Ontwikkeling en evaluatie van een self-management eHealth interventie in de eerste lijn

Het hoofddoel van het project is de ontwikkeling, evaluatie en implementatie van een interventie die de kwaliteit en kwantiteit van primaire preventie binnen de eerste lijn kan verbeteren. Hiervoor werd de interventie ‘Mijn Actieplan’ ontwikkeld. ‘Mijn Actieplan’ is een online eHealth interventie die gebaseerd is op de zelfregulatie theorie om fruit- en groente inname en fysieke activiteit te verhogen bij volwassenen. Door op deze gedragingen te richten, wordt een gezonde levensstijl bij volwassenen gepromoot. Om ‘Mijn Actieplan’ op een evidence-based manier te ontwikkelen en te implementeren in huisartsenpraktijken, werd gebruik gemaakt van het Intervention Mapping Protocol (IMP) als planningsmodel voor de interventie. De zes stappen in het IMP zijn: needs assessment (stap 1), het maken van matrices met veranderingsdoelen (stap 2), de selectie van interventiemethoden en praktische strategieën (stap 3), de ontwikkeling van de interventie (stap 4), het plannen van adoptie, implementatie en behoud (stap 5) en de ontwikkeling van een evaluatiedesign (stap 6). In het rapport worden de genomen theoretische overwegingen en beslissingen binnen de ontwikkeling van ‘Mijn Actieplan’, gemaakt doorheen de verschillende stappen van het IMP, toegelicht. Verder worden de resultaten van de effect- en procesevaluatie van ‘Mijn Actieplan’ besproken. Uit de evaluatie van ‘Mijn Actieplan’ is gebleken dat het programma effectief is in het verhogen van de fruit- en groente-inname en fysieke activiteit van volwassenen. Enkel voor zwaar intensieve fysieke activiteit werd geen effect gevonden. De effect-evaluatie gaf ook aan dat de actieve betrokkenheid van de huisarts niet noodzakelijk was om tot effecten te leiden, en een actieve betrokkenheid van de huisarts ook geen grotere effecten gaf. Gezien ‘Mijn Actieplan’ effectief is in het veranderen van fruitinname, groente-inname en fysieke activiteit, zonder dat de actieve betrokkenheid van de huisarts noodzakelijk is, kan deze interventie in de toekomst dus ook verder verspreid worden via verschillende andere kanalen en settings. Een belangrijk aandachtspunt in zowel de pre-test studie als de evaluatie studie van ‘Mijn Actieplan’ binnen Vlaamse huisartspraktijken, is de hoge drop-out van deelnemers gedurende de interventie. Uit de procesevaluatie bleek dat het moeilijk was huisartsen actief te betrekken bij het implementeren van het programma waardoor de deelnemers niet extra gemotiveerd werden door de huisarts voor verdere deelname. Deelnemende patiënten gaven bij de procesevaluatie ook aan dat een belangrijke reden om te stoppen met het programma een gebrek aan tijd was. Uit de procesevaluatie is ook gebleken dat het programma ‘Mijn Actieplan’ mogelijks in een gewijzigde vorm beter geschikt zou zijn voor verdere implementatie in de dagelijkse routine van de huisartspraktijk. Suggesties uit dit onderzoek om ‘Mijn Actieplan’ verder te verspreiden binnen huisartspraktijken zijn: extra personeel opleiden om de adviezen en actieplannen te bespreken met patiënten, de ontwikkeling van een meer compacte app, de integratie van de eHealth interventie in bestaande medische programma’s (bv. via Vitalink) en/of om ‘Mijn Actieplan’ te combineren met het bestaande GMD+. Tenslotte lijken het ‘belonen’ van huisartsen en het veranderen van attitudes van huisartsen voor louter preventieve consultaties belangrijke aandachtspunten

Process evaluation of an eHealth intervention implemented into general practice : general practitioners’ and patients’ views

(1) Background: It has been shown that online interventions can be enhanced by providing additional support; accordingly, we developed an implementation plan for the use of an eHealth intervention targeting physical activity and healthy nutrition in collaboration with general practitioners (GPs). In this study, GPs and patients evaluated the actual implementation; (2) Methods: Two hundred and thirty two patients completed the feasibility questionnaire regarding the implementation of “MyPlan 1.0” in general practice. Individual interviews were conducted with 15 GPs who implemented “MyPlan 1.0” into their daily work flow; (3) Results: The majority of the patients indicated that general practice was an appropriate setting to implement the online intervention. However, patients were not personally addressed by GPs and advice/action plans were not discussed with the GPs. The GPs indicated that this problem was caused by the severe time restrictions in general practice. GPs also seemed to select those patients who they believed to be able to use (e.g., highly educated patients) and to benefit from the intervention (e.g., patients with overweight); (4) Conclusions: Although GPs were involved in the development of the online intervention and its implementation plan, the programme was not used in general practice as intended

Effect and process evaluation of a real-world school garden program on vegetable consumption and its determinants in primary schoolchildren

