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. 2019 Jun;32(3):338-348.
doi: 10.1111/jhn.12641. Epub 2019 Mar 20.

Facilitators and barriers to a dietitian-implemented blended care weight-loss intervention (SMARTsize): a qualitative study

W H Heideman  1 , F C Rongen  1 , C Bolleurs  2 , E Govers  3 , W Kroeze  1 , I H M Steenhuis  1
Affiliations

Facilitators and barriers to a dietitian-implemented blended care weight-loss intervention (SMARTsize): a qualitative study

W H Heideman et al. J Hum Nutr Diet. 2019 Jun.

Abstract

Background: Dietitians play an important role in the intervention and prevention of being overweight and obesity. More and more blended care interventions are being implemented. The present study aimed to evaluate the delivery by Dutch dietitians of a multicomponent, evidence-based weight-loss programme (SMARTsize), including counselling for relapse prevention. The aim of this qualitative study was to identify facilitators and barriers to the delivery of SMARTsize.

Methods: Nine semi-structured interviews were conducted with 10 dietitians who participated in a larger implementation study. Each interview was recorded and transcribed verbatim. Determinants of theory of implementation, including characteristics of the user, the innovation, organisational context and setting, and innovation strategy guided interviews and analysis. Data were coded and analysed using the framework approach.

Results: According to dietitians, the SMARTsize intervention had a positive influence on patients. The main implementation facilitators were the availability of implementation materials, such as a manual, training in relapse prevention and social support from other dietitians. The main barriers to implementation were organisation and financial reimbursement of cooking classes, the belief that patients need more individual counselling in the starting phase, and the unsuitability for people with low levels of health literacy.

Conclusions: Most dietitians considered that implementation of the SMARTsize intervention consisting of e-health, written information and cooking classes and face-to-face counselling is challenging but feasible. Further development of the SMARTsize intervention and implementation tools is needed to lower experienced barriers. It is also recommended that a version of the intervention to be developed that is suitable for patients with lower levels of health literacy.

Keywords: SMARTsize; implementation; multi-component intervention; qualitative; weight loss.

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Conflict of interest statement

Conflict of interests, source of funding and authorship

IS co‐owns Brickhouse Academy, an educational institution that aims at translating scientific knowledge into practice. In this respect, she trains health professionals, such as dietitians, also on the basis of the educational book that was part of the SMARTsize intervention. She has received royalties from Scriptum Publishers for the book. All other authors declare that they have no competing interests.

This project was funded by ZonMw, The Netherlands Organisation for Health Research and Development, project no. 531005002. ZonMw did not have any role in the design of the study; in the collection, analysis and interpretation of the data; or in the writing of the manuscript.

IS, WK, CB and EG conceived the study design. WH, WK, IS and FR contributed to the design of the article. WH contributed to the data collection. WH and WK contributed to the data analysis. WH, WK and FR contributed to the interpretation of the data. WH, FR and IS drafted the article. All authors read and approved the final manuscript submitted for publication.

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