Background: The impact of physical inactivity and unhealthy diet on health is increasingly profound. Lifestyle\ninterventions targeting both behaviors simultaneously might decrease the prevalence of overweight and comorbidities.\nThe Dutch ââ?¬Ë?BeweegKuurââ?¬â?¢ is a combined lifestyle intervention (CLI) in primary care, to improve physical activity and dietary\nbehavior in overweight people. In a cluster randomized controlled trial, the (cost-) effectiveness of an intensively guided\nprogram has been compared to a less intensively guided program. This process evaluation aimed to assess protocol\nadherence and potential differences between clusters. In addition, sustainability (i.e. continuation of the CLI in practice\nafter study termination) was evaluated.\nMethods: Existing frameworks were combined to design the process evaluation for our intervention and setting specifically.\nWe assessed reach, fidelity, dose delivered and received, context and implementation strategy. Both qualitative and\nquantitative data were used for a comprehensive evaluation. Data were collected in semi-structured interviews with\nhealth care providers (HCPs, n = 25), drop-out registration by HCPs, regular questionnaires among participants (n = 411)\nand logbooks kept by researchers during the trial.\nResults: Protocol adherence by professionals and participants varied between the programs and clusters. In both\nprograms the number of meetings with all HCPs was lower than planned in the protocol. Participants of the supervised\nprogram attended, compared to participants of the start-up program, more meetings with physiotherapists, but fewer\nwith lifestyle advisors and dieticians. The ââ?¬Ë?BeweegKuurââ?¬â?¢ was not sustained, but intervention aspects, networks and\nexperiences were still utilized after finalization of the project. Whether clusters continued to offer a CLI seemed\ndependent on funding opportunities and collaborations.\nConclusions: Protocol adherence in a CLI was problematic in both HCPs and participants. Mainly the amount of\ndietary guidance was lower than planned, and decreased with increasing guidance by PT. Thus, feasibility of changing\nphysical activity and dietary habits simultaneously by one intervention in one year was not as high as expected. Also\nthe sustainability of CLI was poor. When a CLI program is started, re-invention should be allowed and maximum effort\nshould be taken to guarantee long term continuation, by planning both implementation and sustainability carefully.
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