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Rantala E, Vanhatalo S, Valtanen M, Lindström J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Effectiveness of workplace choice architecture modification for healthy eating and daily physical activity. BMC Public Health 2024; 24:939. [PMID: 38561724 PMCID: PMC10986070 DOI: 10.1186/s12889-024-18482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Modifying the choice architecture of behavioural contexts can facilitate health behaviour change, but existing evidence builds mostly on small-scale interventions limited in duration, targets, strategies, and settings. We evaluated the effectiveness of a one-year hybrid type 2 implementation-effectiveness trial aimed at promoting healthy eating and daily physical activity with subtle modifications to the choice architecture of heterogeneous worksites. The intervention was contextualised to and integrated into the routine operations of each worksite. Effectiveness was evaluated in a quasi-experimental pre-post design. METHODS Intervention sites (n = 21) implemented a median of two (range 1-9) intervention strategies for healthy eating and one (range 1-5) for physical activity. Questionnaires pre (n = 1126) and post (n = 943) intervention surveyed employees' behavioural patterns at work (food consumption: vegetables/roots, fruit/berries, nuts/almonds/seeds, sweet treats, fast food, water; physical activity: restorative movement, exercise equipment use, stair use). The post-intervention questionnaire also measured employees' perception of and response to three intervention strategies: a packed lunch recipe campaign, a fruit crew-strategy, and movement prompts. Multi- and single-level regression models evaluated effectiveness, treating intervention as a continuous predictor formed of the site-specific dose (n intervention strategies employed) and mean quality (three-point rating per strategy halfway and at the end of the intervention) of implementation relevant to each outcome. RESULTS Multinomial logistic regression models found the intervention significantly associated with a favourable change in employees' fruit and berry consumption (interaction effect of time and implementation p = 0.006) and with an unfavourable change in sweet treat consumption (p = 0.048). The evidence was strongest for the finding concerning fruit/berry consumption-an outcome that sites with greater dose and quality of implementation targeted by using strategies that reduced the physical effort required to have fruit/berries at work and by covering multiple eating-related contexts at the worksite. The quality of implementation was positively associated with the perception of (p = 0.044) and response to (p = 0.017) the packed lunch recipes, and with response to the fruit crew-strategy (p < 0.001). CONCLUSIONS The results suggest that a contextualised, multicomponent choice architecture intervention can positively influence eating behaviour in diverse real-world settings over a one-year period, and that higher implementation quality can enhance intervention perception and response. However, outcomes may depend on the type of intervention strategies used and the extent of their delivery.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Mikko Valtanen
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
- Department of Mathematics and Statistics, University of Turku, 20014, Turku, Finland
| | - Jaana Lindström
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
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Rantala E, Vanhatalo S, Perez-Cueto FJA, Pihlajamäki J, Poutanen K, Karhunen L, Absetz P. Acceptability of workplace choice architecture modification for healthy behaviours. BMC Public Health 2023; 23:2451. [PMID: 38062407 PMCID: PMC10704714 DOI: 10.1186/s12889-023-17331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Altering the choice architecture of decision contexts can assist behaviour change, but the acceptability of this approach has sparked debate. Considering hypothetical interventions, people generally welcome the approach for promoting health, but little evidence exists on acceptance in the real world. Furthermore, research has yet to explore the implementers' perspective, acknowledging the multidimensionality of the acceptability construct. Addressing these knowledge gaps, this study evaluated the acceptability of a quasi-experimental implementation-effectiveness trial that modified the worksite choice architecture for healthy eating and daily physical activity. METHODS Fifty-three worksites participated in the 12-month intervention and implemented altogether 23 choice architecture strategies (Mdn 3/site), including point-of-choice prompts and changes to choice availability or accessibility. Retrospective acceptability evaluation built on deductive qualitative content analysis of implementer interviews (n = 65) and quantitative analysis of an employee questionnaire (n = 1124). Qualitative analysis examined implementers' thoughts and observations of the intervention and its implementation, considering six domains of the Theoretical Framework of Acceptability: ethicality, affective attitude, burden, intervention coherence, opportunity costs, and perceived effectiveness. Quantitative analysis examined employees' acceptance (7-point Likert scale) of eight specific intervention strategies using Friedman test and mixed-effects logistic regression. RESULTS Implementers considered the choice architecture approach ethical for workplace health promotion, reported mostly positive affective attitudes to and little burden because of the intervention. Intervention coherence supported acceptance through increased interest in implementation, whereas low perceived utility and high intensity of implementation reduced cost acceptance. Perceived effectiveness was mixed and varied along factors related to the implementer, social/physical work environment, employer, and employee. Employees showed overall high acceptance of evaluated strategies (Mdn 7, IQR 6.4-7), though strategies replacing unhealthy foods with healthier alternatives appeared less supported than providing information or enhancing healthy option availability or accessibility (p-values < 0.02). Greater proportion of male employees per site predicted lower overall acceptance (OR 4.4, 95% CI 1.2-16.5). CONCLUSIONS Work communities appear to approve workplace choice architecture interventions for healthy eating and physical activity, but numerous factors influence acceptance and warrant consideration in future interventions. The study contributes with a theory-based, multidimensional evaluation that considered the perspectives of implementers and influenced individuals across heterogeneous real-world settings.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
- VTT Technical Research Centre of Finland, Kuopio, 70211, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
- VTT Technical Research Centre of Finland, Kuopio, 70211, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
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Shakya S, Absetz P, Neupane S. Two-decade trends and factors associated with overweight and obesity among young adults in Nepal. PLOS Glob Public Health 2023; 3:e0002522. [PMID: 37906552 PMCID: PMC10617688 DOI: 10.1371/journal.pgph.0002522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
Overweight and obesity are global epidemics in the adult population, and also affect young people. This study estimated the long-term trend (1996-2019) of overweight and obesity among young adults aged 18 to 29 years in Nepal by sex based on the World Health Organization (WHO) and Asian cut-offs for body mass index (BMI). We also investigated the demographic factors associated with overweight and obesity in the latest survey. This study utilized data from nationwide studies, Demographic and Health Surveys (DHSs) and WHO STEPwise approach to surveillance (STEPS) surveys. The trends in overweight and obesity were studied using trend analysis and joinpoint regression. Average annual percent changes (AAPCs) and their 95% confidence intervals (CIs) were calculated for the trends. Multivariable logistic regression was used to study the factors associated with overweight and obesity. The study findings showed significant upward trends in both overweight and obesity for women with AAPCs of 10.5 (95% CI 6.4-14.7) and 15.8 (95% CI 10.9-20.8) respectively. In the 25-29 age-group, the prevalence of overweight/obesity increased among women from 2.2% to 24.7% between 1996 and 2019, and among men from 8.8% to 25.4% between 2007 and 2019. Increased odds of overweight (AOR 9.15, 95% CI 6.64-12.60), and obesity (AOR 42.09, 95% CI 10.12-175.04) were found in 2019 compared to 1996. Older age and female sex, being married and urban residence were significantly associated with overweight and obesity. In conclusion, this study showed rapid upward trends in overweight and obesity among young adults in Nepal with an accelerated trend among women; the predictors for overweight were older age, female sex and married status, and those for obesity were older age, female sex, and urban residence.
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Affiliation(s)
- Sujata Shakya
- Central Department of Public Health, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Bagmati Province, Nepal
| | - Pilvikki Absetz
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Subas Neupane
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Haregu T, Aziz Z, Cao Y, Sathish T, Thankappan KR, Panniyammakal J, Absetz P, Mathews E, Balachandran S, Fisher EB, Oldenburg B. A peer support program results in greater health benefits for peer leaders than other participants: evidence from the Kerala diabetes prevention program. BMC Public Health 2023; 23:1175. [PMID: 37337201 PMCID: PMC10278268 DOI: 10.1186/s12889-023-16049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/03/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Peer support programs are promising approaches to diabetes prevention. However, there is still limited evidence on the health benefits of peer support programs for lay peer leaders. PURPOSE To examine whether a peer support program designed for diabetes prevention resulted in greater improvements in health behaviors and outcomes for peer leaders as compared to other participants. METHODS 51 lay peer leaders and 437 participants from the Kerala Diabetes Prevention Program were included. Data were collected at baseline, 12 months, and 24 months. We compared behavioral, clinical, biochemical, and health-related quality of life parameters between peer leaders and their peers at the three time-points. RESULTS After 12 months, peer leaders showed significant improvements in leisure time physical activity (+ 17.7% vs. + 3.4%, P = 0.001) and health-related quality of life (0.0 vs. + 0.1, P = 0.004); and a significant reduction in alcohol use (-13.6% vs. -6.6%, P = 0.012) and 2-hour plasma glucose (-4.1 vs. + 9.9, P = 0.006), as compared to participants. After 24 months, relative to baseline, peer leaders had significant improvements in fruit and vegetable intake (+ 34.5% vs. + 26.5%, P = 0.017) and leisure time physical activity (+ 7.9% vs. -0.9%, P = 0.009); and a greater reduction in alcohol use (-13.6% vs. -4.9%, P = 0.008), and waist-to-hip ratio (-0.04 vs. -0.02, P = 0.014), as compared to participants. However, only the changes in fruit and vegetable intake and waist-to-hip ratio were maintained between 12 and 24 months. CONCLUSION Being a peer leader in a diabetes prevention program was associated with greater health benefits during and after the intervention period. Further studies are needed to examine the long-term sustainability of these benefits.
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Affiliation(s)
- Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Zahra Aziz
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Yingting Cao
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | | | | | - Jeemon Panniyammakal
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Science and Technology, Kerala, India
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Liedes H, Mattila E, Honka A, Absetz P, Aittola K, Manninen S, Lintu N, Schwab U, Eloranta AM, Umer A, Tilles-Tirkkonen T, Männikkö R, Ruotsalainen I, Van Gils M, Lindström J, Lakka T, Pihlajamäki J, Vuorinen AL. Associations Between Engagement with the BitHabit Digital Lifestyle Intervention and Changes in Type 2 Diabetes Risk Factors. Stud Health Technol Inform 2023; 302:1009-1010. [PMID: 37203555 DOI: 10.3233/shti230328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Type 2 diabetes (T2D) can be prevented or delayed through a healthy lifestyle. Digital behavior change interventions (DBCIs) may offer cost-effective and scalable means to support lifestyle changes. This study investigated associations between user engagement with a habit-formation-based DBCI, the BitHabit app, and changes in T2D risk factors over 12 months in 963 participants at risk of T2D. User engagement was characterized by calculating use metrics from the BitHabit log data. User ratings were used as a subjective measure of engagement. The use metrics and user ratings were the strongest associated with improvements in diet quality. Weak positive associations were observed between the use metrics and changes in waist circumference and body mass index. No associations were found with changes in physical activity, fasting plasma glucose, or plasma glucose two hours after an oral glucose tolerance test. To conclude, increased use of the BitHabit app can have beneficial impacts on T2D risk factors, especially on diet quality.
