Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD, Maastricht, The Netherlands.
Eur J Epidemiol. 2021 Mar;36(3):345-360. doi: 10.1007/s10654-020-00708-2. Epub 2020 Dec 30.
Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (n = 1,629), aged 45-70 years, randomly selected and recruited in 2005-2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (n = 405), four telephone motivational interviewing (TMI) sessions (n = 407), a combined intervention (two TPC letters and two TMI sessions, n = 408), or no intervention (control group, n = 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).
在全球范围内，建议遵循国家有关体育活动（PA）和水果与蔬菜消费的指南，以促进健康并降低（慢性）疾病的风险。本研究报告了各种社会认知干预措施的有效性，这些措施旨在提高对指南的依从性，并揭示了依从性的预测因素。参与者（n=1629）年龄在 45-70 岁之间，于 2005-2006 年从 23 个荷兰综合诊所中随机选择并招募，随机（集中分层分配）分为四组，接受为期 12 个月的生活方式干预，旨在针对 PA 和水果与蔬菜消费的指南进行依从性。研究组分别接受了四种计算机定制印刷通讯（TPC）信（n=405）、四次电话动机访谈（TMI）会议（n=407）、联合干预（两次 TPC 信和两次 TMI 会议，n=408）或无干预（对照组，n=409）。在基线评估后，所有各方都知道了治疗组。在基线、25、47 和 73 周时，通过自我报告的邮政问卷测量结果。对于 PA，所有三种干预措施与无干预相比，均与更好的指南依从性相关。TPC、TMI 和联合干预的优势比分别为 1.82（95%CI 1.31；2.54）、1.57（95%CI 1.13；2.18）和 2.08（95%CI 1.50；2.88）。未发现计步器效果。对于水果和蔬菜的消费，TPC 似乎优于其他组。水果和蔬菜消费的比值分别为 1.78（95%CI 1.32；2.41）和 1.73（95%CI 1.28；2.33）。对于每种行为，自我效能期望、习惯强度和改变阶段预测了对指南的依从性，而性别、意识和行动计划的数量则预测了对水果和蔬菜摄入量的指南依从性。季节预测了 PA 和水果消费的指南依从性。显示的优势比相当于适度的效果大小，尽管它们大于系统评价中报告的那些。本研究表明，当广泛实施时，资源密集度较低的干预措施可能具有很大的公共卫生影响潜力。本研究的优势在于参与了教育程度较低的成年人，并评估了维持效果。（试验 NL1035，2007-09-06）。
