Is the process of delivery of an individually tailored lifestyle intervention associated with improvements in LDL cholesterol and multiple lifestyle behaviours in people with Familial Hypercholesterolemia?

BMC Public Health

Willem van Mechelen¹  Johannes Brug¹  Lando Koppes LJ³  Mireille van PoppelNM²  Judith Jelsma GM²  Karen Broekhuizen² 

[1] Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands;Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands;TNO, Division Work and Employment, Hoofddorp, The Netherlands

关键词: Efficacy;    Process evaluation;    Motivational interviewing;    Fidelity;    Dose;    Lifestyle behaviours;    Cholesterol;    Computer tailoring;    Counselling;   

Others  :  1163627
DOI  :  10.1186/1471-2458-12-348

 received in 2011-12-12, accepted in 2012-05-04,  发布年份 2012

【 摘 要 】

Background

More insight in the association between reach, dose and fidelity of intervention components and effects is needed. In the current study, we aimed to evaluate reach, dose and fidelity of an individually tailored lifestyle intervention in people with Familial Hypercholesterolemia (FH) and the association between intervention dose and changes in LDL-Cholesterol (LDL-C), and multiple lifestyle behaviours at 12-months follow-up.

Methods

Participants (n = 181) randomly allocated to the intervention group received the PRO-FIT intervention consisting of computer-tailored lifestyle advice (PRO-FIT*advice) and counselling (face-to-face and telephone booster calls) using Motivational Interviewing (MI). According to a process evaluation plan, intervention reach, dose delivered and received, and MI fidelity were assessed using the recruitment database, website/counselling logs and the Motivational Interviewing Treatment Integrity (MITI 3.1.1.) code. Regression analyses were conducted to explore differences between participant and non-participant characteristics, and the association between intervention dose and change in LDL-C, and multiple lifestyle behaviours.

Results

A 34% (n = 181) representative proportion of the intended intervention group was reached during the recruitment phase; participants did not differ from non-participants (n = 623) on age, gender and LDL-C levels. Of the participants, 95% received a PRO-FIT*advice log on account, of which 49% actually logged on and completed at least one advice module. Nearly all participants received a face-to-face counselling session and on average, 4.2 telephone booster calls were delivered. None of the face-to-face sessions were implemented according to MI guidelines. Overall, weak non-significant positive associations were found between intervention dose and LDL-C and lifestyle behaviours.

Conclusions

Implementation of the PRO-FIT intervention in practice appears feasible, particularly PRO-FIT*advice, since it can be relative easily implemented with a high dose delivered. However, only less than half of the intervention group received the complete intervention-package as intended. Strategies to let participants optimally engage in using web-based computer-tailored interventions like PRO-FIT*advice are needed. Further, more emphasis should be put on more extensive MI training and monitoring/supervision.

Trial registration

NTR1899 at ww.trialregister.nl.

