Behavior change in a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention content

Paulina Wa Vermunt,Hans Am Van Oers,Frits Wielaard,Ivon Ej Milder,Caroline A Baan,Jos Dm Schelfhout,Gert P Westert

doi:10.1186/1471-2296-14-78

Abstract

BackgroundDespite the favorable effects of behavior change interventions on diabetes risk, lifestyle modification is a complicated process. In this study we therefore investigated opportunities for refining a lifestyle intervention for type 2 diabetes prevention, based on participant perceptions of behavior change progress.MethodsA 30 month intervention was performed in Dutch primary care among high-risk individuals (FINDRISC-score ≥ 13) and was compared to usual care. Participant perceptions of behavior change progress for losing weight, dietary modification, and increasing physical activity were assessed after18 months with questionnaires. Based on the response, participants were categorized as ‘planners’, ‘initiators’ or ‘achievers’ and frequencies were evaluated in both study groups. Furthermore, participants reported on barriers for lifestyle change.ResultsIn both groups, around 80% of all participants (intervention: N = 370; usual care: N = 322) planned change. Except for reducing fat intake (p = 0.08), the number of initiators was significantly higher in the intervention group than in usual care. The percentage of achievers was high for the dietary and exercise objectives (intervention: 81–95%; usual care: 83–93%), but was lower for losing weight (intervention: 67%; usual care: 62%). Important motivational barriers were ‘I already meet the standards’ and ‘I’m satisfied with my current behavior’. Temptation to snack, product taste and lack of time were important volitional barriers.ConclusionsThe results suggest that the intervention supports participants to bridge the gap between motivation and action. Several opportunities for intervention refinement are however revealed, including more stringent criteria for participant inclusion, tools for (self)-monitoring of health, emphasis on the ‘small-step-approach’, and more attention for stimulus control.Trial registrationNetherlands Trial Register: NTR1082

Highlights

Despite the favorable effects of behavior change interventions on diabetes risk, lifestyle modification is a complicated process
Participants were recruited in January 2008 by 48 general practitioners (GPs) and 24 nurse practitioners from 14 primary care practices in the Netherlands
No significant differences in baseline characteristics and clincial measures were observed between study groups

Summary

Introduction

Despite the favorable effects of behavior change interventions on diabetes risk, lifestyle modification is a complicated process. In this study we investigated opportunities for refining a lifestyle intervention for type 2 diabetes prevention, based on participant perceptions of behavior change progress. Type 2 diabetes mellitus is a serious illness, leading to severe complications [1] and increased mortality [2]. Behavior change interventions can Despite the favorable effects of behavior change interventions on type 2 diabetes risk, lifestyle modification is a complicated process [7,8]. More insight into the process of behavior change may reveal opportunities for refining intervention content and may thereby potentially improve intervention effectiveness [9,10,11]. Evaluation of behavior change in diabetes prevention programs remains limited [10]

Methods

Results

Discussion

Conclusion