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Affiliation(s)
- Hilkka Liedes
- VTT Technical Research Centre of Finland Ltd., Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd., Finland
| | - Anita Honka
- VTT Technical Research Centre of Finland Ltd., Finland
| | | | | | | | | | - Ursula Schwab
- University of Eastern Finland, Finland
- Kuopio University Hospital, Finland
| | | | - Adil Umer
- VTT Technical Research Centre of Finland Ltd., Finland
| | | | - Reija Männikkö
- University of Eastern Finland, Finland
- Terveystalo Healthcare, Finland
| | | | | | | | - Timo Lakka
- University of Eastern Finland, Finland
- Kuopio University Hospital, Finland
- Kuopio Research Institute of Exercise Medicine, Finland
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Haregu T, Lekha TR, Jasper S, Kapoor N, Sathish T, Panniyammakal J, Tapp R, Thankappan KR, Mahal A, Absetz P, Fisher EB, Oldenburg B. The long-term effects of Kerala Diabetes Prevention Program on diabetes incidence and cardiometabolic risk: a study protocol. BMC Public Health 2023; 23:539. [PMID: 36945029 PMCID: PMC10030347 DOI: 10.1186/s12889-023-15392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION India currently has more than 74.2 million people with Type 2 Diabetes Mellitus (T2DM). This is predicted to increase to 124.9 million by 2045. In combination with controlling blood glucose levels among those with T2DM, preventing the onset of diabetes among those at high risk of developing it is essential. Although many diabetes prevention interventions have been implemented in resource-limited settings in recent years, there is limited evidence about their long-term effectiveness, cost-effectiveness, and sustainability. Moreover, evidence on the impact of a diabetes prevention program on cardiovascular risk over time is limited. OBJECTIVES The overall aim of this study is to evaluate the long-term cardiometabolic effects of the Kerala Diabetes Prevention Program (K-DPP). Specific aims are 1) to measure the long-term effectiveness of K-DPP on diabetes incidence and cardiometabolic risk after nine years from participant recruitment; 2) to assess retinal microvasculature, microalbuminuria, and ECG abnormalities and their association with cardiometabolic risk factors over nine years of the intervention; 3) to evaluate the long-term cost-effectiveness and return on investment of the K-DPP; and 4) to assess the sustainability of community engagement, peer-support, and other related community activities after nine years. METHODS The nine-year follow-up study aims to reach all 1007 study participants (500 intervention and 507 control) from 60 randomized polling areas recruited to the original trial. Data are being collected in two phases. In phase 1 (Survey), we are admintsering a structured questionnaire, undertake physical measurements, and collect blood and urine samples for biochemical analysis. In phase II, we are inviting participants to undergo retinal imaging, body composition measurements, and ECG. All data collection is being conducted by trained Nurses. The primary outcome is the incidence of T2DM. Secondary outcomes include behavioral, psychosocial, clinical, biochemical, and retinal vasculature measures. Data analysis strategies include a comparison of outcome indicators with baseline, and follow-up measurements conducted at 12 and 24 months. Analysis of the long-term cost-effectiveness of the intervention is planned. DISCUSSION Findings from this follow-up study will contribute to improved policy and practice regarding the long-term effects of lifestyle interventions for diabetes prevention in India and other resource-limited settings. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry-(updated from the original trial)ACTRN12611000262909; India: CTRI/2021/10/037191.
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Affiliation(s)
- Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - T R Lekha
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | | | | | - Thirunavukkarasu Sathish
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Robyn Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Research Centre for Intelligent Health Care, Coventry University, Coventry, UK
| | | | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Lakka TA, Aittola K, Järvelä-Reijonen E, Tilles-Tirkkonen T, Männikkö R, Lintu N, Karhunen L, Kolehmainen M, Harjumaa M, Mattila E, Järvenpää R, Ermes M, Mikkonen S, Martikainen J, Poutanen K, Schwab U, Absetz P, Lindström J, Pihlajamäki J. Real-world effectiveness of digital and group-based lifestyle interventions as compared with usual care to reduce type 2 diabetes risk - A stop diabetes pragmatic randomised trial. Lancet Reg Health Eur 2023; 24:100527. [PMID: 36620354 PMCID: PMC9810821 DOI: 10.1016/j.lanepe.2022.100527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background No real-world randomised controlled trials (RCTs) have explored the effectiveness of lifestyle interventions based on multiple behaviour change theories and using combined digital and group-based face-to-face delivery to improve risk factors for type 2 diabetes (T2D). Methods We conducted a one-year, multi-centre, unblinded, pragmatic RCT in primary healthcare using the habit formation, self-determination, and self-regulation theories among 2907 adults aged 18-74 years at increased T2D risk randomised into a digital lifestyle intervention group (DIGI, n = 967), a combined digital and group-based lifestyle intervention group (DIGI+GROUP, n = 971), and a control group receiving usual care (CONTROL, n = 969). We collected data on primary outcomes (diet quality by Healthy Diet Index [HDI], physical activity, body weight, fasting plasma glucose, 2-hour plasma glucose) and secondary outcomes (sedentary time, waist circumference, fasting plasma insulin) using digital questionnaires, clinical examinations, fasting blood tests, and 2-hour oral glucose tolerance tests. Main statistical analyses were performed using linear mixed-effects models adjusted for age, sex, and province. This RCT was registered with ClinicalTrials.gov, NCT03156478. Findings The 2907 participants assigned were recruited between March 1st, 2017, and February 28th, 2018. Diet quality improved more (3·2 vs. 1·4 HDI points, p<0·001 for difference between groups, p'<0·001 for group*time interaction) and waist circumference tended to decrease more (-1·8 vs. -1·3 cm, p = 0·028, p' = 0·068) in DIGI+GROUP than in CONTROL. Fasting insulin tended to increase in CONTROL but not in DIGI (1·0 vs. 0·0 mU/L, p = 0·033, p' = 0·054) or in DIGI+GROUP (1·0 vs. 0·5 mU/L, p = 0·042, p' = 0·054). Good adherence to DIGI and DIGI+GROUP (≥median of 501 habits/year in DIGI, ≥5 of all 6 sessions in GROUP) was associated with improved diet quality and good adherence to DIGI with increased physical activity and decreased sedentary time. Interpretation A lifestyle intervention based on multiple behaviour change theories and combined digital and group-based face-to-face delivery improves diet quality and tends to decrease abdominal adiposity and prevent an increase in insulin resistance. Good adherence improves the results of the interventions. Funding Strategic Research Council at Academy of Finland, Academy of Finland, Novo Nordisk Foundation, and Finnish Diabetes Research foundation.
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Affiliation(s)
- Timo A. Lakka
- Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Finland,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland,Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Kirsikka Aittola
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Niina Lintu
- Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Riia Järvenpää
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Finland,Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio Campus, Finland
| | - Janne Martikainen
- School of Pharmacy, University of Eastern Finland, Kuopio Campus, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio Finland
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland,Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio Finland,Corresponding author at: Dean of the Faculty of Health Sciences, Professor in Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
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Shakya S, Neupane S, Absetz P. Two-decade trends and factors associated with overweight and obesity among young adults in Nepal. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Young adults are vulnerable to obesity due to different life stresses and challenges, leading to risks of cardiovascular and metabolic disorders. Studies on the long-term trends of overweight and obesity, especially among young people in Nepal are scanty. The problems among this productive age group should be checked and prevented at the earliest. The study aimed to assess more than two decades of trends from 1996 to 2019 of overweight and obesity among Nepalese young adults (18-29 years) and the socio-demographic factors associated with it.
Methods
We utilized data from the nationwide Demographic and Health Survey (DHS) and WHO STEPwise approach to surveillance (STEPS) survey. These surveys adopted multistage stratified cluster sampling techniques and used house-to-house structured interviews for data collection. We assessed the prevalence of overweight (BMI 25-29.9 kg/m2) and obesity (BMI≥30 kg/m2) in 1996, 2001, 2006, 2011, 2012, 2016, and 2019 among 18,714 young adults in total, and evaluated the associated socio-demographic factors from the 2016 survey, using logistic regression model.
Results
The preliminary study findings showed that from 1996 to 2019, overweight in women increased from 1.5% to 17.0%, and obesity from 0.1% to 3.4%. For men, overweight rose from 14.4% to 16.6%, and obesity from 1.3% to 2.5% from 2012 to 2019. Higher age was associated with higher odds of overweight and obesity compared to a younger age. Men were less likely to have overweight (AOR: 0.68, CI: 0.53-0.88) and obesity (AOR: 0.42, CI: 0.23-0.78) compared to women. Moreover, urban residents had higher odds of having obesity (AOR: 2.35, CI: 1.25-4.44) compared to rural residents.
Conclusions
Overweight and obesity have rising trends among young adults in Nepal. Older age, female and urban residence were associated with higher odds of overweight and obesity. Therefore, the interventions targeted to the risk groups can help in curbing the increasing obesity trends in Nepal.
Key messages
• The information on trends and the factors associated with overweight and obesity may help to identify needs and opportunities to halt the rising obesity trend and prevent risk factors.
• The study findings can guide in formulating a national strategy to combat overweight and obesity among Nepalese youths.
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Affiliation(s)
- S Shakya
- Faculty of Social Sciences, Tampere University , Tampere, Finland
| | - S Neupane
- Faculty of Social Sciences, Tampere University , Tampere, Finland
| | - P Absetz
- Faculty of Social Sciences, Tampere University , Tampere, Finland
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Timm L, Annerstedt KS, Ahlgren JÁ, Absetz P, Alvesson HM, Forsberg BC, Daivadanam M. Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes. PLoS One 2022; 17:e0275576. [PMID: 36201441 PMCID: PMC9536591 DOI: 10.1371/journal.pone.0275576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm. Methods This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon’s TFA. Exploratory factor analysis (EFA) was performed. Results Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38–65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden. Conclusions The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon’s TFA, with a wider variation in perceived burden seen among high risk and younger participants.
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Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | | | - Jhon Álvarez Ahlgren
- Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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10
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Rantala E, Järvelä-Reijonen E, Pettersson K, Laine J, Vartiainen P, Närväinen J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Sensory Appeal and Routines Beat Health Messages and Visibility Enhancements: Mixed-Methods Analysis of a Choice-Architecture Intervention in a Workplace Cafeteria. Nutrients 2022; 14:nu14183731. [PMID: 36145107 PMCID: PMC9505513 DOI: 10.3390/nu14183731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Easier recognition and enhanced visibility of healthy options supposedly increase healthy choices, but real-world evidence remains scarce. Addressing this knowledge gap, we promoted nutritionally favourable foods in a workplace cafeteria with three choice-architectural strategies-priming posters, point-of-choice nutrition labels, and improved product placement-and assessed their effects on visual attention, food choices, and food consumption. Additionally, we developed a method for analysing real-world eye-tracking data. The study followed a pretest-posttest design whereby control and intervention condition lasted five days each. We monitored visual attention (i.e., total number and duration of fixations) and food choices with eye tracking, interviewed customers about perceived influences on food choices, and measured cafeteria-level food consumption (g). Individual-level data represents 22 control and 19 intervention participants recruited at the cafeteria entrance. Cafeteria-level data represents food consumption during the trial (556/589 meals sold). Results indicated that the posters and labels captured participants' visual attention (~13% of fixations on defined areas of interest before food choices), but the intervention had insignificant effects on visual attention to foods, on food choices, and on food consumption. Interviews revealed 17 perceived influences on food choices, the most common being sensory appeal, healthiness, and familiarity. To conclude, the intervention appeared capable of attracting visual attention, yet ineffective in increasing healthier eating. The developed method enabled a rigorous analysis of visual attention and food choices in a natural choice setting. We discuss ways to boost the impact of the intervention on behaviour, considering target groups' motives. The work contributes with a unique, mixed-methods approach and a real-world setting that enabled a multi-dimensional effects evaluation with high external validity.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Correspondence:
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Kati Pettersson
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Janne Laine
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Paula Vartiainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
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11
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Johnson LCM, Haregu T, Sathish T, De Man J, Desloge A, Absetz P, Williams ED, Thankappan KR, Oldenburg B. Effects of a lifestyle intervention on depression and anxiety among adults at risk for diabetes in India: A secondary analysis of the Kerala Diabetes Prevention Program. Prev Med 2022; 162:107172. [PMID: 35868455 DOI: 10.1016/j.ypmed.2022.107172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
The impact of lifestyle interventions on diabetes and mental health conditions have been documented among people with diabetes. However, the mental health benefits of lifestyle interventions designed for diabetes prevention have not been systematically investigated among people at high risk of diabetes, particularly in low- and middle-income countries. We examined the effects of a 12-month peer support lifestyle intervention designed for diabetes prevention on depression and anxiety symptomology in the sample population of the Kerala Diabetes Prevention Program. Mixed-effects linear regression models were used to examine the effect of the intervention on depression and anxiety scores at 12 and 24 months in the total sample of 1007 adults at risk for diabetes and among those with mild-severe depressive or anxiety symptoms at baseline (n = 326 for depression; n = 203 for anxiety). Among all participants, the intervention group had a significantly higher reduction of depressive symptoms as compared to the control group at 12 months (mean diff score = -0.51; 95% CI: -0.95, -0.07; P = 0.02). This effect was not sustained at 24 months. There were no significant intervention effects for anxiety. Among those with mild-severe symptoms at baseline, the intervention group had a significantly higher reduction of depressive symptoms (mean diff score = -1.55; 95% CI -2.50, -0.6; P = 0.001) and anxiety symptoms (mean diff score = -1.64; 95% CI -2.76, -0.52; P = 0.004) at 12 months. The effect was sustained at 24 months for depression, but not anxiety. Lifestyle interventions designed for prevention of diabetes might improve depressive and anxiety symptoms in the short-term, particularly among those with mild-severe symptoms.
