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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

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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
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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.</abstract><type>Journal Article</type><journal>Journal of Primary Care &amp; Community Health</journal><volume>15</volume><journalNumber/><paginationStart/><paginationEnd/><publisher>SAGE Publications</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2150-1319</issnPrint><issnElectronic>2150-1327</issnElectronic><keywords>Adherence, self-efficacy, prediabetes, behavior change, chronic stress, mood</keywords><publishedDay>25</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-06-25</publishedDate><doi>10.1177/21501319241248223</doi><url/><notes/><college>COLLEGE NANME</college><department>Engineering and Applied Sciences School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>EAAS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><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 &amp; 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.</funders><projectreference/><lastEdited>2024-10-14T13:58:06.3911948</lastEdited><Created>2024-10-09T10:42:43.1260445</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Engineering and Applied Sciences - Sport and Exercise Sciences</level></path><authors><author><firstname>Maija</firstname><surname>Huttunen-Lenz</surname><orcid>0000-0002-1034-1613</orcid><order>1</order></author><author><firstname>Sylvia</firstname><surname>Hansen</surname><order>2</order></author><author><firstname>Anne</firstname><surname>Raben</surname><order>3</order></author><author><firstname>Margriet</firstname><surname>Westerterp-Plantenga</surname><order>4</order></author><author><firstname>Tanja</firstname><surname>Adam</surname><order>5</order></author><author><firstname>Ian</firstname><surname>Macdonald</surname><order>6</order></author><author><firstname>Gareth</firstname><surname>Stratton</surname><orcid>0000-0001-5618-0803</orcid><order>7</order></author><author><firstname>Nils</firstname><surname>Swindell</surname><orcid>0000-0003-3742-6139</orcid><order>8</order></author><author><firstname>J. 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spelling v2 67942 2024-10-09 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 6d62b2ed126961bed81a94a2beba8a01 0000-0001-5618-0803 Gareth Stratton Gareth Stratton true false d89a0a3fb118e1cf625fddc68cdf25bb 0000-0003-3742-6139 Nils Swindell Nils Swindell true false 2024-10-09 EAAS 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. Journal Article Journal of Primary Care & Community Health 15 SAGE Publications 2150-1319 2150-1327 Adherence, self-efficacy, prediabetes, behavior change, chronic stress, mood 25 6 2024 2024-06-25 10.1177/21501319241248223 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University Another institution paid the OA fee 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. 2024-10-14T13:58:06.3911948 2024-10-09T10:42:43.1260445 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Maija Huttunen-Lenz 0000-0002-1034-1613 1 Sylvia Hansen 2 Anne Raben 3 Margriet Westerterp-Plantenga 4 Tanja Adam 5 Ian Macdonald 6 Gareth Stratton 0000-0001-5618-0803 7 Nils Swindell 0000-0003-3742-6139 8 J. Alfredo Martinez 9 Santiago Navas-Carretero 10 Teodora Handjieva-Darlenska 11 Svetoslav Handjiev 12 Sally D. Poppitt 13 Marta P. Silvestre 14 Thomas Meinert Larsen 15 Pia Siig Vestentoft 16 Mikael Fogelholm 17 Elli Jalo 18 Jennie Brand-Miller 19 Roslyn Muirhead 20 Wolfgang Schlicht 0000-0002-2134-2259 21 67942__32561__faedb2d89c8d43da9f697a97ff2612de.pdf 10.1177_21501319241248223.pdf 2024-10-09T10:42:43.1260056 Output 734657 application/pdf Version of Record true © The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (CC BY-NC 4.0). true eng https://creativecommons.org/licenses/by-nc/4.0/
title 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
spellingShingle 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
Gareth Stratton
Nils Swindell
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 6d62b2ed126961bed81a94a2beba8a01
d89a0a3fb118e1cf625fddc68cdf25bb
author_id_fullname_str_mv 6d62b2ed126961bed81a94a2beba8a01_***_Gareth Stratton
d89a0a3fb118e1cf625fddc68cdf25bb_***_Nils Swindell
author Gareth Stratton
Nils Swindell
author2 Maija Huttunen-Lenz
Sylvia Hansen
Anne Raben
Margriet Westerterp-Plantenga
Tanja Adam
Ian Macdonald
Gareth Stratton
Nils Swindell
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
format Journal article
container_title Journal of Primary Care & Community Health
container_volume 15
publishDate 2024
institution Swansea University
issn 2150-1319
2150-1327
doi_str_mv 10.1177/21501319241248223
publisher SAGE Publications
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
document_store_str 1
active_str 0
description 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.
published_date 2024-06-25T13:58:04Z
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