【 授权许可】

   
2012 Broekhuizen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Glasgow RE, Bull SS, Gillette C, Klesges LM, Dzewaltowski DA: Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity. Am J Prev Med 2002, 23:62-69.
• [2]Dzewaltowski DA, Estabrooks PA, Glasgow RE: The future of physical activity behavior change research: what is needed to improve translation of research into health promotion practice? Exerc Sport Sci Rev 2004, 32:57-63.
• [3]Linnan L, Steckler A: Process Evaluation for Public Health Interventions and Research. Edited by Linnan L, Steckler A. San Francisco: Jossey-Bass; 2002:1-24.
• [4]Glasgow RE, Emmons KM: How can we increase translation of research into practice? Types of evidence needed. Annu Rev Public Health 2007, 28:413-433.
• [5]Hawe P, Shiell A, Riley T: Complex interventions: how “out of control” can a randomised controlled trial be? BMJ 2004, 328:1561-1563.
• [6]Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al.: Framework for design and evaluation of complex interventions to improve health. BMJ 2000, 321:694-696.
• [7]Broekhuizen K, van Poppel MN, Koppes LL, Brug J, van Mechelen W: A tailored lifestyle intervention to reduce the cardiovascular disease risk of individuals with Familial Hypercholesterolemia (FH): design of the PRO-FIT randomised controlled trial. BMC Publ Health 2010, 10:69. BioMed Central Full Text
• [8]Lustria ML, Cortese J, Noar SM, Glueckauf RL: Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ Couns 2009, 74:156-173.
• [9]Kroeze W, Werkman A, Brug J: A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med 2006, 31:205-223.
• [10]Enwald HP, Huotari ML: Preventing the obesity epidemic by second generation tailored health communication: an interdisciplinary review. J Med Internet Res 2010, 12:e24.
• [11]Neville LM, O’Hara B, Milat A: Computer-tailored physical activity behavior change interventions targeting adults: a systematic review. Int J Behav Nutr Phys Act 2009, 6:30. BioMed Central Full Text
• [12]Neville LM, O’Hara B, Milat AJ: Computer-tailored dietary behaviour change interventions: a systematic review. Health Educ Res 2009, 24:699-720.
• [13]Brug J, Oenema A, Campbell M: Past, present, and future of computer-tailored nutrition education. Am J Clin Nutr 2003, 77:1028S-1034S.
• [14]Brouwer W, Kroeze W, Crutzen R, de Nooijer J, de Vries NK, Brug J, et al.: Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review. J Med Internet Res 2011, 13:e2.
• [15]Evers KE: eHealth promotion: the use of the Internet for health promotion. Am J Health Promot 2006, 20:suppl-7, iii.
• [16]Eysenbach G: The law of attrition. J Med Internet Res 2005, 7:e11.
• [17]Glasgow RE: eHealth Evaluation and Dissemination Research. Am J Prev Med 2007, 32:S119-S126.
• [18]Bonfadelli H: The internet and knowledge gaps. Eur J Commun 2002, 17:65-84.
• [19]Glasgow RE, Nelson CC, Kearney KA, Reid R, Ritzwoller DP, Strecher VJ, et al.: Reach, engagement, and retention in an Internet-based weight loss program in a multi-site randomized controlled trial. J Med Internet Res 2007, 9:e11.
• [20]Hettema J, Steele J, Miller WR: Motivational interviewing. Annu Rev Clin Psychol 2005, 1:91-111.
• [21]Rubak S, Sandbaek A, Lauritzen T, Christensen B: Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005, 55:305-312.
• [22]Martins RK, McNeil DW: Review of motivational interviewing in promoting health behaviors. Clin Psychol Rev 2009, 29:283-293.
• [23]Miller WR, Rollnick S: Motivational Interviewing: Preparing People for Change. New York: Guilford; 2002.
• [24]Madson MB, Campbell TC, Barrett DE, Brondino MJ, Melchert TP: Development of the motivational interviewing supervision and training scale. Psychol Addict Behav 2005, 19:303-310.
• [25]Madson MB, Campbell TC: Measures of fidelity in motivational enhancement: a systematic review. J Subst Abuse Treat 2006, 31:67-73.
• [26]Broekhuizen K, van Poppel MN, Koppes LL, Kindt I, Brug J, van Mechelen W: Can multiple lifestyle behaviors be improved in people with Familial Hypercholesterolemia?. Submitted: Results of a randomized controlled trial; 2012.
• [27]Broekhuizen K, van Poppel MN, Koppes LL, Kindt I, Brug J, van Mechelen W: No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with Familial Hypercholesterolemia compared to usual care: results of a randomised controlled trial. BMC Res Notes 2012, 5:181. BioMed Central Full Text
• [28]van Maarle MC, Stouthard ME, Bonsel GJ: Quality of life in a family based genetic cascade screening programme for familial hypercholesterolaemia: a longitudinal study among participants. J Med Genet 2003, 40:e3.
• [29]Glasgow RE, Vogt TM, Boles SM: Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999, 89:1322-1327.
• [30]Saunders RP, Evans MH, Joshi P: Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract 2005, 6:134-147.