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Affiliation(s)
- Leslie C M Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States of America.
| | - Tilahun Haregu
- Noncommunicable Disease Control Unit, Baker Heart & Diabetes Institute, Melbourne, Australia
| | | | - Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Allissa Desloge
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; MacMillan Center for International and Area Studies, Yale University, New Haven, CT, United States of America
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Emily D Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Brian Oldenburg
- Noncommunicable Disease Control Unit, Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Public Health, La Trobe University, Melbourne, Australia
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12
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Koller JE, Villinger K, Lages NC, Absetz P, Bamert M, Branquinho C, Chaves-Avilés L, Dimitropoulou P, Fernández-Fernández AL, Gaspar de Matos M, Griskevica I, Gutiérrez-Doña B, Hankonen N, Inauen J, Jordanova Peshevska D, Kassianos AP, Kolesnikova J, Lavrič M, Mitanovska T, Neter E, Poštuvan V, Trups-Kalne I, Vargas-Carmiol J, Schupp HT, Renner B. Individual and collective protective responses during the early phase of the COVID-19 pandemic in 10 different countries: Results from the EUCLID online survey. Int J Infect Dis 2022; 122:356-364. [PMID: 35709963 PMCID: PMC9190179 DOI: 10.1016/j.ijid.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In times of unprecedented infectious disease threats, it is essential to understand how to increase individual protective behaviors and support for collective measures. The present study therefore examines factors associated with individual and collective pathways. METHODS Data was collected through an online survey from 4483 participants (70.8% female, M = 41.2 years) across 10 countries from April 15, 2020 to June 2, 2020 as part of the "EUCLID" project (https://euclid.dbvis.de). Structural equation modeling was used to examine individual and collective pathways across and within countries. RESULTS Overall, the adoption of individual protective behaviors and support for collective measures were high. Risk perception on the individual level and perceived effectiveness at the collective level were positively associated with both individual protective behaviors and support for collective measures. Furthermore, the model explained considerable variance in individual (40.7%) and collective protective behaviors (40.8%) and was largely replicated across countries. CONCLUSIONS The study extends previous research by demonstrating that individual risk perception and perceived effectiveness of collective measures jointly affect individual protective health behaviors and support for collective measures. These findings highlight the need to jointly consider a variety of behavioral actions against infectious disease threats, acknowledging interactions between individual and collective pathways.
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Affiliation(s)
- Julia E. Koller
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Corresponding author: Julia E. Koller
| | - Karoline Villinger
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Applied Social and Health Psychology, Department of Psychology, University of Zurich, Switzerland,Corresponding author: Julia E. Koller
| | - Nadine C. Lages
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany
| | | | - Melanie Bamert
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | - Cátia Branquinho
- Institute of Environmental Health, Faculty of Medicine, University of Lisbon, Portugal
| | - Lourdes Chaves-Avilés
- Universidad Estatal a Distancia (UNED), Central Pacific Office (Parrita-Quepos), Costa Rica
| | | | | | | | - Inguna Griskevica
- Department of Health Psychology and Pedagogy, Riga Stradins University, Riga, Latvia
| | - Benicio Gutiérrez-Doña
- Research Vice-Rectory, Research Program in Psychological/Behavioral Sciences, Universidad Estatal a Distancia (UNED), San José, Costa Rica
| | | | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Switzerland
| | | | - Angelos P. Kassianos
- Department of Applied Health Research, UCL, London, UK,Department of Psychology, University of Cyprus, Cyprus
| | - Jelena Kolesnikova
- Department of Health Psychology and Pedagogy, Psychology laboratory, Riga Stradins University, Riga, Latvia
| | - Meta Lavrič
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska, Slovenia,Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Slovenia
| | - Tamara Mitanovska
- Neurovita - Center for Neuropsychology and Cognitive Psychology, Skopje, North Macedonia
| | - Efrat Neter
- Behavioral Sciences Department, Ruppin Academic Center, Israel
| | - Vita Poštuvan
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska, Slovenia,Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Slovenia
| | | | - Jorge Vargas-Carmiol
- Medicine School, Faculty of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Harald T. Schupp
- General and Biological Psychology, Department of Psychology, University of Konstanz, Germany,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
| | - Britta Renner
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Germany,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
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13
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van Olmen J, Absetz P, Mayega RW, Timm L, Delobelle P, Alvesson HM, Naggayi G, Kasujja F, Hassen M, de Man J, Sidney Annerstedt K, Puoane T, Östenson CG, Tomson G, Guwatudde D, Daivadanam M. Process evaluation of a pragmatic implementation trial to support self-management for the prevention and management of type 2 diabetes in Uganda, South Africa and Sweden in the SMART2D project. BMJ Open Diabetes Res Care 2022; 10:e002902. [PMID: 36162865 PMCID: PMC9516210 DOI: 10.1136/bmjdrc-2022-002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems. Process evaluations facilitate understanding why and how interventions work through analyzing the interaction between intervention theory, implementation and context. The Self-Management and Reciprocal Learning for Type 2 Diabetes project implemented and evaluated community-based interventions (peer support program; care companion; and link between facility care and community support) for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. RESEARCH DESIGN AND METHODS This paper reports implementation process outcomes across the three sites, guided by the Medical Research Council framework for complex intervention process evaluations. Data were collected through observations of peer support group meetings using a structured guide, and semistructured interviews with project managers, implementers, and participants. RESULTS The countries aligned implementation in accordance with the feasibility and relevance in the local context. In Uganda and Sweden, the implementation focused on peer support; in South Africa, it focused on the care companion part. The community-facility link received the least attention. Continuous capacity building received a lot of attention, but intervention reach, dose delivered, and fidelity varied substantially. Intervention-related and context-related barriers affected participation. CONCLUSIONS Identification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and flexibility in evaluation design to adapt to the complex nature of the intervention. When designing interventions, it is crucial to consider aspects of the implementing organization or structure, its absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale-up of complex interventions. TRIAL REGISTRATION NUMBER ISRCTN11913581.
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Affiliation(s)
- Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Pilvikki Absetz
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Timm
- Department of Global Health, Karolinska Institute, Stockholm, Sweden
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Rondebosch, Western Cape, South Africa
- Mental Health & Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Glorai Naggayi
- School of Public Health, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Francis Kasujja
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mariam Hassen
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jeroen de Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | | | - Thandi Puoane
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes-Göran Östenson
- Department of Global Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Goran Tomson
- Department of Global Health, Centrum för arbets- och miljömedicin, Stockholm, Sweden
| | - David Guwatudde
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Uppsala Universitet, Uppsala, Sweden
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14
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Aziz Z, Haregu T, Kyobutungi C, Yan L, Irazola V, Absetz P, Bandurek I, Roberts M, Vedanthan R, Folkes S, Cao Y, Wen Y, Aung MN, Danhieux K, Desloge A, Oldenburg B. Strengthening Capacity for Implementation Research Amid COVID-19 Pandemic: Learnings From the Global Alliance for Chronic Diseases Implementation Science School. Int J Public Health 2022; 67:1604944. [PMID: 36016964 PMCID: PMC9395543 DOI: 10.3389/ijph.2022.1604944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: To describe the design, delivery and evaluation of the 3rd Global Alliance for Chronic Diseases (GACD) Implementation Science School (ISS), delivered virtually in 2020 for the first time. Methods: Since 2014, GACD has supported the delivery of more than ten Implementation Science Workshops for more than 500 international participants. It has also been conducting an annual ISS since 2018. In this study, we described the design, delivery and evaluation of the third ISS. Results: Forty-six participants from 23 countries in five WHO regions attended the program. The virtual delivery was well-received and found to be efficient in program delivery, networking and for providing collaborative opportunities for trainees from many different countries. The recently developed GACD Implementation Science e-Hub was found to be an instrumental platform to support the program by providing a stand-alone, comprehensive online learning space for knowledge and skill development in implementation research. Conclusion: The delivery of the virtual GACD ISS proved to be feasible, acceptable and effective and offers greater scalability and sustainability as part of a future strategy for capacity strengthening in implementation research globally.
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Affiliation(s)
- Zahra Aziz
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- *Correspondence: Tilahun Haregu,
| | | | | | - Vilma Irazola
- Instituto de Efectividad Clinicay Sanitaria (IECS), Buenos Aires, Argentina
- Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Isobel Bandurek
- Global Alliance for Chronic Diseases, London, United Kingdom
| | - Morven Roberts
- Global Alliance for Chronic Diseases, London, United Kingdom
| | | | - Sheree Folkes
- Global Alliance for Chronic Diseases, London, United Kingdom
| | - Yingting Cao
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yu Wen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | | | | | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
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15
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Young LM, Moylan S, John T, Turner M, Opie R, Hockey M, Saunders D, Bruscella C, Jacka F, Teychenne M, Rosenbaum S, Banker K, Mahoney S, Tembo M, Lai J, Mundell N, McKeon G, Yucel M, Speight J, Absetz P, Versace V, Chatterton ML, Berk M, Manger S, Mohebbi M, Morgan M, Chapman A, Bennett C, O’Shea M, Rocks T, Leach S, O’Neil A. Evaluating telehealth lifestyle therapy versus telehealth psychotherapy for reducing depression in adults with COVID-19 related distress: the curbing anxiety and depression using lifestyle medicine (CALM) randomised non-inferiority trial protocol. BMC Psychiatry 2022; 22:219. [PMID: 35346115 PMCID: PMC8958477 DOI: 10.1186/s12888-022-03840-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. METHODS The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. DISCUSSION If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021.
