荷兰初级卫生保健中糖尿病预防干预随机对照试验的过程评估：SLIMMER研究
Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.
作者信息
van Dongen Ellen Ji, Duijzer Geerke, Jansen Sophia C, Ter Beek Josien, Huijg Johanna M, Leerlooijer Joanne N, Hiddink Gerrit J, Feskens Edith Jm, Haveman-Nies Annemien
机构信息
1Wageningen University,Division of Human Nutrition and Academic Collaborative Centre AGORA,PO Box 8129,6700 EV Wageningen,The Netherlands.
2GGD Noord- en Oost-Gelderland (Community Health Service),Warnsveld,The Netherlands.
出版信息
Public Health Nutr. 2016 Nov;19(16):3027-3038. doi: 10.1017/S1368980016001282. Epub 2016 Jun 3.
OBJECTIVE
To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness.
DESIGN
A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155).
SETTING
SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs.
SUBJECTS
Subjects at increased risk of developing type 2 diabetes were included.
RESULTS
It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour.
CONCLUSIONS
The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.
目的
调查（i）荷兰初级卫生保健中“SLIMMER干预措施”的实施与接受情况，以及（ii）这如何解释干预措施的有效性。
设计
进行了一项随机对照试验，将受试者随机分配至干预组（为期10个月的饮食与体育活动联合干预）或对照组。开展了一项包括定量和定性方法的过程评估。通过对医疗保健专业人员（n = 45）进行半结构化访谈以及干预参与者问卷调查（n = 155），收集了过程指标（招募、覆盖范围、接受的干预量、可接受性、实施完整性和适用性）的数据。
背景
“SLIMMER”在荷兰25家全科诊所、11名营养师、9家物理治疗师诊所和15家体育俱乐部的初级卫生保健中实施。
受试者
纳入2型糖尿病发病风险增加的受试者。
结果
有可能招募到预期的高风险人群（应答率54%），“SLIMMER干预措施”受到参与者和医疗保健专业人员的高度认可（平均可接受性评分分别为82和80）。干预计划在很大程度上按计划实施，且适用于荷兰初级卫生保健。接受的干预量增加和参与者的可接受性与健康状况改善及饮食行为有关，但与体育活动行为无关。
结论
本研究表明，在荷兰初级卫生保健中实施糖尿病预防干预措施是可行的。接受的干预量增加和参与者可接受性与健康状况改善及饮食行为相关。使用广泛的过程评估计划来深入了解干预措施的实施与接受情况，是识别有助于初级卫生保健中实施完整性和有效预防2型糖尿病的干预组成部分的一种有价值的方法。
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