title: Exploring the process when developing a lifestyle intervention in primary care for type 2 diabetes: a longitudinal process evaluation.
abstract: OBJECTIVE
  A thorough understanding of the processes involved in lifestyle interventions is needed in order to close the gap between research and daily practice. This study explored the processes involved in the provision of a lifestyle intervention to patients with type 2 diabetes mellitus (T2DM) by health care professionals in primary care.
  
  
  METHODS
  Mixed methods.
  
  
  METHODS
  Health care professionals were asked to intensify lifestyle interventions for patients with T2DM in a routine care setting. Data were collected by serial interviews with health care professionals and patients, recorded consultations, an activity questionnaire and biomedical information. Qualitative data were analysed using a framework analysis with a phenomenological approach.
  
  
  RESULTS
  The lifestyle intervention developed by the health care professionals included motivational interviewing, a nutrition and physical activity diary, and a multidisciplinary approach [physiotherapist, dietician, general practitioner and diabetes practice nurse (DPN)]. Participants and health care professionals were positive about the intervention, and patients were more active (P = 0.027), lost weight (P = 0.031) and had lower levels of glycated haemoglobin (P = 0.012). However, qualitative data showed that patients were passive during the consultation, and did not ask questions about ways to improve their lifestyle. DPNs did not use motivational interviewing optimally; provided patients with information that was difficult to understand; and were easily satisfied with the efforts of the patients.
  
  
  CONCLUSIONS
  Lifestyle intervention for patients with T2DM is difficult in routine primary care. DPNs should adapt to the knowledge level of the patients, and patients must be stimulated to take an active role in their treatment. Patients and health care professionals should become equal partners in determining mutually agreeable treatment plans and goals.
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, The Netherlands. Electronic address: joris.linmans@maastrichtuniversity.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: Linmans
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Rossem
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Knottnerus
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Spigt
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Health communication; Lifestyle; Process assessment; Public health practice; Quality improvement; Type 2 diabetes mellitus