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Affiliation(s)
- Lauren M. Young
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Steve Moylan
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Tayla John
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Megan Turner
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Rachelle Opie
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Meghan Hockey
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Dean Saunders
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Courtney Bruscella
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice Jacka
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Megan Teychenne
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Simon Rosenbaum
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Khyati Banker
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sophie Mahoney
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Monica Tembo
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Jerry Lai
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.474047.4Intersect Australia, Sydney, Australia
| | - Niamh Mundell
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Grace McKeon
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Murat Yucel
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Jane Speight
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,Diabetes Victoria, Melbourne, Australia
| | - Pilvikki Absetz
- grid.502801.e0000 0001 2314 6254Tampere University, Tampere, Finland
| | - Vincent Versace
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Michael Berk
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Sam Manger
- grid.1011.10000 0004 0474 1797James Cook University, Townsville, Australia
| | | | - Mark Morgan
- grid.1033.10000 0004 0405 3820Bond University, Gold Coast, Australia
| | - Anna Chapman
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Melissa O’Shea
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Tetyana Rocks
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | | | - Adrienne O’Neil
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
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16
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Lavikainen P, Mattila E, Absetz P, Harjumaa M, Lindström J, Järvelä-Reijonen E, Aittola K, Männikkö R, Tilles-Tirkkonen T, Lintu N, Lakka T, van Gils M, Pihlajamäki J, Martikainen J. Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial. J Med Internet Res 2022; 24:e31530. [PMID: 35200147 PMCID: PMC8914749 DOI: 10.2196/31530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. OBJECTIVE We aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. METHODS This is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. RESULTS More than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. CONCLUSIONS Distinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-6574-y.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Järvelä-Reijonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kirsikka Aittola
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Lakka
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.,Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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17
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Nekouei Marvi Langari M, Lindström J, Absetz P, Laatikainen T, Pihlajamäki J, Tilles-Tirkkonen T, Turunen H. Immigrants' perspectives on healthy life and healthy lifestyle counseling: a focus group study. Scand J Public Health 2022:14034948221075021. [PMID: 35130764 DOI: 10.1177/14034948221075021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immigrants have a higher risk of developing chronic diseases than the general population, but there is a lack of knowledge about appropriate counseling models to promote their health. This study aimed to explore Asian and Russian immigrants' perspectives in Finland on healthy lifestyle and healthy lifestyle counseling to improve the quality of the counseling in primary health care services to prevent type 2 diabetes and other chronic diseases. METHODS We conducted a qualitative study using semi-structured questions for eight focus groups. The participants were 46 adult immigrants (21 Asian and 25 Russian) living legally in Finland. Interviews were transcribed verbatim, coded, and analyzed using deductive content analysis. RESULTS We identified three themes regarding healthy lifestyle: (1) limited knowledge on different dimensions of healthy lifestyle, (2) understanding the impact of culture and community on healthy living, and (3) changing the lifestyle to live healthier after immigration. Moreover, we found three themes regarding healthy lifestyle counseling: (1) shortcomings in health care for providing healthy lifestyle counseling, such as lack of educational materials and miscommunication, (2) influential individual factors for using healthy lifestyle counseling, such as stress, and (3) positive outcomes of healthy lifestyle counseling. CONCLUSION Developing a culturally tailored healthy lifestyle counseling program for the enhancement of immigrants' knowledge regarding healthy lifestyle with consideration of cultural and linguistic aspects is recommended for preventing chronic diseases among immigrants.
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Affiliation(s)
- Maliheh Nekouei Marvi Langari
- Department of Nursing Science, University of Eastern Finland, Finland.,Finnish Institute for Health and Welfare, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Finland
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Faculty of Social Sciences, Tampere University, Finland.,Collaborative Care Systems, Finland
| | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Finland
| | - Jussi Pihlajamäki
- Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Finland
| | - Tanja Tilles-Tirkkonen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Finland.,Kuopio University Hospital, Finland
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18
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Guwatudde D, Delobelle P, Absetz P, Van JO, Mayega RW, Kasujja FX, De Man J, Hassen M, Kiracho EE, Kiguli J, Puoane T, Ostenson CG, Peterson S, Daivadanam M. Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial. PLOS Glob Public Health 2022; 2:e0000425. [PMID: 36962331 PMCID: PMC10021626 DOI: 10.1371/journal.pgph.0000425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/04/2022] [Indexed: 01/02/2023]
Abstract
Health systems in many low- and middle-income countries are struggling to manage type 2 diabetes (T2D). Management of glycaemia via well-organized care can reduce T2D incidence, and associated morbidity and mortality. The primary aim of this study was to evaluate the effectiveness of facility plus community care interventions (integrated care), compared to facility only care interventions (facility care) towards improvement of T2D outcomes in Uganda and South Africa. A pragmatic cluster randomized trial design was used to compare outcomes among participants with T2D and those at high risk. The trial had two study arms; the integrated care arm, and the facility care arm; and in Uganda only, an additional usual care arm. Participants were enrolled at nine primary health facilities in Uganda, and two in South Africa. Participants were adults aged 30 to 75 years, and followed for up to 12 months. Primary outcomes were glycaemic control among participants with T2D, and reduction in HbA1c > = 3 mmol/mol among participants at high risk. Secondary outcomes were retention into care and incident T2D. Adjusted analysis revealed significantly higher retention into care comparing integrated care and facility care versus usual care in Uganda and integrated care versus facility care in South Africa. The effect was particularly high among participants at high risk in Uganda with an incident rate ratio of 2.46 [1.33-4.53] for the facility care arm and 3.52 [2.13-5.80] for the integrated care arm. No improvement in glycaemic control or reduction in HbA1c was found in either country. However, considerable and unbalanced loss to follow-up compromised assessment of the intervention effect on HbA1c. Study interventions significantly improved retention into care, especially compared to usual care in Uganda. This highlights the need for adequate primary care for T2D and suggest a role for the community in T2D prevention. Trial registration number: ISRCTN11913581.
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Affiliation(s)
- David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Josefien Olmen Van
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Mariam Hassen
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Elizabeth Ekirapa Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Claes-Goran Ostenson
- Department of Molecular Medicine & Surgery, Diabetes & Endocrine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Peterson
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Meena Daivadanam
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- International Child Health & Nutrition Research Group, Uppsala University, Uppsala, Sweden
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19
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Chen M, Moran LJ, Harrison CL, Ukke GG, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Lim S. Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis. Obes Rev 2022; 23:e13340. [PMID: 34528393 DOI: 10.1111/obr.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Christie J Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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20
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Chen M, Ukke GG, Moran LJ, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Harrison CL, Lim S. The Effect of Lifestyle Intervention on Diabetes Prevention by Ethnicity: A Systematic Review of Intervention Characteristics Using the TIDieR Framework. Nutrients 2021; 13:4118. [PMID: 34836372 PMCID: PMC8624360 DOI: 10.3390/nu13114118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (≥12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Christie J. Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC 3168, Australia;
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
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21
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Mustonen E, Hörhammer I, Patja K, Absetz P, Lammintakanen J, Talja M, Kuronen R, Linna M. Eight-year post-trial follow-up of morbidity and mortality of telephone health coaching. BMC Health Serv Res 2021; 21:1237. [PMID: 34781936 PMCID: PMC8594149 DOI: 10.1186/s12913-021-07263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF).. Methods 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis. Results The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study. Conclusions No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching. Trial registration NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07263-w.
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Affiliation(s)
- Erja Mustonen
- Social and Health Care Reform, Finnish Institute for Health and Welfare, PL 30, 00271, Helsinki, Finland.
| | - Iiris Hörhammer
- Healthcare Engineering, Management and Architecture Institute, Aalto University, PL 11000, 00076, Espoo, AALTO, Finland
| | - Kristiina Patja
- Department of Public Health, University of Helsinki, Yliopistonkatu 4, 00100, Helsinki, Finland
| | | | | | - Martti Talja
- Päijät-Häme Joint Authority for Health and Wellbeing, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Risto Kuronen
- Päijät-Häme Joint Authority for Health and Wellbeing, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Miika Linna
- Healthcare Engineering, Management and Architecture Institute, Aalto University, PL 11000, 00076, Espoo, AALTO, Finland
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22
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Aittola K, Karhunen L, Männikkö R, Järvelä-Reijonen E, Mikkonen S, Absetz P, Kolehmainen M, Schwab U, Harjumaa M, Lindström J, Lakka T, Tilles-Tirkkonen T, Pihlajamäki J. Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes. Nutrients 2021; 13:nu13114030. [PMID: 34836283 PMCID: PMC8624442 DOI: 10.3390/nu13114030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/15/2023] Open
Abstract
Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.
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Affiliation(s)
- Kirsikka Aittola
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Correspondence: ; Tel.: +358-50-5167269
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland;
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Collaborative Care Systems Finland, 00270 Helsinki, Finland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd., 02044 Espoo, Finland;
| | - Jaana Lindström
- Department of Public Health and Welfare, National Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Timo Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, 70100 Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (L.K.); (R.M.); (E.J.-R.); (P.A.); (M.K.); (U.S.); (T.T.-T.); (J.P.)
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, 70029 Kuopio, Finland
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23
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Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Mølsted Alvesson H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients 2021; 13:nu13113862. [PMID: 34836116 PMCID: PMC8618573 DOI: 10.3390/nu13113862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants’ needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.
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Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Correspondence:
| | - Ida Karlsson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22 Uppsala, Sweden
| | - Helle Mølsted Alvesson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
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24
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Rantala E, Vanhatalo S, Tilles-Tirkkonen T, Kanerva M, Hansen PG, Kolehmainen M, Männikkö R, Lindström J, Pihlajamäki J, Poutanen K, Karhunen L, Absetz P. Choice Architecture Cueing to Healthier Dietary Choices and Physical Activity at the Workplace: Implementation and Feasibility Evaluation. Nutrients 2021; 13:nu13103592. [PMID: 34684592 PMCID: PMC8538928 DOI: 10.3390/nu13103592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023] Open
Abstract
Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, targeting the environment of 53 diverse worksites. The intervention was conducted within a type 2 diabetes prevention study, StopDia. We assessed feasibility through the fidelity, facilitators and barriers, and maintenance of implementation, building on implementer interviews (n = 61 informants) and observations of the worksites at six (t1) and twelve months (t2). We analysed quantitative data with Kruskall-Wallis and Mann-Whitney U tests and qualitative data with content analysis. Intervention sites altogether implemented 23 various choice architectural strategies (median 3, range 0-14 strategies/site), employing 21 behaviour change mechanisms. Quantitative analysis found implementation was successful in 66%, imperfect in 25%, and failed in 9% of evaluated cases. These ratings were independent of the ease of implementation of applied strategies and reminders that implementers received. Researchers' assistance in intervention launch (p = 0.02) and direct contact to intervention sites (p < 0.001) predicted higher fidelity at t1, but not at t2. Qualitative content analysis identified facilitators and barriers related to the organisation, intervention, worksite environment, implementer, and user. Contributors of successful implementation included apt implementers, sufficient implementer training, careful planning, integration into worksite values and activities, and management support. After the study, 49% of the worksites intended to maintain the implementation in some form. Overall, the choice architecture approach seems suitable for workplace health promotion, but a range of practicalities warrant consideration while designing real-world implementation.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
- Correspondence:
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Markus Kanerva
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- D Department, Tikkurila Campus, Laurea University of Applied Sciences, Ratatie 22, 01300 Vantaa, Finland
| | - Pelle Guldborg Hansen
- Department of Communication, Business & Information Technologies, Universitetsvej 1, Roskilde University, 4000 Roskilde, Denmark;
| | - Marjukka Kolehmainen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Jaana Lindström
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044 Espoo, Finland; (S.V.); (M.K.); (K.P.)
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (T.T.-T.); (M.K.); (R.M.); (J.P.); (L.K.); (P.A.)
