Implementation of a group-based lifestyle intervention programme (Healthy Heart) in general practices in The Netherlands: a mixed-methods study

Anne K Smit; Rimke C Vos; Rozemarijn W Bijl; Karin J G Busch; Sanne M Verkleij; Jessica C Kiefte-de Jong; Mattijs E Numans; Tobias N Bonten

doi:10.3399/BJGPO.2023.0064

Implementation of a group-based lifestyle intervention programme (Healthy Heart) in general practices in The Netherlands: a mixed-methods study

BJGP Open. 2023 Dec 19;7(4):BJGPO.2023.0064. doi: 10.3399/BJGPO.2023.0064. Print 2023 Dec.

Authors

Anne K Smit¹, Rimke C Vos², Rozemarijn W Bijl², Karin J G Busch³, Sanne M Verkleij², Jessica C Kiefte-de Jong², Mattijs E Numans², Tobias N Bonten²

Affiliations

¹ Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands a.k.smit@lumc.nl.
² Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands.
³ Primary Care Group The Hague (Hadoks), Hague, The Netherlands.

PMID: 37402548
DOI: 10.3399/BJGPO.2023.0064

Abstract

Background: Lifestyle intervention programmes target behavioural risk factors that contribute to cardiovascular diseases (CVDs). Unfortunately, sustainable implementation of these programmes can be challenging. Gaining insights into the barriers and facilitators for successful implementation is important for maximising public health impact of these interventions. The Healthy Heart (HH) programme is an example of a combined lifestyle intervention programme.

Aim: To analyse the reach, adoption, and implementation of the HH programme.

Design & setting: A mixed-methods study conducted in a general practice setting in The Netherlands.

Method: Quantitative data were collected from the Healthy Heart study (HH study), a non-randomised cluster stepped-wedge trial to assess the effect of the HH programme on patients at high risk of developing CVDs at practice level. Qualitative data were obtained through focus groups.

Results: Out of 73 approached general practices, 55 implemented the HH programme. A total of 1082 patients agreed to participate in the HH study, of whom 64 patients were referred to the HH programme and 41 patients participated. Several barriers for participation were identified such as time investment, lack of risk perception, and being confident in changing lifestyle on their own. Important barriers for healthcare providers (HCPs) to refer a patient were time investment, lack of information to sufficiently inform patients, and preconceived notions regarding which patients the programme was suitable for.

Conclusion: This study has offered insights from a patient and HCP perspective regarding barriers and facilitators for implementation of the group-based lifestyle intervention programme. The identified barriers and facilitators, and the suggested improvements, can be used by others who wish to implement a similar programme.

Keywords: cardiovascular diseases; general practice; group-based intervention; implementation; life style; lifestyle intervention programme; mixed methods.