title: Implementation of a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention delivery.
abstract: BACKGROUND
  As in clinical practice resources may be limited compared to experimental settings, translation of evidence-based lifestyle interventions into daily life settings is challenging. In this study we therefore evaluated the implementation of the APHRODITE lifestyle intervention for the prevention of type 2 diabetes in Dutch primary care. Based on this evaluation we discuss opportunities for refining intervention delivery.
  
  
  METHODS
  A 2.5-year intervention was performed in 14 general practices in the Netherlands among individuals at high risk for type 2 diabetes (FINDRISC-score ≥ 13) (n = 479) and was compared to usual care (n = 446). Intervention consisted of individual lifestyle counselling by nurse practitioners (n = 24) and GPs (n = 48) and group-consultations. Drop-out and attendance were registered during the programme. After the intervention, satisfaction with the programme and perceived implementation barriers were assessed with questionnaires.
  
  
  RESULTS
  Drop-out was modest (intervention: 14.6 %; usual care: 13.2 %) and attendance at individual consultations was high (intervention: 80-97 %; usual care: 86-94 %). Providers were confident about diabetes prevention by lifestyle intervention in primary care. Participants were more satisfied with counselling from nurse practitioners than from GPs. A major part of the GPs reported low self-efficacy regarding dietary guidance. Lack of counselling time (60 %), participant motivation (12 %), and financial reimbursement (11 %) were regarded by providers as important barriers for intervention implementation.
  
  
  CONCLUSIONS
  High participant compliance and a positive attitude of providers make primary care a suitable setting for diabetes prevention by lifestyle counselling. Results support a role for the nurse practitioner as the key player in guiding lifestyle modification. Further research is needed on strategies that could increase cost-effectiveness, such as more stringent criteria for participant inclusion, group-counselling, more tailor-made counselling and integration of screening and / or interventions for different disorders.
authors.affiliation: Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Warandelaan 2, 5037, AB, Tilburg, the Netherlands. prediabeteseindhoven@gmail.com
authors.forename: Paulina W A
authors.initials: PW
authors.lastname: Vermunt
authors.forename: Ivon E J
authors.initials: IE
authors.lastname: Milder
authors.forename: Frits
authors.initials: F
authors.lastname: Wielaard
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Jos D M
authors.initials: JD
authors.lastname: Schelfhout
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.forename: Hans A M
authors.initials: HA
authors.lastname: van Oers
mesh_terms: D003376:Counseling / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D012052:Reimbursement, Incentive; D012107:Research Design; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D000078329:Workforce