Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study

Abstract

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.

Process Evaluation of the Sophia Step Study-A Primary Care Based Three-Armed Randomized Controlled Trial Using Self-Monitoring of Steps With and Without Counseling in Prediabetes and Type 2 Diabetes

“…The dropout rate during the rst 12 months was 10% and dose received can be considered as high for both intervention groups. Similar ndings with high adherence to pedometer interventions have been shown in earlier studies (27,31,32), suggesting that individuals who enroll are highly motivated and prepared to adhere to physical activity interventions. A larger proportion of participants at the urban primary care center, than at the other two centers, had a step goal, both in the group with counseling and the group that did not receive counseling.…”

“…This study demonstrates that self-monitoring of steps both with and without counseling are feasible methods to implement in the primary care setting to increase and maintain daily steps in individuals with prediabetes and type 2 diabetes. The response rate (49%) is comparable to similar interventions and is probably a realistic number to reach with a behavior change program (27)(28)(29). Both genders were equally represented in this study, and every other participant had university education, which is in line with the Swedish general population.…”

Present and future of nutrition guidance : lifestyle advice in primary care

“…Using the intervention mapping protocol, Elsman et al developed a maintenance programme for the SLIMMER diabetes prevention intervention (167). The process evaluation of the SLIMMER study was published by Van Dongen et al (168). Papers have been submitted: on the effect and maintenance of the SLIMMER study (169), on the question of whether the success of the SLIMMER study was modified by socio-economic status (170), on the costeffectiveness of the SLIMMER study (171), on the determinants of lifestyle behaviour change to prevent type 2 diabetes in high-risk persons (172), and a summarizing article in Dutch by Huisarts and Wetenschap (173).…”

Prevention and treatment of obesity

“…In combination with the low frequency of personal contacts with referrers, this meant that not all referrers had sufficient knowledge about the intervention, about their specific role in the process and about how to refer patients. More contacts and better information could probably take away the barriers from the referrers, such as the time investment required for referring [170]. Since general practitioners are not trained to assess a patient's motivation, they should be assisted by the lifestyle coaches to make this assessment [27].…”

“…As for the children's programme, many parents expressed the need for a more personalised care programme, so the option of attending an individual programme, or having fewer group sessions and more individual sessions, may be beneficial. If the children's programme was more tailored, this would contribute to the effectiveness of the intervention, as it would fit the needs better [160,170]. Children and their parents together can work more effectively on their specific goals at a personalised level, making them more responsible for their own behaviour.…”