What do general practitioners think about an online self-regulation programme for health promotion?: focus group interviews

Background: Chronic diseases may be prevented through programmes that promote physical activity and healthy nutrition. Computer-tailoring programmes are effective in changing behaviour in the short- and long-term. An important issue is the implementation of these programmes in general practice. However, there are several barriers that hinder the adoption of eHealth programmes in general practice. This study explored the feasibility of an eHealth programme that was designed, using self-regulation principles. Methods: Seven focus group interviews (a total of 62 GPs) were organized to explore GPs¿ opinions about the feasibility of the eHealth programme for prevention in general practice. At the beginning of each focus group, GPs were informed about the principles of the self-regulation programme `My Plan¿. Open-ended questions were used to assess the opinion of GPs about the content and the use of the programme. The focus groups discussions were audio-taped, transcribed and thematically analysed via NVivo software. Results: The majority of the GPs was positive about the use of self-regulation strategies and about the use of computer-tailored programmes in general practice. There were contradictory results about the delivery mode of the programme. GPs also indicated that the programme might be less suited for patients with a low educational level or for old patients. Conclusions: Overall, GPs are positive about the adoption of self-regulation techniques for health promotion in their practice. However, they raised doubts about the adoption in general practice. This barrier may be addressed (1) by offering various ways to deliver the programme, and (2) by allowing flexibility to match different work flow systems. GPs also believed that the acceptability and usability of the programmes was low for patients who are old or with low education. The issues raised by GPs will need to be taken into account when developing and implementing an eHealth programme in general practice

A self-regulation eHealth intervention to increase healthy Behavior through general practice : protocol and systematic development

Background: Chronic diseases are the principal cause of morbidity and mortality worldwide. An increased consumption of vegetables and fruit reduces the risk of hypertension, coronary heart disease, stroke, and cancer. An increased fruit and vegetable (FV) intake may also prevent body weight gain, and therefore indirectly affect type 2 diabetes mellitus. Insufficient physical activity (PA) has been identified as the fourth leading risk factor for global mortality. Consequently, effective interventions that promote PA and FV intake in a large number of people are required. Objective: To describe the systematic development of an eHealth intervention, MyPlan 1.0, for increasing FV intake and PA. Methods: The intervention was developed following the six steps of the intervention mapping (IM) protocol. Decisions during steps were based upon available literature, focus group interviews, and pilot studies. Results: Based on needs assessment (Step 1), it was decided to focus on fruit and vegetable intake and physical activity levels of adults. Based on self-regulation and the health action process approach model, motivational (eg, risk awareness) and volitional (eg, action planning) determinants were selected and crossed with performance objectives into a matrix with change objectives (Step 2). Behavioral change strategies (eg, goal setting, problem solving, and implementation intentions) were selected (Step 3). Tablet computers were chosen for delivery of the eHealth program in general practice (Step 4). To facilitate implementation of the intervention in general practice, GPs were involved in focus group interviews (Step 5). Finally, the planning of the evaluation of the intervention (Step 6) is briefly described. Conclusions: Using the IM protocol ensures that a theory-and evidence-based intervention protocol is developed. If the intervention is found to be effective, a dynamic eHealth program for the promotion of healthy lifestyles could be available for use in general practice

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

Effectiveness of the self-regulation eHealth intervention ‘MyPlan1.0.’ on physical activity levels of recently retired Belgian adults : a randomized controlled trial

The study purpose was to test the effectiveness of the self-regulation eHealth intervention 'MyPlan1.0.' to increase physical activity (PA) in recently retired Belgian adults. This study was a randomized controlled trial with three points of follow-up/modules (baseline to 1-week to 1-month follow-up). In total, 240 recently retired adults (intervention group [IG]: n = 89; control group [CG]: n = 151) completed all three modules. The IG filled in evaluation questionnaires and received 'MyPlan1.0.', an intervention focusing on both pre- and post-intentional processes for behavioural change. The CG only filled in evaluation questionnaires. Self-reported PA was assessed using the long International Physical Activity Questionnaire, usual week version. Repeated-measures multivariate analysis of variances were conducted in SPSS 22.0. On the short-term (baseline to 1 week), the intervention significantly increased walking for transport (IG: +11 min/week, CG: -6 min/week; P < 0.01). On the intermediate-term (baseline to 1 month), the intervention increased transport-related walking (IG: +14 min/week, CG: +6 min/week; P < 0.01), leisure-time walking (IG: +26 min/week, CG: -14 min/week; P < 0.10), leisure-time vigorous PA (IG: +16 min/week, CG: -4 min/week; P < 0.01), moderate-intensity gardening (IG: +4 min/week, CG: -34 min/week; P < 0.10) and voluntary work-related vigorous PA (IG: +28 min/week, CG: +13 min/week; P < 0.10). Results show that our eHealth intervention is effective in recently retired adults. Future studies should include long-term follow-up to examine whether the effects persist over a longer period

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 &ldquo;MyPlan 1.0&rdquo; in general practice. Individual interviews were conducted with 15 GPs who implemented &ldquo;MyPlan 1.0&rdquo; 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

