? All interventions

The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners.

Hein De Vries, Martijntje Bakker, Patricia Dolan Mullen, Gerard van Breukelen

Patient education and counseling [63:177-87] (2006)

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Smoking during pregnancy is an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in the experimental group and 3% in the control group. The partner intervention was not successful. The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. The program realized short-term effects. An important precondition is that midwives need a proper training.


Long-term efficacy of a Web-based computer-tailored nutrition education intervention for adults including cognitive and environmental feedback: a randomized controlled trial.

Linda Springvloet, Lilian Lechner, Hein De Vries, Anke Oenema

BMC public health [15:372] (2015)

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Unhealthy diets are prevalent in Western countries, especially among low-educated people. To have an effect on health, it is important that dietary changes are sustained over time. This study examines long-term effects of a cognitive and environmental-feedback version of a Web-based computer-tailored (CT) nutrition education intervention targeting fruit, vegetables, high-energy snacks and saturated fat. A randomized controlled trial was conducted with a basic (tailored intervention targeting individual cognitions and self-regulation processes; n = 456), plus (additionally targeting environmental-level factors; n = 459) and control group (generic nutrition information; n = 434). Participants were recruited from the general population and randomly assigned to a study group. Online self-reported questionnaires assessed fruit, vegetable, high-energy snack and saturated fat intake, self-regulation, self-control, and Body Mass Index (BMI) at baseline and nine-months post-intervention. Linear mixed model analyses examined group differences in change over time. Educational differences were examined by 'group X time X education' interaction terms. Effects were examined in the total sample and among participants who did not comply with dietary- or BMI guidelines. The effects on vegetable intake in the total sample differed according to educational level (p = 02). Among low/moderate-educated participants, the basic version was significantly more effective in increasing vegetable intake than the control program (effect size (ES) = 0.32) and plus version (ES = 0.22). No effects were found for high-educated participants. Self-regulation change was significantly larger in the control group than in the basic (ES = 0.18) and plus (ES = 0.16) group. In general, both intervention versions did not result in long-term intervention effects. The exception was an effect of the basic version on self-reported vegetable intake among low/moderate-educated adults in the total sample. More research is needed on how targeting self-regulation processes and environmental-level factors in Web-based CT nutrition education interventions can increase long-term efficacy. Netherlands Trial Registry NTR3396 .


Self-management support in routine primary care by nurses.

Heleen Westland, Carin Schröder, Jessica de Wit, Judith Frings, Jaap Trappenburg, Marieke Schuurmans

British journal of health psychology (2017)

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To examine how and to what extent self-management support, including behaviour change support, is provided by primary care nurses in routine consultations with chronically ill patients. Observational study design. Routine consultations of primary care nurses in the Netherlands with chronically ill patients were audio-taped and analysed. The analysis identified health topics addressed according to health care standards, self-management topics addressed using a validated set of topics, and behaviour change techniques (BCTs) using the Behaviour Change Techniques Taxonomy v1. Seventy-eight routine consultations of 17 primary care nurses with chronically ill patients were included in the analysis. Nurses addressed both health topics and self-management topics in brief, fragmented, and often inconsistent manners. Dietary intake and physical activity were the most frequently addressed topics. Nurses applied 21 BCTs to target behaviour change, but the use of these techniques was mainly inconsistent and implicit. The most consistently used BCTs were review behaviour goal(s) (56.4%) and feedback on behaviour (51.3%). Nurses addressed both health topics and self-management topics in their routine consultations. The duration, frequency, and number of addressed topics differed throughout the consultations. Nurses tended to prioritize the monitoring and optimization of patients' medical treatment and provided limited self-management support. Nurses seldom deepened their focus on behaviour change and infrequently used effective techniques to support this change. Adoption of self-management in primary care, including behaviour change, might be enhanced if nurses consistently and explicitly use effective BCTs in their consultations. Statement of contribution What is already known on this subject? Primary care nurses play a pivotal role in self-management support for patients with a chronic condition. Adequate self-management support requires nurses to activate patients and enhance behaviour change. Little is known regarding to what extent nurses provide self-management support in routine primary care. What does this study add? Self-management support is brief, fragmented, and inconsistently provided by nurses. Nurses tend to prioritize medical treatment optimization and seldom focus on behavioural change. Nurses' use of effective behaviour change techniques is low and should be enhanced.


The role of self-regulating abilities in long-term weight loss in severely obese children and adolescents undergoing intensive combined lifestyle interventions (HELIOS); rationale, design and methods.

Jutka Halberstadt, Sabine Makkes, Emely de Vet, Anita Jansen, Chantal Nederkoorn, Olga Hvan der Baan-Slootweg, Jacob Seidell

BMC pediatrics [13:41] (2013)

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Adequate treatment of severe childhood obesity is important given its serious social, psychological and physical consequences. Self-regulation may be a crucial determinant of treatment success. Yet, little is known about the role that self-regulation and other psychosocial factors play in the long-term outcome of obesity treatment in severely obese children and adolescents.In this paper, we describe the design of a study that aims to determine whether the ability to self-regulate predicts long-term weight loss in severely obese children and adolescents. An additional objective is to identify other psychosocial factors that may modify this relation. The study is designed as a prospective observational study of 120 severely obese children and adolescents (8-19 years) and their parents/caregivers undergoing an intensive combined lifestyle intervention during one year. The intervention uses behavior change techniques to improve the general ability to self-regulate.Measurements will be taken at three points in time: at baseline (start of treatment), at the end of treatment (1 year after baseline) and at follow-up (2 years after baseline). The primary outcome measurement is the gender and age-specific change in SDS-BMI.The children's general self-regulation abilities are evaluated by two behavioral computer tasks assessing two distinct aspects of self-regulation that are particularly relevant to controlling food intake: inhibitory control (Stop Signal Task) and sensitivity to reward (Balloon Analogue Risk Task). In addition to the computer tasks, a self-report measure of eating-specific self-regulation ability is used. Psychosocial factors related to competence, motivation, relatedness and outcome expectations are examined as moderating factors using several questionnaires for the patients and their parents/caregivers. This study will provide knowledge about the relation between self-regulation and long-term weight loss after intensive lifestyle interventions over a two-year period in severely obese children and adolescents, a growing but often overlooked patient group. We aim to investigate to what extent (changes in) the general ability to self-regulate predicts weight loss and weight loss maintenance. This study will also contribute to the knowledge on how this association is modified by other psychosocial factors. The results may contribute to the development of more successful interventions. Netherlands Trial Register (NTR1678, registered 20-Feb-2009).


Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial.

Michael van Vugt, Maartje de Wit, Steven Hendriks, Yvonne Roelofsen, Henk Bilo, Frank Snoek

BMC endocrine disorders [13:53] (2013)

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Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online coaching could improve patient motivation and reduce program attrition. This study aims to test the hypothesis that a web-based self-management program with coaching will prove more effective on improving patient self-management behavior and clinical outcome measures than a web-based self-management program without coaching. The effects of a web-based self-management program with and without coaching will be tested with a nested randomized controlled trial within a healthcare group in the Netherlands. In one year 220 type 2 diabetes patients will be randomized into an intervention group (n = 110) or a control group (n = 110). The control group will receive only the online self-management program. The intervention group will receive the online self-management program and additional online coaching. Participants will be followed for one year, with follow-up measurements at 6 and 12 months. The intervention being tested is set to support type 2 diabetes patients with their diabetes self-management and is expected to have beneficial effects on self-care activities, well being and clinical outcomes. When proven effective this self-management support program could be offered to other health care groups and their type 2 diabetes patients in the Netherlands. Nederlands Trial Register NTR4064.