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Open Access Research article

Implementation of a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention delivery

Paulina WA Vermunt12*, Ivon EJ Milder2, Frits Wielaard1, Caroline A Baan2, Jos DM Schelfhout3, Gert P Westert14 and Hans AM van Oers15

Author Affiliations

1 Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Warandelaan 2, 5037, AB, Tilburg, the Netherlands

2 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, MA, Bilthoven, the Netherlands

3 Association of primary care practices ‘De Ondernemende Huisarts’ (DOH), P.O. Box 704, 5600, AS, Eindhoven, the Netherlands

4 Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands

5 Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, MA, Bilthoven, the Netherlands

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BMC Family Practice 2012, 13:79  doi:10.1186/1471-2296-13-79

Published: 8 August 2012



As in clinical practice resources may be limited compared to experimental settings, translation of evidence-based lifestyle interventions into daily life settings is challenging. In this study we therefore evaluated the implementation of the APHRODITE lifestyle intervention for the prevention of type 2 diabetes in Dutch primary care. Based on this evaluation we discuss opportunities for refining intervention delivery.


A 2.5-year intervention was performed in 14 general practices in the Netherlands among individuals at high risk for type 2 diabetes (FINDRISC-score ≥ 13) (n = 479) and was compared to usual care (n = 446). Intervention consisted of individual lifestyle counselling by nurse practitioners (n = 24) and GPs (n = 48) and group-consultations. Drop-out and attendance were registered during the programme. After the intervention, satisfaction with the programme and perceived implementation barriers were assessed with questionnaires.


Drop-out was modest (intervention: 14.6 %; usual care: 13.2 %) and attendance at individual consultations was high (intervention: 80-97 %; usual care: 86-94 %). Providers were confident about diabetes prevention by lifestyle intervention in primary care. Participants were more satisfied with counselling from nurse practitioners than from GPs. A major part of the GPs reported low self-efficacy regarding dietary guidance. Lack of counselling time (60 %), participant motivation (12 %), and financial reimbursement (11 %) were regarded by providers as important barriers for intervention implementation.


High participant compliance and a positive attitude of providers make primary care a suitable setting for diabetes prevention by lifestyle counselling. Results support a role for the nurse practitioner as the key player in guiding lifestyle modification. Further research is needed on strategies that could increase cost-effectiveness, such as more stringent criteria for participant inclusion, group-counselling, more tailor-made counselling and integration of screening and / or interventions for different disorders.

Type 2 diabetes; Primary care; Lifestyle intervention; Implementation