The effect of the eHealth intervention ‘MyPlan 1.0’ on physical activity in adults who visit general practice : a quasi-experimental trial

Physical inactivity is one of the major risk factors for poor health in the world. Therefore, effective interventions that promote physical activity are needed. Hence, we developed an eHealth intervention for adults, i.e., ‘MyPlan 1.0’, which includes self-regulation techniques for behaviour change. This study examined the effect of ‘MyPlan 1.0’ on physical activity (PA) levels in general practice. 615 adults (≥18 years) were recruited in 19 Flemish general practices, for the intervention group (n = 328) or for the wait-list control group (n = 183). Participants in the intervention group received the web-based intervention ‘MyPlan 1.0’ and were prompted to discuss their personal advice/action plan with their general practitioner. Participants in the wait-list control group only received general advice from the website. Self-reported physical activity was assessed with the International Physical Activity Questionnaire (IPAQ) at baseline and after one month. A three-level (general practice, adults, time) regression analysis was conducted in MLwiN. Significant intervention effects were found for total PA and moderate to vigorous PA with an increase for the intervention group compared to a decrease in the control condition. However, there was a high dropout rate in the intervention group (76%) and the wait-list control group (57%). Our self-regulation intervention was effective in increasing physical activity levels in adults. Future studies should consider strategies to prevent the large dropout from participants

The insights of health and welfare professionals on hurdles that impede economic evaluations of welfare interventions

Background: Four hurdles associated with economic evaluations in welfare interventions were identified and discussed in a previous published literature review. These hurdles include (i) Ignoring the impact of condition-specific outcomes', (ii) Ignoring the impact of QoL externalities', (iii) Calculation of costs from a too narrow perspective' and (iv) The lack of well-described & standardized interventions'. This study aims to determine how healthcare providers and social workers experience and deal with these hurdles in practice and what solutions or new insights they would suggest. Methods: Twenty-two professionals of welfare interventions carried out in Flanders, were interviewed about the four described hurdles using a semi-structured interview. A thematic framework was developed to enable the qualitative analysis. The analysis of the semi-structured interviews was facilitated through the use of the software program QRS NVivo 10. Results: The interviews revealed a clear need to tackle these hurdles. The interviewees confirmed that further study of condition-specific outcomes in economic evaluations are needed, especially in the field of mental health and stress. The proposed dimensions for the condition-specific questionnaires varied however between the groups of interviewees (i.e. general practitioners vs social workers). With respect to QoL externalities, the interviewees confirmed that welfare interventions have an impact on the social environment of the patient (friends and family). There was however no consensus on how this impact of QoL externalities should be taken into account in welfare interventions. Professionals also suggested that besides health care costs, the impact of welfare interventions on work productivity, the patients' social life and other items should be incorporated. Standardization appears to be of limited added value for most of the interviewees because they need a certain degree of freedom to interpret the intervention. Furthermore, the target population of the interventions is diverse which requires a tailor-made approach. Conclusion: This qualitative research demonstrated that these hurdles occur in practice. The proposed solutions for these hurdles can contribute to the improvement of the methodological quality of economic evaluations of welfare interventions

The use and evaluation of self-regulation techniques can predict health goal attainment in adults: an explorative study

Background. Self-regulation tools are not always used optimally, and implementation intention plans often lack quality. Therefore, this study explored participants’ use and evaluation of self-regulation techniques and their impact on goal attainment. Methods. Data were obtained from 452 adults in a proof of concept (POC) intervention of ‘MyPlan’, an eHealth intervention using self-regulation techniques to promote three healthy behaviours (physical activity (PA), fruit intake, or vegetable intake). Participants applied self-regulation techniques to a self-selected health behaviour, and evaluated the self-regulation techniques. The quality of implementation intentions was rated by the authors as a function of instrumentality (instrumental and non-instrumental) and specificity (non-specific and medium to highly specific). Logistic regression analyses were conducted to predict goal attainment. Results. Goal attainment was significantly predicted by the motivational value of the personal advice (OR:1.86), by the specificity of the implementation intentions (OR:3.5), by the motivational value of the action plan (OR:1.86), and by making a new action plan at follow-up (OR:4.10). Interaction-effects with behaviour showed that the specificity score of the implementation intention plans (OR:4.59), the motivational value of the personal advice (OR:2.38), selecting hindering factors and solutions(OR:2.00) and making a new action plan at follow-up (OR:7.54) were predictive of goal attainment only for fruit or vegetable intake. Also, when participants in the fruit and vegetable group made more than three plans, they were more likely to attain their goal (OR:1.73), whereas the reverse was the case in the PA group (OR:0.34). Discussion. The chance that adults reach fruit and vegetable goals can be increased by including motivating personal advice, self-formulated action plans, and instructions/strategies to make specific implementation intentions into eHealth interventions. To increase the chance that adults reach short-term PA goals, it is suggested to keep eHealth PA interventions simple and focus only on developing a few implementation intentions. However, more research is needed to identify behaviour change techniques that can increase health goal attainment at long-term