Healthy Life Centres Research Articles

The Turkish version of the Laval quality of life Questionnaire reliability and validity in obesity

Obesity is a disease that affects quality of life. This study was planned to evaluate the Turkish validity and reliability of the LAVAL quality of life questionnaire. The study was conducted in Izmir Bayraklı District Health Directorate Healthy Life Center No. 1 (October 1, 2021-November 15, 2021) and Gaziemir Municipality (November 15, 2021-March 15, 2022). Dokuz Eylul University Ethics Committee accepted the study on 22.12.2021, with the decision number 2021/38-08. People with a body mass index ≥ 30 kg/m2 and who met the inclusion/exclusion criteria were included in the study. In addition to the Laval Questionnaire, the SF-12 general health quality of life questionnaire and the Obese Specific Quality of Life Scale were used. For the adaptation of the Turkish version of the questionnaire, language validity was first ensured by the back translation method. The mean age of the 235 volunteer participants was 49.11 ± 13.1 years. The Kaiser-Meyer-Olkin coefficient for exploratory factor analysis was calculated as 0.92. RMSEA was 0.61 (RMESA<0.80). Cronbach's alpha value, which is an indicator of the internal consistency coefficient of the Laval Questionnaire in obese individuals, was calculated as 0.95. Obesity Specific Quality of Life and SF-12 Quality of Life Scale scores were found to have a statistically significant effect on the Laval Questionnaire score (p<0.05). The Laval Questionnaire is a valid and reliable questionnaire to measure the quality of life of individuals with obesity in the Turkish population.

The role of Healthy Life Centres in delivering weight management: A retrospective study

IntroductionHealthy Life Centres (HLCs) in Turkey were established as primary health services to promote healthier lifestyle behaviours, aiming to reduce obesity and diseases linked to physical inactivity. This study aimed to investigate the weight management programme delivered by one HLC and to track the participants’ progress in terms of weight loss and adherence to the program. MethodsThis was a retrospective study. Participants consisted of adults aged ≥18 who attended the HLC for weight management from Sept 2017-June 2020. Data including attendance, age, gender, height and body weight were collected and analysed at 3, 6, 12-month time-points. Missing data were interpreted using last observed weight carried forward analysis (LOCF). ResultsOver a two-year period 2652 adults (88% female) consulted the nutrition counselling service, of whom 43% attended once. Mean age of those attending once was 40.2 (12.35) years and age increased significantly with adherence. Baseline body mass index (BMI) was 31.4 (6.32) kg/m2. For those attending at the different time-points, weight loss was 4.4 % of initial body weight at 3-months (n = 841), 8.6 % of initial body weight at 6-month (n = 237), and 11.8 % initial body weight at 12-month follow-up (n = 56). LOCF analysis revealed a significant time effect for change in percentage body weight for the data collected at 6 and 12 months. ConclusionThis programme was successful in reaching clinically meaningful weight loss at 3, 6, 12-month for the participants who committed to the weight management programme. However, there was a substantial decline in participant engagement, with only a 2 % attendance rate at 12 months. Furthermore, it is noteworthy that nearly half of the clients attended only one session during the study period. The findings of the current study can be used to inform policy makers about the strengths and weaknesses of HLCs.

Involvement of service user representatives on a healthcare organizational level at Norwegian Healthy Life Centres: A qualitative study exploring health professionals' experiences.

The involvement of service user representatives in planning, delivering, and evaluating health care services is regarded as essential in Healthy Life Centres (HLCs) to ensure high-quality services. However, information on how HLC-professionals involve service user representatives at a healthcare organizational level at HLCs remains sparse. To explore HLC professionals' experiences involving service user representatives in planning, delivering, and evaluating the HLC services. Five qualitative semi-structured focus group interviews with 27 health professionals from 27 Norwegian HLCs were conducted. Data were analysed using systematic text condensation. The involvement of service user representatives at the HLCs varied from well-integrated and systematized to the opposite. The professionals' primary rationale for involving service user representatives was to include the representatives' unique experiential knowledge to ensure the quality of the service. Experiential knowledge was seen as a 'different' competence, which came in addition to professional competence. The professionals' choice of service user representatives depended on the purpose behind the involvement initiative. The HLC professionals often hand-picked former service users according to their health problems, motivation, and the HLC's need. The professionals said they were responsible for initiating the facilitation to accomplish genuine involvement. Support from their leaders to prioritize these tasks was essential. To meet the demand for adequate service user representatives, the HLCs need access to different service user representatives, representing both diagnose-based and generic service user organisations and the public. To achieve genuine involvement, the rationale behind the involvement and the representatives' role must be clarified, both for the HLC professionals and service user representatives. This will require resources for continuous organizational preparation and facilitation.

Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial

BackgroundInsomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group.MethodsA pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants’ treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241).DiscussionThis large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy.Trial registrationThe trial was retrospectively registered in the ISRCTN registry (ISRCTN16185698).

Ambiguous Facilitation: An Ethnographic Study of the Contextual Aspects of Participation in Group Activities in a Norwegian Healthy Life Centre

Background: Participation is essential in health promotion initiatives such as the Norwegian Healthy Life Centres (HLCs) which offer lifestyle-related guidance to people with lifestyle-related diseases or at risk for such diseases. While participation has been studied in this setting from the perspectives of health personnel or service users, no studies have been conducted on the contextual aspects of participation through studying the interactions between the actors involved in group activities within the service. To lead group activities requires competency in facilitation of learning in groups. The aim of this study is to explore participation in group activities in the context of a Norwegian HLC by studying the interaction between the various actors involved in the activities there. Methods: An ethnographic study was designed based on participant observation of physical activity groups and a healthy nutrition group in a Norwegian HLC over a period of three months. Findings: The findings suggest that (1) the multiple roles of the Health Professional (HP), (2) the process of goal setting, and (3) time frames and the physical context are central contextual aspects of participation in this setting, leading to an ambiguous facilitation of group activities.

Assessment of satisfaction with a healthy life center, a new service model.

Healthy Life Centers have recently been added to Turkey's health system as a new service model. This study aims to determine the level of satisfaction among service receivers with a Healthy Life Center by comparing their expectations at the application stage with their perception after receiving service, via the Servqual service quality measurement model. This descriptive and cross-sectional study was conducted in a Healthy Life Center in Kırklareli City in Turkey. Four hundred and thirty-two participants were included in the survey. In our study, the Servqual scale developed by A. Parasuraman, V. A. Zeithaml, and L. L. Berry and a reliability assessment of the Turkish form performed by Devebakan were used. The Tangibles dimension got the lowest (-0.68 ± 1.04) and the Empathy dimension got the highest (-0.02 ± 0.84) Servqual dimension score among all the dimensions of the scale. The overall Servqual scale score was computed as -0.27 ± 0.63 and there was a statistically significant difference between expectations and perceptions (<0.001). Satisfaction from a healthy life center which is built as a new service model is not at the expected level yet. More studies like this one which is a first in its field in terms of methodology will set the ground for a better understanding of the service receivers' expectations and perceptions. That is how the decision-makers can shape up this new service model according to expectations.

Participants stories about long-term achievement 60-months after attending a Healthy Life Centre programme (the VEND-RISK study) - a qualitative study

ABSTRACT Background Experiences of long-term achievement in participants attending programs for changing health habits including diet and physical activity interventions aiming for weight reduction is lacking. This study aimed to explore how participants experienced their own achievement of healthy habits 60 months after attending a Healthy Life Centre programme in the Norwegian primary healthcare. Methods An explorative qualitative design with an inductive approach was employed. Individual semi-structured interviews were performed with 20 participants attending a Healthy Life Centre programme 60 months ago. They were aged 30–72 years, and 55% were females. Interviews were transcribed verbatim and analysed thematically using systematic text condensation. Results Two main themes emerged from the interviews with three subthemes each. The first theme “Changes over time” includes “Nutritional changes”, “Physical activities adjusted to own presumptions” and “Health habits incorporated into life with manageable goals”. The second theme “Barriers to fulfil changes” includes ”Life circumstances with health issues influences the continuity to adjust to changes”, “a busy everyday life” and “a lack of external drive when not having commitment to the Healthy Life Centre”. Conclusions Focusing on changes adjusted to participants' own everyday lives and having an approach with small goals can facilitate long-term changes in health habits.

Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: a randomised pilot study

Abstract Background Smoking remains prevalent after cardiovascular disease (CVD) events and knowledge on how to facilitate effective cessation in clinical practice is needed. Purpose To test the effect of an in-hospital nurse-led intervention on the participation rate at municipal Healthy Life Centres (HLC) and the use of smoking cessation drugs. Secondary, to determine long-term effects on cessation rates. Methods A prospective, randomized, open-label, parallel-group intervention pilot-study was conducted at a Norwegian secondary care hospital in 2021. Patients with atherosclerotic CVD who smoked at least one cigarette daily when admitted with an acute CVD event were consecutively included. The nurse-led intervention included cessation counselling utilizing motivational interview technique, information and guidance in proper use of cessation drugs and direct referral to a 12-weeks digital (video ± phone) HLC program where patients received free cessation drugs. The low-threshold intervention included written information about the offer in the HLC with free cessation drugs. The primary endpoints were between-group differences in attendance rates at the HLC program and the use of cessation drugs. Results Of 99 potential participants, 24 did not meet the entry criteria whereas 17 declined to participate. Of 58 randomised patients, three died during follow-up and 55 completed the study. Mean age was 65.7 (SD 9.2) years, 35% were female, 88% had low education, 88% had smoked &amp;gt;20 years, and motivation for quitting smoking was high (mean 8.5 on a 0 [no motivation] to 10 [high motivation] Likert scale). Comorbidity was common (mean Charlson score 5.1) and 40% had symptoms of anxiety and/or depression. The nurse-led intervention resulted in significantly higher participation rate at the HLC (48% vs. 4%, difference: 44% [95% CI: 24%, 65%], P&amp;lt;0.0001) and more frequent use of cessation drugs (48% vs. 11%, difference: 37% [95% CI: 15%, 60%], P=0.002) compared to the low-threshold intervention (Figure A). All participants in the intervention group who attended the HLC program were offered follow-up within 21 days following randomisation. In the intervention group 15% used varenicline and 33% used a combination of short and long-acting nicotine replacements. Clinically significant differences in cessation rates after six months were observed between the groups (Figure B). Concomitant carbon monoxide measurements were obtained of 5 participants in the intervention group and 4 in the control group who reported cessation and all confirmed non-smoking. Conclusion Among multi-morbid patients hospitalised for a CVD event, a nurse-led intervention resulted in substantially higher participation rate at a municipal HLC program and higher use of smoking cessation drugs compared to written information. We also found clinically significant long-term effects on cessation rates which needs to be confirmed in a large-scale study. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Dam Foundation

Motivation and Lifestyle-Related Changes among Participants in a Healthy Life Centre: A 12-Month Observational Study.

Healthy Life Centers (HLCs) have been established throughout Norway to support lifestyle changes and promote physical and mental health. We conducted a 12-month observational study among participants in an HLC that aimed to improve physical activity (PA) and dietary behaviors, and this study examined predictors of completion, and changes in psychological variables, lifestyle behaviors, and physical health indicators. The participants (N = 120, 71% female, mean age = 44 years) reported symptoms of psychological distress (77%) and were obese (77%). No baseline characteristics were found to be consistent predictors of completion (42%). Completers had significant improvements in autonomous motivation for PA (d = 0.89), perceived competence for PA (d = 1.64) and diet (d = 0.66), psychological distress (d = 0.71), fruit intake (d = 0.64), vegetable intake (d = 0.38), BMI among all participants (d = 0.21) and obese participants (d = 0.34), body fat percentage among all participants (d = 0.22) and obese participants (d = 0.33), and lower body strength (d = 0.91). Fat-free mass and all forms of PA remained unchanged from baseline to 12 months. Hence, there were indications of improvement among completers on psychological variables, lifestyle behaviors, and physical health indicators. The low rate of completion was a concern, and the unchanged levels of PA reflect an important area of focus for future interventions in the context of HLCs.

