; 22:2127. [PMID: 36401247 PMCID: PMC9675247 DOI: 10.1186/s12889-022-14590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). METHODS: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45-75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor's office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. RESULTS Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9-17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG. CONCLUSIONS A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211.
Collapse
Affiliation(s)
- Jose I Recio-Rodriguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Facultad de Enfermería Y Fisioterapia (Universidad de Salamanca), Salamanca, Spain.
| | - Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Departamento de Ciencias Biomédicas Y del Diagnóstico (Universidad de Salamanca), Gerencia Regional de Salud de Castilla Y León (SACyL), 37007, Salamanca, Spain
| | - Irene A Garcia-Yu
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Cristina Lugones-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Edurne Zabaleta-Del Olmo
- Nursing Department, Nursing Faculty (Universitat de Girona), Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gerència Territorial de Barcelona (Institut Català de La Salut), UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Bolibar
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomas Lopez-Jimenez
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan Llobera
- Unitat de Recerca, Atenció Primària de Mallorca. Servei de Salut de Les Illes Balears. IdISBa, Palma, Spain
| | - Rafel Ramos
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Group of Research in Vascular Health, Unitat de Suport a La Recerca de Girona, Girona Biomedical Research Institute (IdibGi), Girona, Spain
| | - Haizea Pombo
- Bizkaia, Deputy Directorate of Healthcare Assistance, Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation-Biocruces Bizkaia Health Research Institute Innovation Unit, Osakidetza-Servicio Vasco de Salud, Araba, Spain
| | | | - Montserrat Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Francisco Represas-Carrera
- Atención Primaria, Área Sanitaria de Vigo, Servicio Gallego de Salud (SERGAS), Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Galicia, Spain
| | - Jose A Maderuelo-Fernandez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| |
Collapse
|
4
|
Zabaleta-Del-Olmo E, Casajuana-Closas M, López-Jiménez T, Pombo H, Pons-Vigués M, Pujol-Ribera E, Cabezas-Peña C, Llobera J, Martí-Lluch R, Vicens C, Motrico E, Gómez-Gómez I, Maderuelo-Fernández JÁ, Recio-Rodriguez JI, Masluk B, Contreras-Martos S, Jacques-Aviñó C, Aznar-Lou I, Gil-Girbau M, Clavería A, Magallón-Botaya R, Bellón JÁ, Ramos R, Sanchez-Perez A, Moreno-Peral P, Leiva A, González-Formoso C, Bolíbar B. Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial. BMC Public Health 2021; 21:2208. [PMID: 34863136 PMCID: PMC8642878 DOI: 10.1186/s12889-021-11982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".
Collapse
Affiliation(s)
- Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Balmes 22, 08007, Barcelona, Spain
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
| | - Haizea Pombo
- Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation-Biocruces Bizkaia Health Research Institute Innovation Unit, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain
- Deputy Directorate of Healthcare Assistance, Osakidetza-Servicio Vasco de Salud, C/ Araba 45, 01006, Vitoria, Araba, Spain
| | - Mariona Pons-Vigués
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Àrea Assistencial. Servei Català de la Salut (CatSalut), Travessera de les Corts 131-159, Edifici Olímpia, 08228, Barcelona, Spain
| | - Enriqueta Pujol-Ribera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Carmen Cabezas-Peña
- Department of Health, Deputy Directorate of Health Promotion, Public Health Agency, Goverment of Catalonia, Roc Boronat, 81-95 (Edifici Salvany), 08005, Barcelona, Spain
| | - Joan Llobera
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Ruth Martí-Lluch
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
- Unitat de suport a la recerca de Girona. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Carrer Maluquer Salvador 11, 17002, Girona, Spain
- Group of research in Vascular Health, Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí Julià - Edifici M2, Carrer del Dr. Castany, s/n, 17190, Salt, Spain
| | - Caterina Vicens
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
- Centro de Salud Son Serra-La Vileta (Ibsalut), Masanella 22, 07013, Palma, Balearic Islands, Spain
- Facultat de Medicina. Universitat de les Illes Balears, Carretera de Valldemossa, km 7.5, 07122, Palma, Balearic Islands, Spain
| | - Emma Motrico
- Universidad Loyola Andalucía, Avda. de las Universidades, s/n, 41704, Dos Hermanas, Sevilla, Spain
| | - Irene Gómez-Gómez
- Universidad Loyola Andalucía, Avda. de las Universidades, s/n, 41704, Dos Hermanas, Sevilla, Spain
| | - José-Ángel Maderuelo-Fernández
- Institute of Biomedical Research of Salamanca (IBSAL), Edificio Virgen de la Vega, 10.a planta. Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Avda. Portugal 83, 37005, Salamanca, Spain
- Health Service of Castilla y León (SACyL), C/ Arapiles, 25 - 33, 37007, Salamanca, Spain
| | - José I Recio-Rodriguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Avda. Portugal 83, 37005, Salamanca, Spain
- Departamento de Enfermería y Fisioterapia, Universidad de Salamanca, Calle Donantes de Sangre, s/n, 37007, Salamanca, Spain
| | - Barbara Masluk
- Departamento de Psicología y Sociología, Universidad de Zaragoza, C/Pedro Cerbuna 12, 50009, Zaragoza, Spain
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP), Instituto de Investigación Sanitaria, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Sara Contreras-Martos
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Ignacio Aznar-Lou
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, C\ Doctor Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain
| | - Montserrat Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, C\ Doctor Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
| | - Ana Clavería
- Área de Xestión Integrada de Vigo, Servizio Galego de Saúde, c/Rosalía Castro 21-23, 36201, Vigo, Spain
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, Bloque Técnico, Planta 2, Carretera Clara Campoamor n° 341, Beade, 36213, Vigo, Spain
| | - Rosa Magallón-Botaya
- Facultad de Medicina, Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain
- Arrabal Health Centre, Servicio Aragonés de Salud, Andador Aragüés del Puerto 3, 50015, Zaragoza, Spain
- Institute of health research of Aragon (IIS Aragón), Avda. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Juan-Ángel Bellón
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Civil Pabellón 5. 2a Planta, Plaza del Hospital Civil, s/n, 29009, Málaga, Spain
- El Palo Health Centre', Andalusian Health Service (SAS), Avenida Salvador Allende 159, 29018, Málaga, Spain
- Department of Public Health and Psychiatry, Facultad de Medicina, University of Málaga (UMA), Campus de Teatinos, 29071, Málaga, Spain
| | - Rafel Ramos
- Unitat de suport a la recerca de Girona. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Carrer Maluquer Salvador 11, 17002, Girona, Spain
- Group of research in Vascular Health, Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí Julià - Edifici M2, Carrer del Dr. Castany, s/n, 17190, Salt, Spain
- Department of Medical Sciences, School of Medicine, Campus Salut, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
| | - Alvaro Sanchez-Perez
- Primary Care Research Unit, Deputy Directorate of Healthcare Assistance- BioCruces Bizkaia Health Research Institute, Basque Healthcare Service -Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Civil Pabellón 5. 2a Planta, Plaza del Hospital Civil, s/n, 29009, Málaga, Spain
| | - Alfonso Leiva
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Clara González-Formoso
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, Bloque Técnico, Planta 2, Carretera Clara Campoamor n° 341, Beade, 36213, Vigo, Spain
- Unidade de Calidade de Coidados, Área sanitaria de Vigo. Hospital Álvaro Cunqueiro, Estrada Clara Campoamor n° 341, 36312, Vigo, Spain
| | - Bonaventura Bolíbar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| |
Collapse
|