Factors influencing the adoption, implementation, and continuation of physical activity interventions in primary health care: a Delphi study

Prevention, Population and Disease management (PrePoD

Nutrition counselling in general practice: the stages of change model

Healthy lifestyles in the prevention of cardiovascular diseases are of utmost importance for people with non insulin-dependent diabetes mellitus, hypertension, and/or dyslipidemia. Because of their continuous contact with almost all segments of the population, general practitioners can play an important role in initiating and encouraging dietary change. Unfortunately, dietary change programs that may be successful on the short term, often do not lead to long-term success. Using the Stages of Change Model to tailor nutrition counselling activities to patients' different levels of awareness and motivation has been shown to increase program effectiveness. Data from our studies, showed that decreases in (saturated) fat intake were larger in patients who received tailored counselling than in patients who received usual care (total fat intake: -5.6 percent of energy versus -2.4 percent of energy). The extent to which patients reduced their (saturated) fat intake after a nutrition counselling program, however, did not depend on how much their levels of awareness and motivation had changed. In research, short questionnaires are used to measure patients' stage of change. In general practice, however, this does not usually happen and general practitioners likely estimate their patients' interest in lifestyle change. Our study showed that general practitioners do not accurately estimate their patients' readiness to reduce their dietary fat intake (Kappa=0.25). To make dietary counselling in general practice more effective, it was therefore suggested that general practitioners should repeatedly ask their patients about their interest in lifestyle change. In our studies, social support was an independent predictor of intention to reduce dietary fat intake. As our systematic review also supported the key role of social support in the long-termmaintenanceof dietary change, increasing levels of perceived social support should be incorporated in dietary change interventions. The role general practitioners can play in increasing social support, however, may be limited because of the non-reciprocal relationship they have with their patients. Internet has also been suggested as a potential tool to help achieve long-term dietary change. Our final study was therefore designed to study the effectiveness of web-based tailored nutrition counselling and social support for patients at elevated risk for cardiovascular diseases. Patients who reported to use the Internet regularly were either given access to an online counselling tool (intervention) or were given usual care (control). The 33% of the patients in the intervention group who used the online tool had larger reductions in systolic blood pressure (-5.3 mmHg versus -0.16) than patients who did not use the tool. No changes in social support were observed. Nutrition counselling based on the Stages of Change Model is a feasible approach in general practice. As patients' levels of awareness and motivation change continuously, general practitioners' repeated attention for lifestyle is necessary. Collaboration with dieticians can help overcome some of the barriers limiting nutrition counselling practices by general practitioners. In the future, Internet can also play an important role

Public health impact of community-based nutrition and lifestyle interventions

Community-based interventions have increasingly received attention since researchers and public health professionals have come to acknowledge the importance of an environment that makes the healthy choice the easy choice. All stakeholders including the target community are involved to achieve changes in legislation, in people's social and physical context, and in individual characteristics that support healthy diets and other lifestyles. Some early large-scale community-based heart health interventions showed promising results. The Stanford Five City Project, for example, showed net improvements in knowledge of coronary heart disease risk factors of approximately 12%. Net declines in smoking prevalence (14%), cholesterol (2%), and systolic (3%) and diastolic (5%) blood pressure were also observed. Most later studies did not replicate these findings and it was therefore suggested that community-based interventions, which require substantial commitment and resources, may be less effective than approaches targeting high-risk groups. We present the rationale and theories for community-based interventions, and then elaborate on the methodological challenges in the design and the outcome and process evaluation of community-based interventions. We provide an overview of some of the evidence on the effectiveness of community-based heart health interventions and conclude with the perspectives for community-based interventions in future research and practice

Wijkscan Zeist

B&G, PZ