Skip to main content

Table 4 The PVS-PREDIAPS clinical intervention reported according to the Template for Intervention Description and Replication (TIDieR) checklist

From: Fidelity evaluation of the compared procedures for conducting the PVS-PREDIAPS implementation strategy to optimize diabetes prevention in primary care

Brief name

PVS-PREDIAPS (from the Spanish “Prescribe Vida Saludable-Prevención diabetes en Atención Primaria de Salud”)

Rationale

The 5 A’s (Ask, Advise, Agree, Assist, and Arrange follow-up) intervention framework was used to standardize the provision of the evidence-based behavior modification techniques used to promote changes in physical activity (150 min of moderate physical activity a week) and diet (Mediterranean-type healthy diet) to prevent type-2 diabetes in high-risk patients

Materials and Procedures

Intervention delivery procedure

The multiple active intervention components and strategies are structured following the 5 A’s (Ask, Advise, Agree, Assist, and Arrange follow-up) intervention framework

Assess

Assess the risk of type-2 diabetes to identify patients eligible for the intervention and compliance with recommended levels of physical activity and daily servings of fruit and vegetables using the PVS screening questionnaire.

Advise

Provide clear, specific and personalized advice on changing lifestyles, including information on health risks and benefits

Agree

Select in collaboration with the patient the lifestyles change objectives, based on the preferences, interests and capacity for the change of the patient

Assist

Cooperatively design an action plan with the patient that determines the specific objectives of lifestyle change, including the identification of possible barriers, problem solving, and coping strategies to facilitate behavior change. The lifestyle change plan designed is provided to the patient in the form of a printed prescription.

Arrange follow-up

Organize follow-up (in person or by phone) every 3 months up to one year to provide ongoing assistance and support, and to adjust the action plan as necessary.

Provided supporting materials

Patients at high risk of type-2 diabetes received printed materials to support health care professionals’ promotion intervention in order to foster patients’ motivation to change lifestyles and to provide guidance in how to perform lifestyle change successfully. Specifically, those receiving healthy diet advice or prescription (see the intervention procedure bellow) received a printed version of the Spanish Society of Community Nutrition (SENC from the Spanish “Sociedad Española de Nutrición Comunitaria”) document [web Access: https://www.nutricioncomunitaria.org/es/otras-publicaciones]. Those receiving the physical activity promotion intervention were provided with a PVS-Physical Activity pamphlet with information about benefits of physical activity and risk of inactivity, and a summary of potential barriers and coping strategies to overcome them.

Who provided the intervention?

In general, family physicians performed the screening and referred high-risk patients identified to nurses for delivery of the healthy lifestyle promotion. Nurses first asked patients about their lifestyle and then provided personalized advice tailored to the patient’s needs, encouraging individuals motivated to make lifestyle changes to attend an additional consultation at which a lifestyle change is prescribed and a personalized plan for modifying habits and monitoring change achieved over time is developed in collaboration with the patient. Though the distribution of the components of the intervention is established at the level of PC team, physicians were allowed to opt for a different approach (e.g., also assessing lifestyle behaviors and providing advice, in addition to screening for T2D risk).

How? Where? When?

The healthy lifestyle promotion intervention was delivered in routine context of primary care during opportunistic or programmed visits.

Tailoring

Although the intervention is based on a shared decision-making process in relation to behavior change, it takes into account the patient’s willingness to change and their autonomy in a context of cordiality. Thus, those who are not committed to the possibility of making a change in behavior after receiving the advice and being confronted with the possibility of making an additional consultation to design a personalized plan to change habits, receive the support material and are summoned to address the issue on a future visit. Those committed to change who accept the additional appointment for the design of a personalized plan for change habits are those who receive the intervention fully, including the follow-up.

Modifications

No modifications were performed during the trial

How well the intervention was delivered

An information and communication tool integrated in the electronic health record was developed in order to help and guide healthcare professionals to deliver the healthy lifestyles promotion intervention in a standardized way. The tool includes the following functions:

- Facilitates the assessment of lifestyle behaviors, tracks the clinical diagnosis of compliance with current recommendations, and enhances motivation for changing behaviors.

- Helps to identify sub-populations at high risk of developing chronic diseases, based on data stored in clinical databases.

- Guides professionals in the provision of personalized medical advice adapted to the patient and offers an outline for the prescription of personalized plans to modify lifestyle behaviors.

- Registers and stores data of the actions carried out in each person’s EHR to promote follow-up.