• [31]Moyers TB, Martin T, Manual JK, Miller WR, Ernst D: Revised Global Scales: Motivation Interviewing Treatment Integrity 3.0 (MITI 3.0). casaa.unm.edu/download/MITI3_1.pdf. University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions (CASAA); 2007. Ref Type: Internet Communication
• [32]Halcomb EJ, Davidson PM: Is verbatim transcription of interview data always necessary? Appl Nurs Res 2006, 19:38-42.
• [33]Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D: Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003, 56:1163-1169.
• [34]van Assema P, Brug J, Kok G, Brants H: The reliability and validity of a Dutch questionnaire on fat consumption as a means to rank subjects according to individual fat intake. Eur J Cancer Prev 1992, 1:375-380.
• [35]van Assema P, Brug J, Ronda G, Steenhuis I: The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J Hum Nutr Diet 2001, 14:377-390.
• [36]van Assema P, Brug J, Ronda G, Steenhuis I, Oenema A: A short dutch questionnaire to measure fruit and vegetable intake: relative validity among adults and adolescents. Nutr Health 2002, 16:85-106.
• [37]Mudde AN, Willemsen MC, Kremers S, de Vries H: Meetinstrumenten voor onderzoek naar roken en stoppen met roken. Den Haag: STIVORO; 2000.
• [38]Horne R, Weinman J: Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999, 47:555-567.
• [39]Issa JS, Strunz C, Giannini SD, Forti N, Diament J: Precision and accuracy of blood lipid analyses by a portable device (Cholestech-LDX). Arq Bras Cardiol 1996, 66:339-342.
• [40]Panz VR, Raal FJ, Paiker J, Immelman R, Miles H: Performance of the CardioCheck PA and Cholestech LDX point-of-care analysers compared to clinical diagnostic laboratory methods for the measurement of lipids. Cardiovasc J S Afr 2005, 16:112-117.
• [41]Carey M, Markham C, Gaffney P, Boran C, Maher V: Validation of a point of care lipid analyser using a hospital based reference laboratory. Ir J Med Sci 2006, 175:30-35.
• [42]StOEH (Stichting Opsporing Erfelijke Hypercholesterolemie)Annual Report 2009;2010
• [43]Robroek SJ, van Lenthe FJ, Van Empelen P, Burdorf A: Determinants of participation in worksite health promotion programmes: a systematic review. Int J Behav Nutr Phys Act 2009, 6:26. BioMed Central Full Text
• [44]Dzewaltowski DA, Estabrooks PA, Klesges LM, Bull S, Glasgow RE: Behavior change intervention research in community settings: how generalizable are the results? Health Promot Int 2004, 19:235-245.
• [45]Bennett GG, Glasgow RE: The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health 2009, 30:273-292.
• [46]Robroek SJ, Brouwer W, Lindeboom D, Oenema A, Burdorf A: Demographic, behavioral, and psychosocial correlates of using the website component of a worksite physical activity and healthy nutrition promotion program: a longitudinal study. J Med Internet Res 2010, 12:e44.
• [47]Brouwer W, Oenema A, Raat H, Crutzen R, de Nooijer J, de Vries NK, et al.: Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public. Health Educ Res 2010, 25:585-595.
• [48]Bennett GA, Roberts HA, Vaughan TE, Gibbins JA, Rouse L: Evaluating a method of assessing competence in Motivational Interviewing: a study using simulated patients in the United Kingdom. Addict Behav 2007, 32:69-79.
• [49]Carels RA, Darby L, Cacciapaglia HM, Konrad K, Coit C, Harper J, et al.: Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol 2007, 26:369-374.
• [50]Tollison SJ, Lee CM, Neighbors C, Neil TA, Olson ND, Larimer ME: Questions and reflections: the use of motivational interviewing microskills in a peer-led brief alcohol intervention for college students. Behav Ther 2008, 39:183-194.
• [51]Groeneveld IF, Proper KI, Absalah S, van der Beek AJ, van Mechelen W: An individually based lifestyle intervention for workers at risk for cardiovascular disease: a process evaluation. Am J Health Promot 2011, 25:396-401.
• [52]Kreman R, Yates BC, Agrawal S, Fiandt K, Briner W, Shurmur S: The effects of motivational interviewing on physiological outcomes. Appl Nurs Res 2006, 19:167-170.
• [53]Britt E, Hudson SM, Blampied NM: Motivational interviewing in health settings: a review. Patient Educ Couns 2004, 53:147-155.
• [54]Levensky ER, Forcehimes A, O’Donohue WT, Beitz K: Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations. Am J Nurs 2007, 107:50-58.
• [55]Poirier MK, Clark MM, Cerhan JH, Pruthi S, Geda YE, Dale LC: Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change. Mayo Clin Proc 2004, 79:327-331.
• [56]McKay HG, Danaher BG, Seeley JR, Lichtenstein E, Gau JM: Comparing two web-based smoking cessation programs: randomized controlled trial. J Med Internet Res 2008, 10:e40.
• [57]Wanner M, Martin-Diener E, Braun-Fahrlander C, Bauer G, Martin BW: Effectiveness of active-online, an individually tailored physical activity intervention, in a real-life setting: randomized controlled trial. J Med Internet Res 2009, 11:e23.