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Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms

Maija Huttunen-Lenz Orcid Logo, Sylvia Hansen, Anne Raben, Margriet Westerterp-Plantenga, Tanja Adam, Ian Macdonald, Gareth Stratton Orcid Logo, Nils Swindell Orcid Logo, J. Alfredo Martinez, Santiago Navas-Carretero, Teodora Handjieva-Darlenska, Svetoslav Handjiev, Sally D. Poppitt, Marta P. Silvestre, Thomas Meinert Larsen, Pia Siig Vestentoft, Mikael Fogelholm, Elli Jalo, Jennie Brand-Miller, Roslyn Muirhead, Wolfgang Schlicht Orcid Logo

Journal of Primary Care & Community Health, Volume: 15

Swansea University Authors: Gareth Stratton Orcid Logo, Nils Swindell Orcid Logo

  • 10.1177_21501319241248223.pdf

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DOI (Published version): 10.1177/21501319241248223

Abstract

Background: Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For intervent...

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Published in: Journal of Primary Care & Community Health
ISSN: 2150-1319 2150-1327
Published: SAGE Publications 2024
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa67942
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Abstract: Background: Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence “behavioral mechanisms” such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed. Method: Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol. Results: There was no increase in the participants’ self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions. Conclusions: The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.
Keywords: Adherence, self-efficacy, prediabetes, behavior change, chronic stress, mood
College: Faculty of Science and Engineering
Funders: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the following funding. The EU framework program 7 (FP7/2007–2013) grant agreement # 312057. National Health and Medical Research Council—EU Collaborative Grant, AUS 8, ID 1067711. The Glycemic Index Foundation Australia through royalties to the University of Sydney. The NZ Health Research Council (14/191) and University of Auckland Faculty Research Development Fund. The Cambridge Weight Plan donated all products for the 8-week LED period. The Danish Agriculture & Food Council. The Danish Meat and Research Institute. National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK). Biotechnology and Biological Sciences Research Council (BBSRC) (UK). Engineering and Physical Sciences Research Council (EPSRC) (UK). Nutritics (Dublin) donated all dietary analyses software used by UNOTT. Juho Vainio Foundation (FIN), Academy of Finland (grant numbers: 272376, 314383, 266286, 314135), Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital (FIN), Jenny and Antti Wihuri Foundation (FIN), and Emil Aaltonen Foundation (FIN). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The article processing charge was funded by the Baden-Württemberg Ministry of Science, Research and Culture and the University of Education Schwäbisch Gmünd in the funding programme Open Access Publishing.

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