Supporting healthy movement behaviours in people with metabolic risk, prediabetes, or type 2 diabetes in primary health care

Sammanfattning: The overall aim of this thesis was to investigate if a pedometer-based intervention inthe primary health care setting can support people with prediabetes or type 2 diabetestowards healthier movement behaviours. Moreover, health care professionals’experiences of supporting people with metabolic risk factors to increase theirphysical activity were explored.This thesis consists of four papers based on data from two research studies. Paper I,II, and III are based on a randomised controlled trial called the Sophia Step Study,which is a two-year, three-armed pedometer-based intervention. The three groupscomprised a multi-component group that received a pedometer and extracounselling, a single-component group that received a pedometer, and a controlgroup that received standard care.The aim of the Sophia Step Study was to support individuals with prediabetes or type2 diabetes in becoming regularly physically active by reporting their daily number ofsteps, with or without extra counselling. Paper IV is based on a qualitative interviewstudy that explored nurses’, physicians’, and physiotherapists’ experiences in primaryhealth care when supporting patients with metabolic risk factors to physical activity.In paper I, the effects of self-monitoring steps with or without counselling supportfor HbA1c, other cardiometabolic risk factors and physical activity during the twoyearintervention were evaluated. In paper II, the effects of the intervention wereevaluated on relative time in different movement behaviours. In paper III, predictorsassociated with intermediate and post intervention increases in steps were explored. Finally, in paper IV, barriers and facilitators perceived by health care professionalswho work within Swedish primary care to support people with metabolic risk factorsto increase their physical activity were explored.The results show that the Sophia Step Study did not have an effect on the primaryoutcome HbA1c. However, a significant effect was found for the multi-componentgroup on absolute time in moderate-to-vigorous physical activity during the entiretwo-year period, as well as for the single-component group at six months. No effect, however, was found for the absolute time in the other movement behaviours, thenumber of daily steps, any of the biomarkers or the anthropometric variables. Usingrelative time, instead of absolute time, when evaluating the effect showed a morepronounced effect in all movement behaviours within both intervention groups overthe two-year period. At six months, lower number of steps at baseline was asignificant predictor for increasing ≥500 steps per day. At 24 months, men, youngerparticipants, and those with higher self-efficacy at baseline had significantly higherodds for increasing ≥500 steps per day. Barriers and facilitators for supportingpeople with metabolic risk factors in increasing their physical activity, as experiencedby nurses, physiotherapists and physicians, were identified at multiple levels,represented by four generic categories: ‘Patient readiness for change’, ‘Supporting theprocess of change’, ‘The professional role’, and ‘The organisation of primary care’.The overall conclusion is that the self-monitoring of steps with a pedometer seems tobe an effective behaviour change technique in maintaining healthy movementbehaviours; however, the counselling component of the intervention did not seem toimprove the effect. In addition, the intervention did not find evidence for improvedmetabolic control or improved cardiometabolic risk factors. Moreover, barriers toand facilitators for supporting patients with metabolic risk factors can be found atseveral levels within primary care, from individual patients and health careprofessionals to the organisational level. In the primary health care setting, thisshould be emphasised when implementing support with the intention to increasephysical activity in people with metabolic risk factors, prediabetes or type 2 diabetes.