Objectives: This study aimed to investigate the effectiveness of a school garden program on children’s vegetable consumption and determinants and to gain insight into the process of the program. Methods: The “Taste Garden” is a real-world nine-week school garden program developed and implemented by a local organization. A total of 350 children (149 intervention group, 201 control group) filled out questionnaires on vegetable consumption, determinants and process of the program. Additionally, teachers filled out a process evaluation questionnaire. For effect evaluation, interaction effects (time x group) were considered, using multilevel repeated measures analyses in MLwiN 3.02. Interaction effects were repeated, taking into account quality of implementation (time x implementation group). Process evaluation was descriptively assessed with SPSS 24.0. Results: Overall, beside some practical concerns of teachers, the program was well perceived by teachers and children. However, an intervention effect of “The Taste Garden” was only found for knowledge (p = 0.02), with a very small effect size (0.55%). When taking into account implementation quality, only small effects were found for awareness (p between 0.005 and 0.007 and an effect size of 0.63%) and knowledge (p between 0.04 and 0.09 and an effect size of 0.65%). Conclusions: Evaluation of the real-world “Taste Garden” program, which was positively perceived by teachers, showed no effects on vegetable consumption and small effects on its determinants. Adaptations of the current format and longer follow-up periods are therefore recommended

Parenting practices as a mediator in the association between family socio-economic status and screen-time in primary schoolchildren : a Feel4Diabetes study

The aim of this study was to examine the mediating effects of specific parenting practices on the association between family socio-economic status (SES) and screen-time of 6- to 9-year-old children from families with an increased risk of developing type 2 diabetes. This cross-sectional study, focusing on families with an increased risk of developing type 2 diabetes, used the Belgian baseline data of the Movie Models intervention, integrated within the European Feel4Diabetes intervention, and included 247 parents (57.6% lower SES family; 78.0% mothers) who completed a questionnaire. Mediating effects were tested using MacKinnon's product-of-coefficients test via multilevel linear regression analyses. Being consistent concerning rules about gaming (β = 0.127; standard error = 0.055; 95% CI = 0.020; 0.234) and avoiding negative role modeling concerning TV-time (β = -0.082; standard error = 0.040; 95% CI = -0.161; -0.003) significantly mediated the inverse association between family SES and children's screen-time. Parents from lower SES families were more consistent concerning rules about gaming and watched more TV nearby their child compared to parents from higher SES families, and these parenting practices were related to more screen-time. No other parenting practices were found to mediate this association. Thus, parents from lower SES families with a higher risk for developing type 2 diabetes might limit their own TV-time nearby their child to reduce their child's screen-time. Future research should examine other possible mediating factors to develop effective interventions targeting this important at-risk group

Evaluation of a brief intervention for promoting mental health among employees in social enterprises : a cluster randomized controlled trial

Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects

Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families : a cluster randomized trial

Background This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents. Methods Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects. Results Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them. Conclusion The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families

Effectiveness of a family-, school- and community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus : the Feel4Diabetes-study

BackgroundThe study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium.MethodsThe Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4years; 72.0% women) and 444 children (mean age 8.0years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year.ResultsIn parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p=0.05; eta (2)(p)=0.008) and steps (p=0.03; eta (2)(p)=0.006%) on weekdays, with physical activity decreasing (more) in the intervention group.ConclusionsThe F4D-intervention lacks effectiveness on high-risk families' physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group).Trial registrationThe Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015

Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetesstudy school based component

Background: Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. Methods: Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. Results: From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention’s acceptance in specific or vulnerable population groups. Conclusions: Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives. Keywords: Obesity prevention, Type 2 diabetes prevention, Primary school children, Families, School based intervention.The Feel4Diabetes-study has received funding from the European Union's Horizon 2020 research and innovation programme [Grant Agreement: n degrees 643708]. The content of this article reflects only the authors' views and the European Community is not liable for any use that may be made of the information contained therein

The association between children’s and parents’ co-TV viewing and their total screen time in six European countries : cross-sectional data from the Feel4diabetes-study

In many European children, high levels of screen time can be found, which is associated with several adverse health outcomes. Therefore, there is a need for identifying effective intervention strategies that reduce screen time in children. A factor that may contribute to excessive screen time in children may be "co-TV viewing" (i.e., the time that parents and children spend on watching TV together), as parents often recognize the importance of limiting children's (individual) screen time, but often encourage TV viewing as a family because of its perceived benefits (e.g., educational purposes). The primary aim of this study was to investigate the (sex-specific) association between co-TV viewing and both children's and parents' screen time, and these associations were investigated across and within six European countries. In total, 10,969 parents (Mean(age) = 40.7 +/- 5.3 years, Mean(BMI) = 24.4 +/- 4.6) of primary school children (Mean(age) = 8.2 +/- 1.0 years, 49.0% boys, Mean(BMI) = 17.3 +/- 2.8) completed a questionnaire assessing co-TV viewing and screen time. Multilevel regression analyses were conducted. Across countries, positive associations were found between co-TV viewing and both children's (beta = 11.85, SE = 3.69, p < 0.001) and parents' screen time (beta = 14.47, SE = 4.43, p = 0.001). Similar associations were found in most (but not all) countries. The results suggest that targeting co-TV viewing might be a promising intervention strategy because of its potential to limit screen time of both children and parents