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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25
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Jalkanen K, Järvenpää R, Tilles-Tirkkonen T, Martikainen J, Aarnio E, Männikkö R, Rantala E, Karhunen L, Kolehmainen M, Harjumaa M, Poutanen K, Ermes M, Absetz P, Schwab U, Lakka T, Pihlajamäki J, Lindström J. Comparison of Communication Channels for Large-Scale Type 2 Diabetes Risk Screening and Intervention Recruitment: Empirical Study. JMIR Diabetes 2021; 6:e21356. [PMID: 34499036 PMCID: PMC8461532 DOI: 10.2196/21356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/26/2020] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention. Objective This study aims to compare the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire, with emphasis on reaching those at most risk. The participants expressing their willingness to participate is the final step in the risk screening test, and we aim to determine which channels had the most participants reach this step. Methods We established a stepwise web-based T2D risk screening tool with automated feedback according to the T2D risk level and, for those who were eligible, an invitation to participate in the StopDia prevention intervention study conducted in a primary health care setting. The risk estimate was based on the Finnish Diabetes Risk Score; history of repeatedly measured high blood glucose concentration; or, among women, previous gestational diabetes. We used several channels to invite people to the StopDia web-based screening tool, and respondents were classified into 11 categories based on the channel through which they reported having learned about StopDia. The demographics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through risk screening steps. Results A total of 33,399 persons started filling the StopDia screening tool. Of these, 86.13% (28,768/33,399) completed the test and named at least one communication channel as the source of information about StopDia. Altogether, 26,167 persons filled in sufficient information to obtain risk estimates. Of them, 53.22% (13,925/26,167) were at increased risk, 30.06% (7866/26,167) were men, and 39.77% (10,136/25,485) had low or middle education levels. Most frequently mentioned channels were workplace (n=6817), social media or the internet (n=6712), and newspapers (n=4784). The proportion of individuals at increased risk was highest among those reached via community pharmacies (415/608, 68.3%) and health care (1631/2535, 64.33%). The communication channel reaching the largest percentage of interested and eligible men (1353/3979, 34%) was relatives or friends. Health care (578/1069, 54.07%) and radio or television (225/487, 46.2%) accounted for the largest proportion of people with lower education. Conclusions Communication channels reaching a large number of people, such as social media and newspapers, were the most effective channels for identifying at-risk people. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with a particularly high T2D risk. Thus, communication and recruitment channels should be selected and modified based on the intended target group. International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-6574-y
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Affiliation(s)
- Kari Jalkanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riia Järvenpää
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Emma Aarnio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Eeva Rantala
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Leila Karhunen
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Marjukka Kolehmainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Timo Lakka
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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26
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Chen M, Ukke G, Sood S, Bennett C, Khomami M, Moran L, Harrison C, Absetz P, Teede H, Lim S. 1386Ethnic differences in lifestyle interventions for diabetes prevention: a systematic review and meta-analysis. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The risk of type 2 diabetes varies by ethnicity, but ethnic differences in response to lifestyle interventions for diabetes prevention remain unclear. This systematic review and meta-analysis aimed to assess differences in the effects of lifestyle interventions on diabetes incidence, glycemic outcomes and anthropometric measures between ethnic groups.
Methods
MEDLINE, EMBASE, Pubmed, CINAHL, PsycInfo and EBM Reviews were searched (to June 2020) with no language restriction for randomized and non-randomized controlled trials on lifestyle interventions involving diet and/or physical activity in adults at risk of type 2 diabetes. Ethnicity was categorized into European, South Asian, Other Asian, Middle Eastern, Latin American and African groups based on the World Bank regions. Risk ratios for diabetes incidence and mean differences for glycemic outcomes (fasting glucose, 2-h glucose, HbA1c) and anthropometric measures (weight, BMI, waist circumference) were pooled using random-effects meta-analysis.
Results
Sixty articles representing 43 studies (18,691 participants) were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in diabetes incidence, glycemic outcomes and anthropometric measures compared with controls (all P<0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI and waist circumference (all P<0.05) but not for diabetes incidence, fasting glucose and HbA1c (all P>0.05).
Conclusions
Lifestyle interventions are similarly effective in reducing diabetes incidence, fasting glucose and HbA1c for all ethnic groups, however, 2-h glucose and anthropometric outcomes should be optimized in certain ethnic groups.
Key messages
Lifestyle intervention is likely effective in preventing the progression to type 2 diabetes equally across all ethnic groups.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Gebresilasea Ukke
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Australia
| | - Mahnaz Khomami
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
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27
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Absetz P, Van Olmen J, Guwatudde D, Puoane T, Alvesson HM, Delobelle P, Mayega R, Kasujja F, Naggayi G, Timm L, Hassen M, Aweko J, De Man J, Álvarez Ahlgren J, Annerstedt KS, Daivadanam M. SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden. Transl Behav Med 2021; 10:25-34. [PMID: 32011719 DOI: 10.1093/tbm/ibz188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.
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Affiliation(s)
| | - Josefien Van Olmen
- Department of Primary and Interdisciplinary Care, University of Antwerp 2000, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Thandi Puoane
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Peter Delobelle
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa.,Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - Roy Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Francis Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Gloria Naggayi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Linda Timm
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Mariam Hassen
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Juliet Aweko
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Jeroen De Man
- Department of Primary and Interdisciplinary Care, University of Antwerp 2000, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jhon Álvarez Ahlgren
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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28
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Johnson LCM, Desloge A, Sathish T, Williams ED, Absetz P, Haregu T, De Man J, Thankappan KR, Oldenburg B. The relationship between common mental disorders and incident diabetes among participants in the Kerala Diabetes Prevention Program (K-DPP). PLoS One 2021; 16:e0255217. [PMID: 34297780 PMCID: PMC8301665 DOI: 10.1371/journal.pone.0255217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
This study aims to describe the prevalence of depression and anxiety among a population sample of people at high risk for type 2 diabetes in Kerala, India, and examine the relationship between depressive symptoms, anxiety, and incident Type 2 Diabetes Mellitus (T2DM) over a two-year period. We used data from the Kerala Diabetes Prevention Program, a cluster-randomized controlled trial for diabetes prevention among 1007 high-risk individuals. The prevalence of depression and anxiety were estimated using the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder 7-item scale, respectively. We calculated proportions for depression and anxiety and performed generalized estimating equations (GEE) to examine the relationship between baseline mental health status and incident T2DM. The prevalence of depression and anxiety at baseline were 7.5% and 5.5%, respectively. Compared with those reporting none/low symptoms, the odds ratio for incident diabetes was 1.07 (95% CI 0.54–2.12) for participants with moderate to severe depression and 0.73 (95% CI 0.23–2.28) for participants with moderate to severe anxiety, after adjusting for potential confounders. Our findings suggest that the prevalence of depression and anxiety were higher than those previously reported in the general population in India. However, among this sample of community-based adults at high risk of developing T2DM, the presence of moderate to severe depression and/or anxiety symptoms was not significantly associated with the risk of developing T2DM. Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909. Registered 10 March 2011.
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Affiliation(s)
- Leslie C. M. Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Allissa Desloge
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MacMillan Center for International and Area Studies, Yale University, New Haven, Connecticut, United States of America
| | - Thirunavukkarasu Sathish
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Tampere University, Tampere, Finland
| | - Tilahun Haregu
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | | | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Roponen J, Ruusunen A, Absetz P, Partonen T, Kuvaja-Köllner V, Hujo M, Nuutinen O. Nutrition-focused group intervention with a strength-based counseling approach for people with clinical depression: a study protocol for the Food for Mind randomized controlled trial. Trials 2021; 22:344. [PMID: 34001230 PMCID: PMC8127236 DOI: 10.1186/s13063-021-05279-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/17/2021] [Indexed: 02/18/2023] Open
Abstract
Background Depression is a highly prevalent mental disorder with major public health effects globally. It impairs the quality of life and reduces the ability to work and function, leading to increasing costs of sick leaves and disability pensions. Current treatment strategies focus on biological and psychological pathways while understating the role of lifestyle factors. Epidemiological studies have shown convincing evidence of an inverse relationship between diet quality and depression. However, only limited data are available on the therapeutic effects of diet quality improvement on depression. Using a randomized controlled trial design, our primary aim is to investigate the effectiveness and cost-effectiveness of a behavioral nutrition group intervention compared to a social support intervention in the treatment of depression. Methods Participants (N=144, aged 20–65 years) with a diagnosis of moderate or severe depression recruited in collaboration with outpatient care units will be randomized into two arms: Food for Mind (FM) nutrition intervention (n=72) or Bring Good Mood (BGM) social support control group (n=72). Both arms will be provided with 6 group sessions over an 8-week period. FM involves improving diet quality by applying strength-based behavioral nutrition counseling and activities facilitated by a registered dietitian. The control arm comprises a befriending protocol. During the interventions, all participants will continue their treatment for depression as usual. Longitudinal data are collected at baseline, at 8 weeks, and at 6- and 12-month follow-ups. Depressive symptoms, diet quality, eating behavior, ability to work and function, and quality of life are assessed by self-reported questionnaires. A treatment expectancy questionnaire will be administered at baseline and an acceptability questionnaire at 8 weeks. The Center for Epidemiologic Studies Depression Scale is used as the primary endpoint at 1 year. The results will be analyzed with linear mixed-effects models. Economic evaluation includes both cost-effectiveness and cost-utility analysis. Two incremental cost-effectiveness ratios will be calculated to evaluate the incremental cost per QALY and the incremental cost per improvement in CES-D. Discussion If the intervention proves to be cost-effective and acceptable, it be can be implemented in healthcare to support the treatment of depression. Trial registration ClinicalTrials.gov NCT03904771. Retrospectively registered on 5 April 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05279-5.
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Affiliation(s)
- Johanna Roponen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Geelong, Victoria, Australia
| | | | - Timo Partonen
- Finnish Institute for Health and Welfare (THL), Department of Public Health and Welfare, Helsinki, Finland
| | - Virpi Kuvaja-Köllner
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Mika Hujo
- Faculty of Science and Forestry, School of Computing, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Outi Nuutinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
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De Man J, Absetz P, Sathish T, Desloge A, Haregu T, Oldenburg B, Johnson LCM, Thankappan KR, Williams ED. Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis. Front Psychol 2021; 12:676398. [PMID: 34054677 PMCID: PMC8155718 DOI: 10.3389/fpsyg.2021.676398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cross-cultural evidence on the factorial structure and invariance of the PHQ-9 and the GAD-7 is lacking for South Asia. Recommendations on the use of unit-weighted scores of these scales (the sum of items' scores) are not well-founded. This study aims to address these contextual and methodological gaps using data from a rural Indian population. METHODS The study surveyed 1,209 participants of the Kerala Diabetes Prevention Program aged 30-60 years (n at risk of diabetes = 1,007 and n with diabetes = 202). 1,007 participants were surveyed over 2 years using the PHQ-9 and the GAD-7. Bifactor-(S - 1) modeling and multigroup confirmatory factor analysis were used. RESULTS Factor analysis supported the existence of a somatic and cognitive/affective subcomponent for both scales, but less explicitly for the GAD-7. Hierarchical omega values were 0.72 for the PHQ-9 and 0.76 for the GAD-7. Both scales showed full scalar invariance and full or partial residual invariance across age, gender, education, status of diabetes and over time. Effect sizes between categories measured by unit-weighted scores versus latent means followed a similar trend but were systematically higher for the latent means. For both disorders, female gender and lower education were associated with higher symptom severity scores, which corresponds with regional and global trends. CONCLUSIONS For both scales, psychometric properties were comparable to studies in western settings. Distinct clinical profiles (somatic-cognitive) were supported for depression, and to a lesser extent for anxiety. Unit-weighted scores of the full scales should be used with caution, while scoring subscales is not recommended. The stability of these scales supports their use and allows for meaningful comparison across tested subgroups. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336603&isReview=true.
