Search

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. [ABSTRACT FROM AUTHOR]

Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.Design: An observational checklist was developed to assess goal and implementation intentions and 'missed opportunities for lifestyle counselling'. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.Setting: Dutch general practice.Subjects: One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.Results: Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important 'missed opportunity for lifestyle counselling'.Conclusions: Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment. [ABSTRACT FROM AUTHOR]

ObjectiveGeneral practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants.DesignCross-sectional study, mail questionnaire.SettingDutch general practice.SubjectsFour hundred and seventy-two GP in practice for 5–30 years.ResultsOur study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices.ConclusionsThe majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the self-efficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice. [ABSTRACT FROM AUTHOR]

Background: Although many evidence-based diabetes prevention interventions exist, they are not easily applicable in real-life settings. Moreover, there is a lack of examples which describe the adaptation process of these interventions to practice. In this paper we present an example of such an adaptation. We adapted the SLIM (Study on Lifestyle intervention and Impaired glucose tolerance Maastricht) diabetes prevention intervention to a Dutch real-life setting, in a joint decision making process of intervention developers and local health care professionals. Methods: We used 3 adaptation steps in accordance with current adaptation frameworks. In the first step, the elements of the SLIM intervention were identified. In the second step, these elements were judged for their applicability in a real-life setting. In the third step, adaptations were proposed and discussed for those elements which were deemed not applicable. Participants invited for this process included intervention developers and local health care professionals (n=19). Results: In the first adaptation step, a total of 22 intervention elements were identified. In the second step, 12 of these 22 intervention elements were judged as inapplicable. In the third step, a consensus was achieved for the adaptations of all 12 elements. The adapted elements were in the following categories: target population, techniques, intensity, delivery mode, materials, organisational structure, and political and financial conditions. The adaptations either lay in changing the SLIM protocol (6 elements) or the real-life working procedures (1 element), or a combination of both (4 elements). Conclusions: The positive result of this study is that a consensus was achieved within a relatively short time period (nine months) between the developers of the SLIM intervention and local health care professionals on the adaptations needed to make SLIM applicable in a Dutch real-life setting. Our example shows that it is possible to combine the perspectives of scientists and practitioners, and to find a balance between evidence-base and applicability concerns. [ABSTRACT FROM AUTHOR]

Studies the determinants of the nutrition guidance practices of Dutch primary care physicians (PCPs). Barriers to nutrition guidance practices; Nutrition attitudes and beliefs; PCPs and factors determining their extent of nutrition education and information of patients.

Studies the nutrition information seeking behavior of primary care physicians (PCPs) in Netherlands. PCPs' implementation of different strategies of nutrition guidance of patients; Determinants of nutrition information seeking behavior; Attitudes of primary care physicians about themselves receiving nutrition information.

Investigates the role of primary care physician in providing nutrition information to the public in Netherlands by using a random sample of Dutch consumers referral to 11 nutrition information sources (NIS). Response, characteristics and background of respondents; Perceived expertise of NIS; Factor analysis on NIS; Determinants of referral to NIS.

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.

Objective: Pilot-testing of the adapted Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM) and to determine its feasibility and likelihood of achieving desired impact., Methods: Pilot intervention study (a 10-month combined lifestyle intervention) using a one group pre-test post-test design with on-going process measures (i.e. reach, acceptability, implementation integrity, and applicability) and several health outcomes (e.g. body weight)., Results: In total, 31 subjects participated in the SLIMMER (SLIM iMplementation Experience Region Noord- en Oost-Gelderland) intervention. Participant weight loss was -3.5 kg (p=0.005). Both participants and health care professionals (i.e. practice nurses, dieticians, and physiotherapists) were satisfied with the intervention. The intervention was implemented as planned and appeared to be suitable for application in practice. Refinements have been identified and will be made prior to further implementation and evaluation., Conclusion: Implementation of the SLIMMER intervention is feasible in a Dutch real-life setting and it is likely to achieve desired impact. Practising and optimising the intervention creates local support for SLIMMER among stakeholders., Practice Implications: Performing a pilot study on the basis of a structured approach is a meaningful step in the process of optimising the feasibility and potential impact of an evidence-based intervention in a real-life setting., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

All over the world, prevalence and incidence rates of type 2 diabetes mellitus are rising rapidly. Several trials have demonstrated that prevention by lifestyle intervention is (cost-) effective. This calls for translation of these trials to primary health care. This article gives an overview of the translation of the SLIM diabetes prevention intervention to a Dutch real-life setting and discusses the role of primary health care in implementing lifestyle intervention programmes. Currently, a 1-year pilot study, consisting of a dietary and physical activity part, performed by three GPs, three practice nurses, three dieticians and four physiotherapists is being conducted. The process of translating the SLIM lifestyle intervention to regular primary health care is measured by means of the process indicators: reach, acceptability, implementation integrity, applicability and key factors for success and failure of the intervention. Data will be derived from programme records, observations, focus groups and interviews. Based on these results, our programme will be adjusted to fit the role conception of the professionals and the organization structure in which they work.

Background: One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients., Objective: Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study., Methods: This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, van Woerkum CMJ, Fieren CJ, van t'Hof MA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29-36.) demonstrated that 'noticing patients' overweight and guidance of treatment' was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997)., Results: This analysis shows both similarity and differences in working mechanism of determinants of noticing patients' overweight and guidance of treatment between 1997 and 2007. The backbone of the mechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference., Conclusions: The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients' overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.

