GPs who are more knowledgeable about lifestyle interventions and objective screening of patients to see whether they would benefit from such interventions can increase the number of effective referrals. Other ways to support participants in lifestyle interventions may lead to increased effectiveness, which will help participants to stay active longer and have a higher quality of life. These conclusions are drawn by human movement scientist Adrie Bouma of the UMCG, who will be awarded a PhD for her research by the University of Groningen on 21 November.
A substantial part of the population is not sufficiently active and does not meet the recommendations for a healthy diet. Lifestyle programmes seem useful tools for promoting a healthier lifestyle. Earlier research has shown that such interventions may lead to people exercising more frequently. However, many people do not follow such recommendations and do not exercise enough. Adrie Bouma investigated what factors could contribute to more effective lifestyle interventions. In her study, she examined the role of GPs as referrers. She also developed a new and more effective way to support participants in such interventions.
The role of GPs as referrers
Bouma’s research shows that GPs do not have sufficient resources for objective screening of patients to determine whether they might benefit from a lifestyle programme. Moreover, GPs are often not motivated to do so, and they lack the means to make such referrals. They also have little knowledge of effective and successful interventions. Bouma shows that GPs mainly refer patients if they display clear somatic symptoms, and only rarely make preventive referrals. It appears that GPs who themselves have a healthy lifestyle, exercise pattern and diet make more such referrals.
Barriers and participants’ motivation
The combination of participants’ motivation to exercise and the barriers they believe prevent them from exercising determines the success of lifestyle interventions. Bouma’s research shows that the support for participants has so far mainly focused on their motivation, which is only effective in the short term. In the long term, Bouma concludes, it is more effective to support participants to tackle the barriers that prevent them from exercising. For this purpose, she developed a new method for behavioural change: the barrier-belief approach. It comprises four strategies: 1) teaching participants other ways to achieve lifestyle goals, thus circumventing their barriers; 2) changing participants’ goals, to lower their barriers; 3) changing the participants’ beliefs about their barriers; 4) inducing participants to accept the investments required and the consequences of reaching their goals. Bouma followed participants of lifestyle interventions for two years. Her study shows that participants supported on the basis of the new method, which teaches them to cope with their barriers, remained active for a longer period and experienced a higher quality of life.
Improving the effectiveness of lifestyle programmes
Bouma recommends that a brief patient lifestyle checklist be included in the general practice protocol. She also believes that health professionals should more often consider lifestyle changes as a viable treatment option in addition to regular medical care and recommends that official guidelines and tools be developed for patient screening. This will give GPs a referral indication, which will increase the number of people that can be helped. According to Bouma, information about lifestyle programmes should be offered to primary health professionals to increase their knowledge of such interventions. Finally, she recommends that GPs closely cooperate with health professionals who specialize in behavioural change and supervise such interventions.
Programmes starting in January 2019
Bouma believes that effective evidence-based lifestyle interventions increase life expectancy and improve quality of life. Certain lifestyle programmes will be reimbursed by health insurers from January 2019 onwards. These are based on participant motivation. According to Bouma, it is better to focus on removing patient barriers. While the plans of the Ministry of Health, Welfare and Sport mainly target obese people, she feels that other people should be given the opportunity to follow these programmes too.
Adrie Bouma (Stiens, 1978) studied Human Movement Sciences at the University of Groningen. She conducted her PhD research at the SHARE research institute of the University Medical Center Groningen while working as a lecturer-researcher at the School of Sports Studies of the Hanze University of Applied Sciences, Groningen. The title of her thesis is The barrier-belief approach, a new perspective of changing behavior in primary care. Adrie Bouma works as a postdoc researcher at the department of Rehabilitation of the UMCG, where she currently investigates lifestyle interventions in secondary care and their efficacy.
The thesis can be found online.