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Affiliation(s)
- Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Tampere University, Tampere, Finland
- University of Eastern Finland, Kuopio, Finland
| | | | - Allissa Desloge
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leslie C. M. Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
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Lu S, He Y, Searle K, Absetz P, Oldenburg B, Reavley N. Using Stakeholder Perceptions to Inform Future Efforts to Implement Mental Health First Aid Training in China: A Qualitative Study. Front Psychiatry 2021; 12:557282. [PMID: 33935815 PMCID: PMC8081887 DOI: 10.3389/fpsyt.2021.557282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Mental Health First Aid (MHFA) training program has been widely implemented in many high-income countries. Evidence on the adaptation of this and other similar programs in resource-constrained settings like China is very limited. This study aimed to explore the views of key stakeholders on the implementation issues and contextual factors relevant to the scale-up of MHFA in China. Methods: Informed by the Consolidated Framework for Implementation Research, five implementation domains of intervention characteristics, characteristics of individuals, contextual adaptation, outer and inner setting, and implementation process were investigated through semi-structured in-depth interviews. Twenty-four stakeholders with diverse expertise in the Chinese mental health system were interviewed. Transcripts were coded using NVivo 12 software and thematically analyzed. Results: Fifteen themes and 52 sub-themes were identified in relation to the five domains. Participants saw MHFA as meeting the need for more evidence-based interventions to improve population mental health. Previous participants in MHFA training were satisfied with the course, but their intentions to help and levels of self-efficacy varied. Contextual adaptation of course content, delivery formats, and financing models, was seen as essential. External health policies and some socioeconomic factors (e.g., improved living conditions) were perceived as potential enablers of scalability. Low levels of engagement in health interventions and lack of supportive social norms were identified as potential barriers while executive support, quality control, and sustainable funding were viewed as facilitators of implementation. Conclusion: MHFA training meets some very important current societal and public health needs in China. To achieve its potential impact, significant contextual adaptation is required, particularly in terms of course content, delivery formats, and financing models. Overcoming low levels of engagement in community-based mental health interventions and combating stigma will also be critical for its scale-up.
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Affiliation(s)
- Shurong Lu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Yanling He
- Shanghai Mental Health Centre, Shanghai, China
| | - Kendall Searle
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Collaborative Care Systems Finland, Helsinki, Finland
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Äikäs A, Absetz P, Hirvensalo M, Pronk N. Eight-Year Health Risks Trend Analysis of a Comprehensive Workplace Health Promotion Program. Int J Environ Res Public Health 2020; 17:E9426. [PMID: 33339189 PMCID: PMC7765570 DOI: 10.3390/ijerph17249426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
Research has shown that workplace health promotion (WHP) efforts can positively affect employees' health risk accumulation. However, earlier literature has provided insights of health risk changes in the short-term. This prospective longitudinal quasi-experimental study investigated trends in health risks of a comprehensive, eight-year WHP program (n = 523-651). Health risk data were collected from health risk assessments in 2010-2011, 2013-2014, and 2016-2017, applying both a questionnaire and biometric screenings. Health risk changes were investigated for three different time-periods, 2010-2013, 2014-2017, and 2010-2017, using descriptive analyses, t-tests, and the Wilcoxon Signed Rank and McNemar's test, where appropriate. Overall health risk transitions were assessed according to low-, moderate-, and high-risk categories. Trend analyses observed 50-60% prevalence for low-, 30-35% for moderate-, and 9-11% high-risk levels across the eight years. In the overall health risk transitions of the three time-periods, 66-73% of participants stayed at the same risk level, 13-15% of participants improved, and 12-21% had deteriorated risk level across the three intervention periods. Our findings appear to indicate that the multiyear WHP program was effective in maintaining low and moderate risk levels, but fell short of reducing the total number of health risks at the population level.
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Affiliation(s)
- Antti Äikäs
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland;
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Mirja Hirvensalo
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland;
| | - Nicolaas Pronk
- HealthPartners Institute, HealthPartners, Bloomington, MN 55420, USA;
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Hankonen N, Absetz P, Araújo-Soares V. Changing activity behaviours in vocational school students: the stepwise development and optimised content of the 'let's move it' intervention. Health Psychol Behav Med 2020; 8:440-460. [PMID: 34040880 PMCID: PMC8114352 DOI: 10.1080/21642850.2020.1813036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: School-based interventions that increase physical activity (PA) in a sustainable way are lacking. Systematic and participatory, theory and evidence-based intervention development may enhance the effectiveness of complex behavioural interventions in the long term. However, detailed descriptions of the intervention development process are rarely openly published, hindering transparency and progress in the field. Aims: To illustrate a stepwise process to develop intervention targeting PA and sedentary behaviour (SB) among older adolescents, and to describe the final, optimised version of the intervention, detailing content of sessions by theoretical determinants and techniques. Methods: Two established intervention development frameworks (Intervention Mapping and Behaviour Change Wheel) were integrated, leading to a comprehensive evidence and theory-based process. It was informed by empirical studies, literature reviews, expert and stakeholder consultation, including scenario evaluation and component pre-testing. In all steps, contextual fit and potential for sustainability were ensured by stakeholder engagement. Results: As a large majority of youth opposed decreasing screen time, increasing PA and decreasing SB were defined as target behaviours, with peers and the school context including classroom practices as key social environments in influencing youth PA (problem specification, step 1). Behavioural diagnosis (step 2) identified a variety of determinants in the domains of capability (e.g. self-regulation skills), motivation (e.g. outcome expectations) and environmental opportunities. These were organised into an intervention theory integrating several formal theories, including Self-Determination Theory. Theory-aligned principles guided material design (Step 3). Feasibility RCT allowed optimisation into a final intervention protocol (step 4). Conclusions: Intervention elements target students directly, and indirectly by changing teacher behaviour and the school and wider environment. A systematic development and optimisation led to a high potential for sustainability. The detailed intervention content, with specification of the hypothesised mechanisms, allows for other researchers to replicate, adapt or refine parts or the whole intervention, considering specific target groups and (sub-)cultures.
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Affiliation(s)
- Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland
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Sathish T, Oldenburg B, Thankappan KR, Absetz P, Shaw JE, Tapp RJ, Zimmet PZ, Balachandran S, Shetty SS, Aziz Z, Mahal A. Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting: Trial-based analysis of the Kerala Diabetes Prevention Program. BMC Med 2020; 18:251. [PMID: 32883279 PMCID: PMC7472582 DOI: 10.1186/s12916-020-01704-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from high-income countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. METHODS The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial of 1007 individuals conducted in 60 polling areas (electoral divisions) in Kerala state. Participants (30-60 years) were those with a high diabetes risk score and without diabetes on an oral glucose tolerance test. The intervention group received a 12-month peer-support lifestyle intervention involving 15 group sessions delivered in community settings by trained lay peer leaders. There were also linked community activities to sustain behavior change. The control group received a booklet on lifestyle change. Costs were estimated from the health system and societal perspectives, with 2018 as the reference year. Effectiveness was measured in terms of the number of diabetes cases prevented and quality-adjusted life years (QALYs). Three times India's gross domestic product per capita (US$6108) was used as the cost-effectiveness threshold. The analyses were conducted with a 2-year time horizon. Costs and effects were discounted at 3% per annum. One-way and multi-way sensitivity analyses were performed. RESULTS Baseline characteristics were similar in the two study groups. Over 2 years, the intervention resulted in an incremental health system cost of US$2.0 (intervention group: US$303.6; control group: US$301.6), incremental societal cost of US$6.2 (intervention group: US$367.8; control group: US$361.5), absolute risk reduction of 2.1%, and incremental QALYs of 0.04 per person. From a health system perspective, the cost per diabetes case prevented was US$95.2, and the cost per QALY gained was US$50.0. From a societal perspective, the corresponding figures were US$295.1 and US$155.0. For the number of diabetes cases prevented, the probability for the intervention to be cost-effective was 84.0% and 83.1% from the health system and societal perspectives, respectively. The corresponding figures for QALY gained were 99.1% and 97.8%. The results were robust to discounting and sensitivity analyses. CONCLUSIONS A community-based peer-support lifestyle intervention was cost-effective in individuals at high risk of developing diabetes in India over 2 years. TRIAL REGISTRATION The trial was registered with Australia and New Zealand Clinical Trials Registry ( ACTRN12611000262909 ). Registered 10 March 2011.
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Affiliation(s)
- Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada.
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Australia
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Robyn J Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, Australia
| | - Paul Z Zimmet
- Central Clinical School, Monash University, Melbourne, UK
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Population Research Centre, University of Kerala, Trivandrum, Kerala, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Zahra Aziz
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Kerala, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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De Man J, Wouters E, Delobelle P, Puoane T, Daivadanam M, Absetz P, Remmen R, van Olmen J. Testing a Self-Determination Theory Model of Healthy Eating in a South African Township. Front Psychol 2020; 11:2181. [PMID: 32982885 PMCID: PMC7477942 DOI: 10.3389/fpsyg.2020.02181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/03/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The burden of type 2 diabetes is growing rapidly in sub-Saharan Africa. Healthy eating has been shown to prevent the disease but is challenging to maintain. Self-determination theory offers a motivational framework for maintaining a healthy diet based on evidence from western settings. This study aims to assess whether self-determination theory can explain healthy diet behavior in a disadvantaged urban South African population. METHODS Cross-sectional data from a South African township population (N = 585; pre-diabetes = 292, diabetes = 293, age 30-75) were analyzed using structural equation modeling, while controlling for socio-demographic factors. Measures included self-reported autonomous and controlled motivation, perceived competence (measured through barrier self-efficacy), perceived relatedness (measured through perceived participation of significant others) and, as indicator for healthy diet, frequency of fruit, vegetable, and non-refined starch intake. RESULTS Healthy eating was positively associated (β = 0.26) with autonomous motivation, and negatively associated (β = -0.09) with controlled motivation. Perceived competence and relatedness were positively associated with healthy eating (β = 0.49 and 0.37) and autonomous motivation (β = 0.65 and 0.35), and negatively associated with controlled motivation (β = -0.26 and -0.15). Autonomous motivation mediated the effect of perceived competence and relatedness on healthy eating. The model supported a negative association between controlled and autonomous motivation. CONCLUSION This is the first study providing evidence for self-determination theory explaining healthy eating in a disadvantaged sub-Saharan African setting among people at risk of or with diabetes type two. Our findings suggest that individuals who experience support from friends or family and who feel competent in adopting a healthy diet are more likely to become more motivated through identifying the health benefits of healthy eating as their goal. This type of autonomous motivation was associated with a healthier diet compared to individuals whose motivation originated in pressure from others or feelings of guilt or shame. Our recommendations for public health interventions include: focus on the promotion of diet-related health benefits people can identify with; encourage social support by friends or family; reinforce people's sense of competence and skills; and avoid triggering perceived social pressure or feelings of guilt.