Objective: to obtain an in-depth understanding of verbal and written nutrition communication in Dutch midwifery practice., Design, Setting and Participants: data were collected by recording 12 initial antenatal consultations (12 weeks into the pregnancy) with primiparous women from four Dutch midwifery practices spread over The Netherlands, followed by two semi-structured qualitative interviews with the women. The interviews were undertaken on the day after the consultation and two weeks later., Findings: analysis of the recordings revealed that a nutrition brochure was offered in an information pack, but it was not used or referred to by the midwives. Verbally, clients were informed about healthy nutrition in general terms. Specific, personally relevant nutrition-related questions and motivators of nutrition behaviour were rarely clarified and addressed. Midwives tried to create a good relationship with their clients by being friendly, complimentary, confirmative and supportive. Women appreciated talking about nutrition with the midwife because of her expertise. The subsequent interviews with the women revealed, however, that nutrition communication took place relatively late in pregnancy at a point when women were more interested in 'hearing the baby's heart beat'. Furthermore, clients seldom looked through the nutrition brochure at home., Key Conclusion: the provision of a nutrition brochure does not serve any real purpose., Implications for Practice: to reach optimal synergy between verbal and written nutrition communication in midwifery practice, midwives should actively refer to a nutrition brochure in addition to verbal communication. Moreover, health organisations should realise that the provision of nutrition brochures to midwives does not mean that these brochures will be used as an integral part of midwives' nutrition communication with clients.

Objectives: To examine whether preconception and pregnancy could be an occasion triggering women's interest, search and need for both general and pregnancy-specific nutrition-related information, in order to: (i) provide a greater understanding of the life course perspective (in this case on nutrition behaviours and pregnancy) and (ii) to contribute to the rationale of nutrition interventions aimed at women of child-bearing age., Methods: Data were collected in a cross-sectional study with the aid of a face-to-face interview. The sample consisted of four groups each of about 100 Dutch nulliparous women each: women trying to conceive and women in the first, second or third trimester of their first pregnancy., Results: Pregnant women were more interested in nutrition information than before preconception and before pregnancy, especially the first-trimester group. The frequency of search for nutrition information differed significantly between the groups: the first-trimester group searched for information most frequently. Women wanting to conceive and women in their third trimester of pregnancy found significantly more pregnancy-specific information topics than women in their first and second trimester of pregnancy. Women wanting to conceive had significantly higher needs for general and specific nutrition-related topics compared to pregnant women. Overall, the Internet, the midwife and books were the favourite information sources., Conclusions: The study provided indications that preconception and pregnancy are moments in life that lead to an increased interest, need and search for particularly pregnancy-specific nutrition-related information. This should be borne in mind when healthy nutrition promotion activities are being developed.

Objective: The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables., Methods: Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST., Results: Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses., Conclusion: The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted., Practice Implications: We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Background: Consumers have been exposed to nutrition information from a variety of sources, including the family doctor. They are often not aware of their own risk behavior regarding nutrition., Objective: This study sought to assess food associations, conversation topics, interest in food topics, and use of information sources by means of qualitative consumer research. Another aim was to provide a hypothetical model for nutrition awareness that could be tested in a quantitative survey., Design: Three focus groups with 30 Dutch consumers altogether were carried out. Qualitative data were analyzed with the computer software program NUD*IST (QSR, Melbourne) by sorting text blocks into categories, and new themes emerged. In addition, a hypothetical model for nutrition awareness was developed., Results: Consumers associated food most often with safe food, and food safety was the topic most often discussed. Tasty food was the most important food conversation topic. The family doctor was the information source most talked about. Furthermore, consumers possibly lacked some nutrition awareness., Conclusions: Careful analysis revealed new themes (new in the past 10 y), such as concerns about food safety and reconsideration of the roles of family doctors and dietitians. Based on these themes, recommendations for nutrition communication were composed.

Background: Conjugated linoleic acid (CLA), which is present in milk products and meat from ruminants, appears to have anticarcinogenic activity against breast cancer in animal and in vitro experiments. To date, few epidemiologic data are available in humans., Objective: This study evaluated the relation between intakes of CLA and other fatty acids and breast cancer incidence in the Netherlands Cohort Study., Design: Intake data derived from a validated 150-item food-frequency questionnaire were linked to an existing database with analytic data on specific fatty acids in European foods (the TRANSFAIR study). With 6.3 y of follow-up and 941 incident cases of breast cancer, multivariate rate ratios and 95% CIs were calculated for energy-adjusted intakes of fatty acids and CLA-containing food groups (eg, butter, cheese, milk, other milk products, and meat)., Results: CLA intake showed a weak, positive relation with breast cancer incidence (rate ratio for highest compared with lowest quintile: 1.24, 95% CI: 0.91, 1.69; P for trend = 0.02). Statistically significant positive associations were found with total trans fatty acids and (borderline) with saturated fatty acids. Significant inverse associations were found with monounsaturated and cis unsaturated fatty acids, whereas total fat and energy intake of CLA-containing food groups were not related to breast cancer incidence., Conclusion: The suggested anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in this epidemiologic study in humans.