Preventing type 2 diabetes, overweight and obesity in the Norwegian primary healthcare: a longitudinal design with 60 months follow-up results and a cross-sectional design with comparison of dropouts versus completers

ObjectivesStudies have demonstrated that it is possible to prevent type 2 diabetes for individuals at high risk, but long-term results in the primary healthcare are limited and high dropout rates...

Healthy and unhealthy eating after a behaviour change intervention in primary care.

To prevent and reduce non-communicable diseases, the Norwegian Directorate of Health encourages Healthy Life Centres (HLCs) in all municipalities. This study investigates whether the behaviour change interventions at HLCs positively affected participants' diet and to evaluate predictors for healthy and unhealthy eating. Our data are part of the Norwegian Healthy Life Centre Study, a 6-month, pragmatic randomised controlled trial (RCT). Totally, 118 participants ≥18 years old were randomised to an intervention group (n 57), or a waiting list (control group) (n 61). Eighty-six participants met at the 6 months follow-up visit. We merged the participants to one cohort for predictor analyses, using linear regressions. The RCT of the HLCs' interventions had no effect on healthy and unhealthy eating 6 months after baseline compared with controls. A short, additional healthy eating education programme produced a modest, statistically significant improvement in healthy eating compared with controls. This did not, however, reduce unhealthy eating. Higher income predicted unhealthier eating over time. Increasing body mass index and impaired physical functioning also led to an increase in unhealthy eating. Healthy eating at 6 months was predicted by self-rated health (SRH), vitality and life satisfaction, and hampered by musculo-skeletal challenges and impaired self-esteem (SE). SRH impacted improvement in healthy eating during the 6 months. The effect of interventions on healthier eating may be improved by an emphasis on developing positive self-concepts like better SRH, vitality, life satisfaction, and SE.

A Qualitative Study of Cancer Survivors' Experienced Outcomes of a Multidimensional Rehabilitation Program in Primary Healthcare.

Cancer survival rates are increasing, but survival is often followed by several late effects. Cancer survivors' need for complex rehabilitation is well documented, but this is mostly missing in primary healthcare. The aim of this study was to explore cancer survivors' experienced outcomes of a multidimensional rehabilitation program in primary healthcare. The study used a qualitative method with a descriptive research design. Fifty-six cancer survivors completed a 12-week rehabilitation program built upon the 5 elements of goal setting, physical exercise, psychoeducation, individual follow-up, and peer support. Data were collected at the end of the program via 8 focus group interviews, and systematic text condensation was used to analyze the data. "Increased coping and participation" was identified as the overarching theme of the participants' experienced outcomes from the program, and this was elaborated by 3 main themes: (1) "increased energy and capacity," (2) "acceptance and understanding," and (3) "structure and hope." The multidimensional rehabilitation program seemed to address cancer survivors' multiple challenges in survivorship. Proximity and accessibility to a local rehabilitation program and professionals' competence seemed to be essential factors for the participants' experienced outcomes of the program. A multidimensional rehabilitation program integrated in a Healthy Life Centre in primary healthcare may be beneficial for cancer survivors' coping and participation in everyday life. Cancer nurses play a crucial role in initiating and facilitating such programs.

Previous life experiences and social relations affecting individuals wish for support when establishing healthy habits \u2013 a qualitative study of Norwegian Healthy Life Centre participants

BackgroundInterventions to reduce and prevent overweight, obesity and T2D has been advocated worldwide. In Norway, Healthy Life Centres have been established to help individuals to reduce and prevent diseases, offering physical activity and dietary advice to establish healthy habits. Previous life experiences, social support and help from health personnel could play a role in the process of establishing healthy habits. The aim of this study was to explore how two groups of Healthy Life Centre participants described their previous life experiences, social relations and wish for support from Healthy Life Centre personnel.MethodsA qualitative design was used, including 49 individual semi-structured interviews. The interviews for this study were performed in two different samples, one sample of participants applying for HLC participation in 2013 (n = 23) and one sample of participants invited to HLC participation in 2015 (n = 26). The data was analyzed using systematic text condensation.ResultsThree main themes in a chronological (past, present and future) order were identified: 1. Previous life experiences stamping life situation (past time). 2. Social relations being a support or a burden in everyday life (present time) and 3. Expressing wishes for HLC support (future).ConclusionsIn the process of establishing healthy habits, the need for help from personnel may be differentiated based on previous life experiences and present social relations.