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Affiliation(s)
- Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Belville, South Africa
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Belville, South Africa
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Health Systems and Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roy Remmen
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Harjumaa M, Absetz P, Ermes M, Mattila E, Männikkö R, Tilles-Tirkkonen T, Lintu N, Schwab U, Umer A, Leppänen J, Pihlajamäki J. Internet-Based Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Design and 6-Month Usage Results of Randomized Controlled Trial. JMIR Diabetes 2020; 5:e15219. [PMID: 32779571 PMCID: PMC7448183 DOI: 10.2196/15219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/29/2019] [Accepted: 02/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background Type 2 diabetes can be prevented through lifestyle changes, but sustainable and scalable lifestyle interventions are still lacking. Habit-based approaches offer an opportunity to induce long-term behavior changes. Objective The purposes of this study were to describe an internet-based lifestyle intervention for people at risk for type 2 diabetes targeted to support formation of healthy habits and explore its user engagement during the first 6 months of a randomized controlled trial (RCT). Methods The app provides an online store that offers more than 400 simple and contextualized habit-forming behavioral suggestions triggered by daily life activities. Users can browse, inspect, and select them; report their performances; and reflect on their own activities. Users can also get reminders, information on other users’ activities, and information on the prevention of type 2 diabetes. An unblended parallel RCT was carried out to evaluate the effectiveness of the app in comparison with routine care. User engagement is reported for the first 6 months of the trial based on the use log data of the participants, who were 18- to 70-year-old community-dwelling adults at an increased risk of type 2 diabetes. Results Of 3271 participants recruited online, 2909 were eligible to participate in the RCT. Participants were randomized using a computerized randomization system to the control group (n=971), internet-based intervention (digital, n=967), and internet-based intervention with face-to-face group coaching (F2F+digital, n=971). Mean age of control group participants was 55.0 years, digital group 55.2 years, and F2F+digital 55.2 years. The majority of participants were female, 81.1% (787/971) in the control group, 78.3% (757/967) in the digital group, and 80.7% (784/971) in the F2F+digital group. Of the participants allocated to the digital and F2F+digital groups, 99.53% (1929/1938) logged in to the app at least once, 98.55% (1901/1938) selected at least one habit, and 95.13% (1835/1938) reported at least one habit performance. The app was mostly used on a weekly basis. During the first 6 months, the number of active users on a weekly level varied from 93.05% (1795/1929) on week 1 to 51.79% (999/1929) on week 26. The daily use activity was not as high. The digital and F2F+digital groups used the app on a median of 23.0 and 24.5 days and for 79.4 and 85.1 minutes total duration, respectively. A total of 1,089,555 habit performances were reported during the first 6 months. There were no significant differences in the use metrics between the groups with regard to cumulative use metrics. Conclusions Results demonstrate that internet-based lifestyle interventions can be delivered to large groups including community-dwelling middle-aged and older adults, many with limited experience in digital app use, without additional user training. This intermediate analysis of use behavior showed relatively good engagement, with the percentage of active weekly users remaining over 50% at 6 months. However, we do not yet know if the weekly engagement was enough to change the lifestyles of the participants. Trial Registration ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478
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Affiliation(s)
- Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Miikka Ermes
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Reija Männikkö
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Niina Lintu
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Adil Umer
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Juha Leppänen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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De Man J, Wouters E, Absetz P, Daivadanam M, Naggayi G, Kasujja FX, Remmen R, Guwatudde D, Van Olmen J. What Motivates People With (Pre)Diabetes to Move? Testing Self-Determination Theory in Rural Uganda. Front Psychol 2020; 11:404. [PMID: 32265775 PMCID: PMC7105875 DOI: 10.3389/fpsyg.2020.00404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Sub-Saharan Africa is experiencing a rapid growth of type 2 diabetes (T2D) and its related burden. Regular physical activity (PA) is a successful prevention strategy but is challenging to maintain. Self-determination theory (SDT) posits that more autonomous forms of motivation are associated with more sustainable behavior change. Evidence to support this claim is lacking in sub-Saharan Africa. This study aims to explore the relationships between latent constructs of autonomous and controlled motivation, perceived competence, perceived relatedness, PA behavior, and glycemic biomarkers. Methods Structural equation modeling was applied to cross-sectional data from a rural Ugandan population (N = 712, pre-diabetes = 329, diabetes = 383). Outcome measures included self-reported moderate and vigorous PA, pedometer counts, and fasting plasma glucose (FPG) and glycated hemoglobin (HbA1C). Results Our findings support SDT, but also suggest that different types of motivation regulate different domains and intensities of PA. Higher frequency of vigorous PA – which was linked to a lower HbA1C and FPG – was predicted by autonomous motivation (β = 0.24) but not by controlled motivation (β = −0.05). However, we found no association with moderate PA frequency nor with pedometer counts. Perceived competence and perceived relatedness predicted autonomous motivation. Autonomous motivation functioned as a mediator between those needs and PA behavior. Conclusion This is the first study providing evidence for a SDT model explaining PA among people at risk of, or living with, T2D in a rural sub-Saharan African setting. Our findings suggest that individuals who experience genuine support from friends or family and who feel competent in doing vigorous PA can become motivated through identification of health benefits of PA as their own goals. This type of motivation resulted in a higher frequency of vigorous PA and better glycemic biomarkers. On the other hand, people who felt more motivated through pressure from others or through feelings of guilt or shame were not more engaged in PA. Clinical Trial Registration ISRCTN 11913581. Registered January 10, 2017.
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Affiliation(s)
- Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Health Systems and Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gloria Naggayi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Roy Remmen
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Josefien Van Olmen
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Mustonen E, Hörhammer I, Absetz P, Patja K, Lammintakanen J, Talja M, Kuronen R, Linna M. Eight-year post-trial follow-up of health care and long-term care costs of tele-based health coaching. Health Serv Res 2020; 55:211-217. [PMID: 31884682 PMCID: PMC7080381 DOI: 10.1111/1475-6773.13251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients. DATA SOURCES/STUDY SETTING Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted. STUDY DESIGN A total of 1,535 patients (≥45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups. PRINCIPAL FINDINGS Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect €1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD. CONCLUSIONS Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.
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Affiliation(s)
- Erja Mustonen
- Päijät‐Häme Joint Authority for Health and WellbeingLahtiFinland
| | - Iiris Hörhammer
- Healthcare Engineering, Management and Architecture InstituteAalto UniversityAaltoFinland
| | - Pilvikki Absetz
- University of Eastern FinlandKuopioFinland
- CEO, Collaborative Care Systems FinlandHelsinkiFinland
| | - Kristiina Patja
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | | | - Martti Talja
- Päijät‐Häme Joint Authority for Health and WellbeingLahtiFinland
| | - Risto Kuronen
- Päijät‐Häme Joint Authority for Health and WellbeingLahtiFinland
| | - Miika Linna
- Healthcare Engineering, Management and Architecture InstituteAalto UniversityAaltoFinland
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Güil Oumrait N, Daivadanam M, Absetz P, Guwatudde D, Berggreen-Clausen A, Mölsted Alvesson H, De Man J, Sidney Annerstedt K. Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm. Nutrients 2020; 12:nu12030620. [PMID: 32120791 PMCID: PMC7146106 DOI: 10.3390/nu12030620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants’ main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the effect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence.
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Affiliation(s)
- Nuria Güil Oumrait
- Department of Global Public Health, Karolinska Institutet, 171 65 Solna, Sweden
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, 171 65 Solna, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22 Uppsala, Sweden
- International Maternal and Child Health division, Department of Women’s and Children’s Health, Uppsala University, 752 37 Uppsala, Sweden
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Ggaba Road, Kansanga Box 20000, Uganda
| | | | | | - Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, 2000 Antwerp, Belgium
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Tilles-Tirkkonen T, Aittola K, Männikkö R, Absetz P, Kolehmainen M, Schwab U, Lindström J, Lakka T, Pihlajamäki J, Karhunen L. Eating Competence Is Associated with Lower Prevalence of Obesity and Better Insulin Sensitivity in Finnish Adults with Increased Risk for Type 2 Diabetes: The StopDia Study. Nutrients 2019; 12:nu12010104. [PMID: 31905938 PMCID: PMC7019577 DOI: 10.3390/nu12010104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 02/01/2023] Open
Abstract
A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, internal regulation and contextual skills related to food and eating. In total, 3147 Finnish adults aged 18-74 at an increased risk for type 2 diabetes identified via online risk screening participated in the baseline examinations of the Stop Diabetes (StopDia) study. The participants filled out the digital questionnaire on food intake, physical activity and sleep, and the Satter Eating Competence Inventory 2.0TM (ecSI 2.0TM). In addition, anthropometric and laboratory measurements were performed at primary healthcare centres. Eating competent individuals (37%, classified by ecSI 2.0TM) had a better quality of diet (p < 0.05 for all). Additionally, eating competence was associated with a lower prevalence of previously undiagnosed type 2 diabetes, abdominal obesity, metabolic syndrome and hypertriglyceridaemia, and with better insulin sensitivity (p < 0.05 for all). However, these associations, except for metabolic syndrome, were at least partly mediated by body mass index. Eating competence is associated with a healthy diet and could, thus, in the long term, support the prevention of type 2 diabetes.
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Affiliation(s)
- Tanja Tilles-Tirkkonen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
- Correspondence: ; Tel.: +358-40-727-9791
| | - Kirsikka Aittola
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
| | - Reija Männikkö
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
| | - Pilvikki Absetz
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
- Collaborative Care Systems Finland, 00270 Helsinki, Finland
| | - Marjukka Kolehmainen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
| | - Ursula Schwab
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Timo Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, 70100 Kuopio, Finland
| | - Jussi Pihlajamäki
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS Kuopio, Finland
| | - Leila Karhunen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland; (K.A.); (R.M.); (P.A.); (M.K.); (U.S.); (J.P.); (L.K.)
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Dunbar JA, Versace V, Janus E, Laatikainen T, Vartiainen E, Absetz P, Best JD, Bennett C. Letter to the Editor Regarding "Public Health Approaches to Type 2 Diabetes Prevention: The US National Diabetes Prevention Program and Beyond". Curr Diab Rep 2019; 19:130. [PMID: 31748826 DOI: 10.1007/s11892-019-1262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James A Dunbar
- Deakin Rural Health, Deakin University, Warrnambool Campus, Warrnambool, Victoria, Australia.
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warrnambool Campus, Warrnambool, Victoria, Australia
| | - Edward Janus
- Western Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
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Sathish T, Aziz Z, Absetz P, Thankappan KR, Tapp RJ, Balachandran S, Shetty SS, Oldenburg B. Participant recruitment into a community-based diabetes prevention trial in India: Learnings from the Kerala Diabetes Prevention Program. Contemp Clin Trials Commun 2019; 15:100382. [PMID: 31193921 PMCID: PMC6545388 DOI: 10.1016/j.conctc.2019.100382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/05/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background Data on participant recruitment into diabetes prevention trials are limited in low- and middle-income countries (LMICs). We aimed to provide a detailed analysis of participant recruitment into a community-based diabetes prevention trial in India. Methods The Kerala Diabetes Prevention Program was conducted in 60 polling areas (electoral divisions) of the Neyyatinkara taluk (subdistrict) in Trivandrum district, Kerala state. Individuals (age 30–60 years) were screened with the Indian Diabetes Risk Score (IDRS) at their homes followed by an oral glucose tolerance test (OGTT) at community-based clinics. Individuals at high-risk of developing diabetes (IDRS score ≥60 and without diabetes on the OGTT) were recruited. Results A total of 1007 participants (47.2% women) were recruited over nine months. Pilot testing, personal contact and telephone reminders from community volunteers, and gender matching of staff were effective recruitment strategies. The major recruitment challenges were: (1) during home visits, one-third of potential participants could not be contacted, as they were away for work; and (2) men participated less frequently in the OGTT screening than women (75.2% vs. 84.2%). For non-participation, lack of time (42.0%) was most commonly cited followed by ‘I am already feeling healthy’ (30.0%), personal reasons (24.0%) and ‘no benefit to me or my family’ (4.0%). An average of 17 h were spent to recruit one participant with a cost of US$23. The initial stage of screening and recruitment demanded higher time and costs. Conclusions This study provides valuable information for future researchers planning to implement community-based diabetes prevention trials in India or other LMICs. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909.
