Table 4 Opportunities for refining intervention delivery on different health care levels
Level | Finding | Opportunity for intervention delivery |
|---|---|---|
Participant | * High attendance rates in our study compared to others [11, 12, 22] | * Use of organisational elements that can contribute to participant compliance: |
| Â | Â | - Immediately plan next appointment during consultations |
| Â | Â | - Persons who do not show up are contacted by the practice assistant |
| Â | Â | - Assign 1provider in the practice who is responsible for coordination / planning of the consultations. |
| Â | * Lack of participant motivation experienced by providers as a major barrier for intervention implementation | * Stimulate participant motivation to change unhealthy habits: |
| Â | Â | - In-depth analysis of (barriers for ) participant behavioural change to reveal starting points for refining intervention content[5, 6, 23]. |
| Â | Â | - More attention for environmental factors promoting unhealthy behaviour[24] |
| Â | Â | - Counselling based on shared decision making to enlarge participant empowerment[25] |
| Â | Â | - More effort into stimulating participants to engage social support[5, 23, 26]. |
Professional | * Lower participant satisfaction with GP guidance than with nurse practitioner guidance. | * Role for the nurse practitioner as the key player in guiding participant lifestyle change [29, 30] |
| Â | * Lower self-efficacy of GPs regarding dietary counselling compared to nurse practittioners. | Â |
| Â | * Lack of specialistic nutritional knowledge reported by nurse practitioners | * Introduce elements to fill gaps in knowledge and/or skills of nurse practitioners |
|  | * Nearly 40 % of the nurse practitioners report limited self-efficacy for dietary counselling | - Referral to skilled supporting staff, like dieticians[5] |
| Â | Â | - Extend motivational interviewing course towards a specialized prevention manager training[31], including modules to enlarge the knowledge of nutrition and physical activity in diabetes prevention. |
Organisation | * Lack of counselling time and financial reimbursement regarded by providers as major bottlenecks for intervention implementation | * Consider and investigate prevention strategies that could increase cost-effectiveness [6], such as: |
| Â | * Modest diabetes risk reduction compared to studies in experimental settings [8, 11, 12, 26]. | - More stringent criteria for participant inclusion, based on risk[6, 11]and / or motivation[27] |
| Â | Â | |
| Â | Â | - A more tailor-made or patient-centred intervention structure[6, 35] |
| Â | Â | - Integration of lifestyle interventions for different disorders[36] |