The implementation of SMARTsize in the dietetic practice: Evaluation and experiences
The aim of this study was to evaluate the delivery by Dutch dietitians of a multi-component, evidence-based weight-loss program (SMARTsize), including counseling for relapse prevention. The implementation process and the outcomes of the intervention were explored.
An observational study design was used, including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies (all measured on a five point scale), and BBMI were collected among 225 patients. Nine semi-structured interviews were conducted with dietitians. Paired sample t-tests and ANOVA were used. Interviews were transcribed, coded and analyzed using the framework approach.
Use of the intervention components varied from 50% to 100% and satisfaction ranged from 7.2–8.0 (using a ten point scale). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5) and portion control strategies (+0.7) at T1, compared with T0, BMI was significantly decreased at T3 compared with T0 (-2.2 kg/m2). There was no significant differences in BMI between patients with or without counselling. According to dietitians, the main implementation facilitators were the availability of implementation materials, such as a manual, a training and social support from other dietitians. The main barriers were organization and financial reimbursement of cooking classes, the belief that patients need more individual counseling in the starting phase, and the unsuitability for people with low levels of health literacy.
Discussion and conclusions
Implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss. It is recommended to develop a version of the intervention that is suitable for patients with lower levels of health literacy and to diminish experienced barriers in implementation.
Key words: Overweight, obesitas, intervention, proces evaluation, portion controle, SMARTsize