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Affiliation(s)
- Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, VIC, 3053, Australia
| | - Zahra Aziz
- Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, VIC, 3053, Australia
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Kavumpurathu Raman Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
| | - Robyn Jennifer Tapp
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
| | - Suman Surendra Shetty
- Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, VIC, 3053, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, VIC, 3053, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, The University of Melbourne, Carlton, VIC, 3053, Australia
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Daivadanam M, Ingram M, Sidney Annerstedt K, Parker G, Bobrow K, Dolovich L, Gould G, Riddell M, Vedanthan R, Webster J, Absetz P, Mölsted Alvesson H, Androutsos O, Chavannes N, Cortez B, Devarasetty P, Fottrell E, Gonzalez-Salazar F, Goudge J, Herasme O, Jennings H, Kapoor D, Kamano J, Kasteleyn MJ, Kyriakos C, Manios Y, Mogulluru K, Owolabi M, Lazo-Porras M, Silva W, Thrift A, Uvere E, Webster R, van der Kleij R, van Olmen J, Vardavas C, Zhang P. The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PLoS One 2019; 14:e0214454. [PMID: 30958868 PMCID: PMC6453477 DOI: 10.1371/journal.pone.0214454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.
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Affiliation(s)
- Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Maia Ingram
- Department of Community, Environment and Policy, University of Arizona, Tucson, Arizona, United States of America
| | | | - Gary Parker
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Kirsty Bobrow
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michaela Riddell
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York City, New York, United States of America
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland
- University of Eastern Finland, Helsinki, Finland
| | | | - Odysseas Androutsos
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Briana Cortez
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Praveen Devarasetty
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Edward Fottrell
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Francisco Gonzalez-Salazar
- Department of Basic Sciences, Universidad de Monterrey, Monterrey, Nuevo Leon, Mexico
- Centro de Investigacion Biomedica, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico
| | - Jane Goudge
- Faculty of Health Sciences, University of the Witwatersrand, Centre for Health Policy, School of Public Health, Braamfontein, Johannesburg, South Africa
| | - Omarys Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Hannah Jennings
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, Delhi, India
| | - Jemima Kamano
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Marise J. Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Kishor Mogulluru
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Maria Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Miraflores, Lima, Peru
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, United Kingdom
| | - Amanda Thrift
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ezinne Uvere
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
- University of Antwerp, Antwerpen, Belgium
| | | | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
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De Man J, Aweko J, Daivadanam M, Alvesson HM, Delobelle P, Mayega RW, Östenson CG, Kirunda B, Kasujja FX, Guwattude D, Puoane T, Sanders D, Peterson S, Tomson G, Sundberg CJ, Absetz P, Van Olmen J. Diabetes self-management in three different income settings: Cross-learning of barriers and opportunities. PLoS One 2019; 14:e0213530. [PMID: 30889215 PMCID: PMC6424475 DOI: 10.1371/journal.pone.0213530] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/22/2019] [Indexed: 11/19/2022] Open
Abstract
The burden of type 2 diabetes is increasing rapidly, not least in Sub-Saharan Africa, and disadvantaged populations are disproportionally affected. Self-management is a key strategy for people at risk of or with type 2 diabetes, but implementation is a challenge. The objective of this study is to assess the determinants of self-management from an implementation perspective in three settings: two rural districts in Uganda, an urban township in South Africa, and socio-economically disadvantaged suburbs in Sweden. Data collection followed an exploratory multiple-case study design, integrating data from interviews, focus group discussions, and observations. Data collection and analysis were guided by a contextualized version of a transdisciplinary framework for self-management. Findings indicate that people at risk of or with type 2 diabetes are aware of major self-management strategies, but fail to integrate these into their daily lives. Depending on the setting, opportunities to facilitate implementation of self-management include: improving patient-provider interaction, improving health service delivery, and encouraging community initiatives supporting self-management. Modification of the physical environment (e.g. accessibility to healthy food) and the socio-cultural environment (i.e. norms, values, attitudes, and social support) may have an important influence on people's lifestyle. Regarding the study methodology, we learned that this innovative approach can lead to a comprehensive analysis of self-management determinants across different settings. An important barrier was the difficult contextualization of concepts like perceived autonomy and self-efficacy. Intervention studies are needed to confirm whether the pathways suggested by this study are valid and to test the proposed opportunities for change.
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Affiliation(s)
- Jeroen De Man
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Juliet Aweko
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | | | - Peter Delobelle
- School of Public Health, University of the Western Cape, Belville, South Africa
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Claes-Göran Östenson
- Department of Molecular Medicine & Surgery, Diabetes and Endocrine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Kirunda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Guwattude
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Belville, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Belville, South Africa
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Göran Tomson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Josefien Van Olmen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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Köykkä K, Absetz P, Araújo-Soares V, Knittle K, Sniehotta FF, Hankonen N. Combining the reasoned action approach and habit formation to reduce sitting time in classrooms: Outcome and process evaluation of the Let's Move It teacher intervention. Journal of Experimental Social Psychology 2019. [DOI: 10.1016/j.jesp.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pihlajamäki J, Männikkö R, Tilles-Tirkkonen T, Karhunen L, Kolehmainen M, Schwab U, Lintu N, Paananen J, Järvenpää R, Harjumaa M, Martikainen J, Kohl J, Poutanen K, Ermes M, Absetz P, Lindström J, Lakka TA. Digitally supported program for type 2 diabetes risk identification and risk reduction in real-world setting: protocol for the StopDia model and randomized controlled trial. BMC Public Health 2019; 19:255. [PMID: 30823909 PMCID: PMC6397451 DOI: 10.1186/s12889-019-6574-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The StopDia study is based on the convincing scientific evidence that type 2 diabetes (T2D) and its comorbidities can be prevented by a healthy lifestyle. The need for additional research is based on the fact that the attempts to translate scientific evidence into actions in the real-world health care have not led to permanent and cost-effective models to prevent T2D. The specific aims of the StopDia study following the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are to 1) improve the Reach of individuals at increased risk, 2) evaluate the Effectiveness and cost-effectiveness of the digital lifestyle intervention and the digital and face-to-face group lifestyle intervention in comparison to routine care in a randomized controlled trial (RCT), and 3) evaluate the Adoption and Implementation of the StopDia model by the participants and the health care organizations at society level. Finally, we will address the Maintenance of the lifestyle changes at participant level and that of the program at organisatory level after the RCT. METHODS The StopDia study is carried out in the primary health care system as part of the routine actions of three provinces in Finland, including Northern Savo, Southern Carelia, and Päijät-Häme. We estimate that one fifth of adults aged 18-70 years living in these areas are at increased risk of T2D. We recruit the participants using the StopDia Digital Screening Tool, including questions from the Finnish Diabetes Risk Score (FINDRISC). About 3000 individuals at increased risk of T2D (FINDRISC ≥12 or a history of gestational diabetes, impaired fasting glucose, or impaired glucose tolerance) participate in the one-year randomized controlled trial. We monitor lifestyle factors using the StopDia Digital Questionnaire and metabolism using laboratory tests performed as part of routine actions in the health care system. DISCUSSION Sustainable and scalable models are needed to reach and identify individuals at increased risk of T2D and to deliver personalized and effective lifestyle interventions. With the StopDia study we aim to answer these challenges in a scientific project that is fully digitally integrated into the routine health care. TRIAL REGISTRATION ClinicalTials.gov . Identifier: NCT03156478 . Date of registration 17.5.2017.
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Affiliation(s)
- Jussi Pihlajamäki
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Reija Männikkö
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Leila Karhunen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Marjukka Kolehmainen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Ursula Schwab
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Paananen
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Riia Järvenpää
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | | | - Johanna Kohl
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Pilvikki Absetz
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - Jaana Lindström
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo A. Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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van Olmen J, Delobelle P, Guwatudde D, Absetz P, Sanders D, Mölsted Alvesson H, Puoane T, Ostenson CG, Tomson G, Mayega RW, Sundberg CJ, Peterson S, Daivadanam M. Using a cross-contextual reciprocal learning approach in a multisite implementation research project to improve self-management for type 2 diabetes. BMJ Glob Health 2018; 3:e001068. [PMID: 30555727 PMCID: PMC6267315 DOI: 10.1136/bmjgh-2018-001068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/16/2022] Open
Abstract
This paper reports on the use of reciprocal learning for identifying, adopting and adapting a type 2 diabetes self-management support intervention in a multisite implementation trial conducted in a rural setting in a low-income country (Uganda), a periurban township in a middle-income country (South Africa) and socioeconomically disadvantaged suburbs in a high-income country (Sweden). The learning process was guided by a framework for knowledge translation and structured into three learning cycles, allowing for a balance between evidence, stakeholder interaction and contextual adaptation. Key factors included commitment, common goals, leadership and partnerships. Synergistic outcomes were the cocreation of knowledge, interventions and implementation methods, including reverse innovations such as adaption of community-linked models of care. Contextualisation was achieved by cross-site exchanges and local stakeholder interaction to balance intervention fidelity with local adaptation. Interdisciplinary and cross-site collaboration resulted in the establishment of learning networks. Limitations of reciprocal learning relate to the complexity of the process with unpredictable outcomes and the limited generalisability of results.
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Affiliation(s)
- Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, Faculty of Health Sciences - University of Cape Town, Cape Town, South Africa
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Thandi Puoane
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Claes-Goran Ostenson
- Department of Molecular Medicine and Surgery, Diabetes and Endocrine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Göran Tomson
- Department of Public Health Sciences, Karolinska Institutet and Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carl Johan Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Uppsala University, Uppsala, Sweden
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Dept of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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48
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Aweko J, De Man J, Absetz P, Östenson CG, Swartling Peterson S, Mölsted Alvesson H, Daivadanam M. Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm. Int J Environ Res Public Health 2018; 15:E1810. [PMID: 30135373 PMCID: PMC6164476 DOI: 10.3390/ijerph15091810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.
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Affiliation(s)
- Juliet Aweko
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Jeroen De Man
- Department of Public Health, Institute of Tropical Medicine, 43, 2000 Antwerp, Belgium.
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland.
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 77 Stockholm, Sweden.
| | - Stefan Swartling Peterson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, 751 85 Uppsala, Sweden.
| | - Helle Mölsted Alvesson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- Department of Food, Nutrition and Dietetics, Uppsala University, P.O. Box 560, 751 22 Uppsala, Sweden.
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Aziz Z, Mathews E, Absetz P, Sathish T, Oldroyd J, Balachandran S, Shetty SS, Thankappan KR, Oldenburg B. A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program. Implement Sci 2018; 13:97. [PMID: 30021592 PMCID: PMC6052531 DOI: 10.1186/s13012-018-0791-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs. METHODS The 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks. RESULTS Provider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be 'very useful' by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as 'very interested', and 55% found the group sessions 'very useful' in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program. CONCLUSION A comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs. TRIAL REGISTRATION Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909 . Registered 10 March 2011.
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Affiliation(s)
- Zahra Aziz
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia.
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
| | - Pilvikki Absetz
- School of Health Sciences, University of Tampere, Tampere, Finland.,Collaborative Care Systems Finland, Helsinki, Finland
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia
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50
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Thankappan KR, Sathish T, Tapp RJ, Shaw JE, Lotfaliany M, Wolfe R, Absetz P, Mathews E, Aziz Z, Williams ED, Fisher EB, Zimmet PZ, Mahal A, Balachandran S, D'Esposito F, Sajeev P, Thomas E, Oldenburg B. A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program. PLoS Med 2018; 15:e1002575. [PMID: 29874236 PMCID: PMC5991386 DOI: 10.1371/journal.pmed.1002575] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. METHODS AND FINDINGS The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30-60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66-1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: -1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. CONCLUSIONS A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.
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Affiliation(s)
- Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- * E-mail:
| | - Robyn J. Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Jonathan E. Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mojtaba Lotfaliany
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - Elezebeth Mathews
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Zahra Aziz
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Edwin B. Fisher
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, North Carolina, United States of America
| | - Paul Z. Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Fabrizio D'Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Priyanka Sajeev
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- Kerala Social Security Mission, Trivandrum, Kerala, India
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Victoria, Australia
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