title: Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.
abstract: To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness.
  
  
  
  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).
  
  
  
  SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs.
  
  
  
  Subjects at increased risk of developing type 2 diabetes were included.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
authors.forename: Ellen Ji
authors.initials: EJ
authors.lastname: van Dongen
authors.affiliation: 1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
authors.forename: Geerke
authors.initials: G
authors.lastname: Duijzer
authors.affiliation: 2GGD Noord- en Oost-Gelderland (Community Health Service),Warnsveld,The Netherlands.
authors.forename: Sophia C
authors.initials: SC
authors.lastname: Jansen
authors.affiliation: 2GGD Noord- en Oost-Gelderland (Community Health Service),Warnsveld,The Netherlands.
authors.forename: Josien
authors.initials: J
authors.lastname: Ter Beek
authors.affiliation: 3Leyden Academy on Vitality and Ageing,Leiden,The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Huijg
authors.affiliation: 1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Leerlooijer
authors.affiliation: 4Wageningen University,Strategic Communication,Sub-department Communication,Philosophy and Technology: Centre for Integrative Development,Social Sciences,Wageningen,The Netherlands.
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Hiddink
authors.affiliation: 1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
authors.forename: Edith Jm
authors.initials: EJ
authors.lastname: Feskens
authors.affiliation: 1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
authors.forename: Annemien
authors.initials: A
authors.lastname: Haveman-Nies
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D015397:Program Evaluation; D012107:Research Design; D012307:Risk Factors
keywords: Diabetes; Lifestyle intervention; Prevention; Primary health care; Process evaluation; Randomised controlled trial