Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme

International Journal of Behavioral Nutrition and Physical Activity DDebeatveelopment and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme Judith HM Helmink Jessie JM Meis Inge de Weerdt Femke N Visser Nanne K de Vries 0 Stef PJ Kremers 0 0 School for Public Health and Primary Care (CAPHRI) and School for Nutrition, Toxicology and Metabolism (NUTRIM), Department of Health Promotion, Maastricht University , the Netherlands Background: The number of patients with diabetes is increasing. BeweegKuur (Dutch for 'Exercise Therapy') is a Dutch lifestyle intervention which aims to effectively and feasibly promote physical activity and better dietary behaviour in primary health care to prevent diabetes. Methods: The goal of this paper is to present the development process and the contents of the intervention, using a model of systematic health promotion planning. The intervention consists of a 1-year programme for diabetic and prediabetic patients. Patients are referred by their general practitioner (GP) to a lifestyle advisor (LSA), usually the practice nurse or a physiotherapist. Based on specific inclusion criteria and in close collaboration with the patient, an individual exercise programme is designed and supervised by the LSA. This programme can be attended at existing local exercise facilities or (temporarily) under the supervision of a specialized exercise coach or physiotherapist. All participants are also referred to a dietician and receive diet-related group education. In the first pilot year (2008), the BeweegKuur programme was implemented in 7 regions in the Netherlands (19 GP practices and health centres), while 14 regions (41 GP practices and health centres) participated during the second year. The aim is to implement BeweegKuur in all regions of the Netherlands by 2012. Discussion: The BeweegKuur programme was systematically developed in an evidence- and practice-based process. Formative monitoring studies and (controlled) effectiveness studies are needed to examine the diffusion process and the effectiveness and cost-effectiveness of the intervention. - Background Commissioned by the Dutch Ministry of Health, Welfare and Sports (VWS), a lifestyle intervention called 'BeweegKuur' was developed by the Netherlands Institute for Sport and Physical Activity (NISB)[1]. The BeweegKuur is a lifestyle intervention tailored to the individual needs of patients, focusing on a change in physical activity behaviour and dietary behaviour, to support the prevention and treatment of type 2 diabetes mellitus. The intervention is developed with the aim to become an effective and feasible primary health care based intervention, which in time can be reimbursed under the Dutch basic health insurance scheme. The current paper describes the rationale for the development of the BeweegKuur programme, as well as its development and contents. It also outlines the design of a formative evaluation study of the pilot implementation. Effective interventions should be based on the model of systematic intervention planning and development (Figure 1, see also [2,3]). The first step of this planning model comprises a needs assessment. This step involves gathering both quantitative (e.g., literature review) and qualitative (e.g., in-depth interviews) information regarding the needs for intervention development. The needs assessment starts by reviewing health and quality of life. It also reviews personal (i.e. patient-related) and environmental 1. Health and quality of life 2. Needs of patients and health care providers 3. Empirical evidence from earlier programmes Determinants of (sustained) exercise adherence and improved dietary behaviour (e.g., health care professionals) factors involved in unhealthy lifestyle, as well as empirical evidence on existing primary health care interventions. The second step of the model explores the determinants of (sustained) exercise adherence and improved dietary behaviour. This is followed by the development of a prototype for the intervention (step 3) and its pilot implementation (step 4). All these steps should be evaluated in the fifth step. With respect to the prototype development and pilot implementation, the evaluation is typically and preferably of a formative nature [4]. The structure of this paper follows the steps of this planning model. Step 1: Needs Assessment Health and quality of life Approximately 740,000 people in the Netherlands were diagnosed with diabetes in 2007, 90% of whom had type 2 diabetes [5], while 250,000 to 740,000 people are estimated to be unaware that they have the disease [5]. Additionally, approximately 900,000 people aged 60 years and older suffer from early-stage diabetes (Impaired Glucose Tolerance: pre-diabetes) [6]. The number of Dutch citizens with diabetes is expected to have doubled by 2025, partly due to the ageing population and the increasing number of overweight people [6]. At least 40% of people with type 2 diabetes suffer from chronic complications, such as cardiovascular diseases, neuropathy, retinopathy and renal failure [7]. These types of complications particularly limit their mobility and, therefore, their ability to be physically and socially active, resulting in a reduced ability to live independently and in a lower quality of life [8]. Physical inactivity, unhealthy dietary behaviour and obesity play a significant role in the development of type 2 diabetes [9]. Currently, at least five million people in the Netherlands are overweight and physically inactive [6]. It has been argued that the greatest benefit to health can be achieved by getting physically inactive people with diabetes to become active, which can delay the development of complications in the long term and support and postpone pharmaceutical treatment [10,11]. The advantageous effects of exercise include changes in body composition and a decrease in blood pressure. Exercise also results in favourable effects on the regulation of the blood glucose level [12]. Finally, exercise as well as healthy dietary behaviour are not only important in the treatment of type 2 diabetes, but also decrease the risk of developing diabetes, and are therefore an important primary prevention measure [13]. Needs of patients and primary health care providers Before developing a prototype of the BeweegKuur intervention, a preliminary needs assessment was carried out (see Figure 2). A literature search was used to explore existing lifestyle interventions, national as well as international [14]. Based on this literature review, in-depth interviews were conducted with leaders of Dutch national projects relevant to the BeweegKuur programme. The outcomes of these interviews were used to develop the first outline of the intervention. During its development, the outline was discussed with primary health care providers as well as patients by means of face-to-fa (...truncated)