Is a motivational interviewing based lifestyle intervention for obese pregnant women across Europe implemented as planned? Process evaluation of the DALI study
Authors/Creators
- Jelsma, Judith G. M.1
- Simmons, David2
- Gobat, Nina3
- Rollnick, Stephen3
- Blumska, Kinga4
- Jans, Goele5
- Galjaard, Sander5
- Desoye, Gernot6
- Corcoy, Rosa7
- Juarez, Fabiola7
- Kautzky-Willer, Alexandra8
- Harreiter, Jürgen8
- van Assche, Andre5
- Devlieger, Roland5
- Timmerman, Dirk5
- Hill, David9
- Damm, Peter10
- Mathiesen, Elisabeth R.10
- Wender-Ożegowska, Ewa4
- Zawiejska, Agnieszka4
- Lapolla, Annunziata11
- Dalfrà, Maria G.11
- del Prato, Stefano12
- Bertolotto, Alessandra12
- Dunne, Fidelma13
- Jensen, Dorte M.14
- Andersen, Liselotte14
- Snoek, Frank J.15
- van Poppel, Mireille N. M.1
- 1. Department of Public and Occupational Health and, Amsterdam Public Health research institute, VU University Medical Centre, Van der Boechorststraat 7, 1081BT Amsterdam, Amsterdam, The Netherlands
- 2. Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England, UK
- 3. School of Medicine, Cardiff University, Cardiff, Wales, UK
- 4. Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
- 5. KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- 6. Department of Obstetrics and Gynecology, Medizinische Universität Graz, Graz, Austria
- 7. Institut de Recerca de L'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- 8. Medical University of Vienna, Vienna City, Austria
- 9. Recherche en Santé Lawson SA, St. Gallen, Switzerland
- 10. Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- 11. Universita Degli Studi di Padova, Padova, Italy
- 12. Università di Pisa, Pisa, Italy
- 13. National University of Ireland, Galway, Ireland
- 14. Odense University Hospital, Odense, Denmark
- 15. Department of Medical Psychology, Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands
Description
Background: Process evaluation is an essential part of designing and assessing complex interventions. The vitamin D and lifestyle intervention study (DALI) study is testing different strategies to prevent development of gestational diabetes mellitus among European obese pregnant women with a body mass index ≥29 kg/m2. The intervention includes guidance on physical activity and/or healthy eating by a lifestyle coach trained in motivational interviewing (MI). The aim of this study was to assess the process elements: reach, dose delivered, fidelity and satisfaction and to investigate whether these process elements were associated with changes in gestational weight gain (GWG).
Methods: Data on reach, dose delivered, fidelity, and satisfaction among 144 participants were collected. Weekly recruitment reports, notes from meetings, coach logs and evaluation questionnaires (n = 110) were consulted. Fidelity of eight (out of twelve) lifestyle coach practitioners was assessed by analysing audio recorded counselling sessions using the MI treatment integrity scale. Furthermore, associations between process elements and GWG were assessed with linear regression analyses.
Results: A total of 20% of the possible study population (reach) was included in this analysis. On average 4.0 (of the intended 5) face-to-face sessions were delivered. Mean MI fidelity almost reached 'expert opinion' threshold for the global scores, but was below 'beginning proficiency' for the behavioural counts. High variability in quality of MI between practitioners was identified. Participants were highly satisfied with the intervention, the lifestyle coach and the intervention materials. No significant associations were found between process elements and GWG.
Conclusion: Overall, the intervention was well delivered and received by the study population, but did not comply with all the principles of MI. Ensuring audio recording of lifestyle sessions throughout the study would facilitate provision of individualized feedback to improve MI skills. A larger sample size is needed to confirm the lack of association between process elements and GWG.
Trial registration: ISRCTN registry: ISRCTN70595832; Registered 12 December 2011.