Correction: Psychological Distress and Physical-Activity Levels among People Consulting a Healthy Life Centre for Lifestyle Change

This article details a correction to the article: Sevild, C. H., Dyrstad, S. M., &amp; Bru, L. E. (2020). Psychological Distress and Physical-Activity Levels among People Consulting a Healthy Life Centre for Lifestyle Change. Physical Activity and Health, 4(1). DOI: <a href="https://doi.org/10.5334/paah.55" target="_blank">https://doi.org/10.5334/paah.55</a>.

Kayseri İl Sağlık Müdürlüğü Sağlıklı Hayat Merkezleri Diyet Poliklinikleri 2018 Yılı Verilerinin Değerlendirilmesi

Aim: This study was carried out to evaluate the change of body weights of the applicants to the diet polyclinics in 5 wellness centers in Kayseri in 2018. Material and Methods: This study was conducted by examining the data of 5.462 people who applied to dietitian outpatient clinics in the field of primary health care in Kayseri in 2018. Data were scanned through the Public Health Management System (HSYS) and transferred to SPSS 21.0. Obesity classifications were made by calculating Body Mass Index (BMI). Written permission from Kayseri Provincial Health Directorate and ethical approval from Erciyes University Non-Clinical Researches Ethics Committee were obtained for the study. Results: In 2018, 5462 people over the age of 18 applied to dietician outpatient clinics in 5 healthy life centers in Kayseri. It was observed that 58.4% of the applicants had over 30 BMI. 53.2% of those who come at least once are stage 1 obese. 52.7% of those who come at least twice are stage 1 obese. While the median BMI of obese individuals who came for the second time was 34.7 at the first visit, their BMI median at the second visit was found to be 33.1. When the medians are compared with the Wilcoxon test, the differences are statistically significant. Conclusion: In our study, it was determined that diet polyclinics that serve in health centers are effective in losing weight. Gyms within healthy life centers; The creation of physiologists and sports coaches will contribute to the fight against obesity.

Healthy Life Centres: a 3-month behaviour change programme’s impact on participants’ physical activity levels, aerobic fitness and obesity: an observational study

ObjectivesIndividuals with low socioeconomic status and multimorbidity tend to have lower physical activity (PA) levels than the general population. Primary care is an important setting for reaching high-risk individuals to...

Beneficial self-management support and user involvement in Healthy Life Centres-A qualitative interview study in persons afflicted by overweight or obesity.

BackgroundRelapse is high in lifestyle interventions involving behavioural change and weight loss maintenance. The purpose of lifestyle self‐management interventions offered at Healthy Life Centres (HLCs) is to empower the participants, leading to self‐management and improved health. Exploring beneficial self‐management support and user involvement in HLCs is critical for quality, improving effectiveness and guiding approaches to lifestyle change support in overweight and obesity.ObjectiveThe aim of this study was to explore how persons afflicted by overweight or obesity attending lifestyle interventions in Norwegian HLCs experience beneficial self‐management support and user involvement.MethodSemi‐structured in‐depth interviews were conducted with 13 service users (5 men and 8 women). Data were analysed using qualitative content analysis.ResultsOne main theme was identified: regaining self‐esteem and dignity through active involvement and long‐term self‐worth support in partnership with others. This main theme comprised four themes: (a) self‐efficacy through active involvement and better perceived health, (b) valued through health‐care professionals (HPs) acknowledgement, equality and individualized support, (c) increased motivation and self‐belief through fellowship and peer support; and (d) maintenance of lifestyle change through accessibility and long‐term support.ConclusionService users’ active involvement, acknowledgement and long‐term self‐worth support from HPs and peers seem to support self‐management and user involvement and may be some of the successful ingredients to lifestyle change. However, prolonged follow‐up support is needed. A collectivistic and long‐term perspective can integrate the importance of significant others and shared responsibility.

How are body mass and body attitude impacted by a behaviour change intervention in primary care? A pragmatic randomised controlled trial.

Aims:This study evaluated the effect of behaviour change interventions at Norwegian Healthy Life Centres on change in body mass index (BMI) and body attitude, and explored the predictors for change after 6 months. Methods: We randomised 118 participants to either an intervention or a control group. Eligible participants: ⩾18 years and able to take part in group-based interventions. Body attitude, weight, and height were assessed at inclusion and after 6 months. We analysed the data using simple and multiple regression. Results: Eighty-six participants completed 6-month follow-up. The study found no intervention effect on BMI or body attitude across the two groups. However, an interaction effect indicated that the leaner participants in the intervention group reduced their weight significantly (b 0.94, p < 0.001). BMI reduction was predicted by self-efficacy for physical activity and autonomous motivation for change. Weight loss was associated with impaired body attitude, body shape concern, impaired weight-related self-esteem, weight cycling, and controlled motivation for change. Improvement in body attitude was positively impacted by self-rated health, the experience of childhood respect, life satisfaction, and self-efficacy for physical activity. Impaired body attitude was predicted by body shape concern, impaired weight-related self-esteem, and controlled motivation. Conclusions: The interventions did not affect body mass on average, but promoted weight loss among the leaner participants. Because weight reduction was associated body shape concern and impaired body attitude, the study supports the claim that interventions should be weight neutral and aim to improve body image and psychological well-being rather than weight reduction.

Psychological Distress and Physical-Activity Levels among People Consulting a Healthy Life Centre for Lifestyle Change

Aims: Healthy Life Centres were developed in Norway to support lifestyle-changes. Aims of the study were: First, to assess physical-activity levels and psychological distress among participants at one centre and compare them to representative samples. Second, to investigate associations of physical activity level and mental distress. Methods: Participants between 18-71 years of age were included (N = 120). Accelerometer-based levels of physical activity (ActiGraph GT3X) and psychological distress (Hopkins Symptom Check List-10) were compared to national, representative samples of healthy Norwegians and overweight/obese nationals. Associations between indicators of physical activity levels and psychological distress were analysed. Results: The participants were predominantly obese (77%) and had symptoms of psychological distress (77%). They engaged in 73% less light physical activity but performed 15% more moderate-vigorous physical activity compared to the representative samples. However, moderate-vigorous physical activity was not adequately sustained in our sample, so significantly fewer participants fulfilled physical-activity level recommendations (16% versus 32%), but not in comparison to the national obese sample (12% versus 19%). The prevalence of psychological distress was seven times higher compared to the national sample, and five times higher than the overweight/obese sample. Associations of physical activity and psychological distress were non-significant. Conclusion: The prevalence of psychological distress was unexpectedly high, and in combination with obesity it indicates a challenging strive when aiming to increase physical activity levels. Therefore, the Healthy Life Centre participants may also benefit from psychological counselling, though more research from HLCs and similar services is needed to conclude on the subject. Publisher's Note: A corrigendum relating to this article has been published at http://doi.org/10.5334/paah.84 .

Initiation and maintenance of lifestyle changes among participants in a healthy life centre: a qualitative study

BackgroundSince the early 2000s, Healthy Life Centres have been established in Norway to promote physical and mental health. Yet to date, little is known about the efficacy of Healthy Life Centres in promoting health behaviour change and maintenance or the factors that underlie these processes. Accordingly, the aim of the current study was to examine the factors that participants in a Healthy Life Centre perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet.MethodParticipants were purposely recruited from among adherers in a 12-month multi-method research project at a Healthy Life Centre. Individual, semi-structured interviews were conducted with 8 women and 6 men who were between the ages of 20 and 61 years old. Data were analysed using Systematic Text Condensation.ResultsThree main themes were derived from this analysis. The first theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. The second theme focused on strategies for coping with the challenges and potential pitfalls that were associated with various unpleasant experiences and life events. The third theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes.ConclusionThe current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants’ experiences. In line with self-determination theory, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritizations in order to balance healthy lifestyle behaviours with the routines of “daily life” while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways.