Nutrition care by primary-care physicians: advancing our understanding using the COM-B framework.

OBJECTIVE: To investigate the nutrition education provided by primary-care physicians (PCP). DESIGN: An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms. SETTING: USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand. PARTICIPANTS: Primary-care physicians. RESULTS: Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations. CONCLUSIONS: The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.

Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial.

BACKGROUND: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. METHODS: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. RESULTS: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). CONCLUSIONS: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. TRIAL REGISTRATION: The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.

Is the success of the SLIMMER diabetes prevention intervention modified by socioeconomic status? A randomised controlled trial.

AIM: To explore the role of socioeconomic status (SES) in participation, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out, and effectiveness in the SLIMMER diabetes prevention intervention. METHODS: SLIMMER was a randomised controlled intervention, carried out in a real-world setting, targeting 40- to 70-year-old adults at increased risk of developing type 2 diabetes (n=316). The intervention group participated in a 10-month combined dietary and physical activity programme. Measurements were carried out at baseline, 12months, and 18months. Effectiveness was determined for fasting insulin, HbA1c, weight, BMI, waist circumference, and waist-to-height-ratio. Differences between the low SES (no, primary, or lower secondary school) and higher SES group were tested using logistic regression and ANCOVA. RESULTS: Fifty-two percent of the SLIMMER participants had a low SES. No differences in participation were observed between the low and higher SES group. The most important reason for non-participation in the low SES group was 'lack of interest' (32%), whereas in the higher SES group this was 'I already exercise enough' (31%). Attendance, acceptability, adherence, drop-out, and effectiveness after 12months were similar in the low and higher SES group. After 18months, the low SES group seemed to maintain slightly better effects for fasting insulin, HbA1c, and waist circumference. CONCLUSIONS: The current study showed that participation, attendance, acceptability, adherence, drop-out, and effectiveness of the SLIMMER intervention were in general not modified by socioeconomic status. The SLIMMER intervention can contribute to health promotion for individuals in both low and higher socioeconomic groups.

Operationalising the health aspects of sustainable diets: a review.

OBJECTIVE: Shifting towards a more sustainable food consumption pattern is an important strategy to mitigate climate change. In the past decade, various studies have optimised environmentally sustainable diets using different methodological approaches. The aim of the present review was to categorise and summarise the different approaches to operationalise the health aspects of environmentally sustainable diets. DESIGN: Conventional keyword and reference searches were conducted in PubMed, Scopus, Web of Knowledge and CAB Abstracts. Inclusion criteria were: (i) English-language publication; (ii) published between 2005 and October 2015; (iii) dietary data collected for the diet as a whole at the national, household or individual level; (iv) comparison of the current diet with dietary scenarios; and (v) for results to consider the health aspect in some way. SETTING: Consumer diets. SUBJECTS: Adult population. RESULTS: We reviewed forty-nine studies that combined the health and environmental aspects of consumer diets. Hereby, five approaches to operationalise the health aspect of the diet were identified: (i) food item replacements; (ii) dietary guidelines; (iii) dietary quality scores; (iv) diet modelling techniques; and (v) diet-related health impact analysis. CONCLUSIONS: Although the sustainability concept is increasingly popular and widely advocated by nutritional and environmental scientists, the journey towards designing sustainable diets for consumers has only just begun. In the context of operationalising the health aspects, diet modelling might be considered the preferred approach since it captures the complexity of the diet as a whole. For the future, we propose SHARP diets: environmentally Sustainable (S), Healthy (H), Affordable (A), Reliable (R) and Preferred from the consumer's perspective (P).

Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.

OBJECTIVE: To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. DESIGN: A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SETTING: SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. SUBJECTS: Subjects at increased risk of developing type 2 diabetes were included. RESULTS: It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. CONCLUSIONS: The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.

Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice.

OBJECTIVE: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement. DESIGN: An observational checklist was developed to assess goal and implementation intentions and 'missed opportunities for lifestyle counselling'. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire. SETTING: Dutch general practice. SUBJECTS: One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity. RESULTS: Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important 'missed opportunity for lifestyle counselling'. CONCLUSIONS: Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review.

BACKGROUND: In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. METHODS: Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. RESULTS: Especially in the last three years, many studies have been published. The majority of the studies were positive about PNs' actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs' role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this. CONCLUSION: The PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.

Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention.

BACKGROUND: Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands. METHODS: The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention. RESULTS: The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme. CONCLUSIONS: The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions.

Feasibility and potential impact of the adapted SLIM diabetes prevention intervention in a Dutch real-life setting: the SLIMMER pilot study.

OBJECTIVE: Pilot-testing of the adapted Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM) and to determine its feasibility and likelihood of achieving desired impact. METHODS: Pilot intervention study (a 10-month combined lifestyle intervention) using a one group pre-test post-test design with on-going process measures (i.e. reach, acceptability, implementation integrity, and applicability) and several health outcomes (e.g. body weight). RESULTS: In total, 31 subjects participated in the SLIMMER (SLIM iMplementation Experience Region Noord- en Oost-Gelderland) intervention. Participant weight loss was -3.5 kg (p=0.005). Both participants and health care professionals (i.e. practice nurses, dieticians, and physiotherapists) were satisfied with the intervention. The intervention was implemented as planned and appeared to be suitable for application in practice. Refinements have been identified and will be made prior to further implementation and evaluation. CONCLUSION: Implementation of the SLIMMER intervention is feasible in a Dutch real-life setting and it is likely to achieve desired impact. Practising and optimising the intervention creates local support for SLIMMER among stakeholders. PRACTICE IMPLICATIONS: Performing a pilot study on the basis of a structured approach is a meaningful step in the process of optimising the feasibility and potential impact of an evidence-based intervention in a real-life setting.

SLIMMER: a randomised controlled trial of diabetes prevention in Dutch primary health care: design and methods for process, effect, and economic evaluation.

BACKGROUND: Implementation of interventions in real-life settings requires a comprehensive evaluation approach. The aim of this article is to describe the evaluation design of the SLIMMER diabetes prevention intervention in a Dutch real-life setting. METHODS/DESIGN: The SLIMMER study is a randomised, controlled intervention study including subjects aged 40 through 70 years with impaired fasting glucose or high risk of diabetes. The 10-month SLIMMER intervention involves a dietary and physical activity intervention, including case management and a maintenance programme. The control group receives usual health care and written information about a healthy lifestyle. A logic model of change is composed to link intervention activities with intervention outcomes in a logical order. Primary outcome is fasting insulin. Measurements are performed at baseline and after 12 and 18 months and cover quality of life, cardio-metabolic risk factors (e.g. glucose tolerance, serum lipids, body fatness, and blood pressure), eating and physical activity behaviour, and behavioural determinants. A process evaluation gives insight in how the intervention was delivered and received by participants and health care professionals. The economic evaluation consists of a cost-effectiveness analysis and a cost-utility analysis. Costs are assessed from both a societal and health care perspective. DISCUSSION: This study is expected to provide insight in the effectiveness, including its cost-effectiveness, and delivery of the SLIMMER diabetes prevention intervention conducted in Dutch primary health care. Results of this study provide valuable information for primary health care professionals, researchers, and policy makers. TRIAL REGISTRATION: The SLIMMER study is registered with ClinicalTrials.gov (NCT02094911) since March 19, 2014.

Adapting the SLIM diabetes prevention intervention to a Dutch real-life setting: joint decision making by science and practice.

BACKGROUND: Although many evidence-based diabetes prevention interventions exist, they are not easily applicable in real-life settings. Moreover, there is a lack of examples which describe the adaptation process of these interventions to practice. In this paper we present an example of such an adaptation. We adapted the SLIM (Study on Lifestyle intervention and Impaired glucose tolerance Maastricht) diabetes prevention intervention to a Dutch real-life setting, in a joint decision making process of intervention developers and local health care professionals. METHODS: We used 3 adaptation steps in accordance with current adaptation frameworks. In the first step, the elements of the SLIM intervention were identified. In the second step, these elements were judged for their applicability in a real-life setting. In the third step, adaptations were proposed and discussed for those elements which were deemed not applicable. Participants invited for this process included intervention developers and local health care professionals (n=19). RESULTS: In the first adaptation step, a total of 22 intervention elements were identified. In the second step, 12 of these 22 intervention elements were judged as inapplicable. In the third step, a consensus was achieved for the adaptations of all 12 elements. The adapted elements were in the following categories: target population, techniques, intensity, delivery mode, materials, organisational structure, and political and financial conditions. The adaptations either lay in changing the SLIM protocol (6 elements) or the real-life working procedures (1 element), or a combination of both (4 elements). CONCLUSIONS: The positive result of this study is that a consensus was achieved within a relatively short time period (nine months) between the developers of the SLIM intervention and local health care professionals on the adaptations needed to make SLIM applicable in a Dutch real-life setting. Our example shows that it is possible to combine the perspectives of scientists and practitioners, and to find a balance between evidence-base and applicability concerns.

Determinants of Dutch general practitioners' nutrition and physical activity guidance practices.

OBJECTIVE: General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants. DESIGN: Cross-sectional study, mail questionnaire. SETTING: Dutch general practice. SUBJECTS: Four hundred and seventy-two GP in practice for 5­30 years. RESULTS: Our study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices. CONCLUSIONS: The majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the selfefficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice.

Nutrition and physical activity guidance practices in general practice: a critical review.

OBJECTIVE: The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS: Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. RESULTS: In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. CONCLUSION: We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs' provision of combined lifestyle advice to overweight and obese patients seems to be rather low. PRACTICE IMPLICATIONS: Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.

Translating the SLIM diabetes prevention intervention into SLIMMER: implications for the Dutch primary health care.

All over the world, prevalence and incidence rates of type 2 diabetes mellitus are rising rapidly. Several trials have demonstrated that prevention by lifestyle intervention is (cost-) effective. This calls for translation of these trials to primary health care. This article gives an overview of the translation of the SLIM diabetes prevention intervention to a Dutch real-life setting and discusses the role of primary health care in implementing lifestyle intervention programmes. Currently, a 1-year pilot study, consisting of a dietary and physical activity part, performed by three GPs, three practice nurses, three dieticians and four physiotherapists is being conducted. The process of translating the SLIM lifestyle intervention to regular primary health care is measured by means of the process indicators: reach, acceptability, implementation integrity, applicability and key factors for success and failure of the intervention. Data will be derived from programme records, observations, focus groups and interviews. Based on these results, our programme will be adjusted to fit the role conception of the professionals and the organization structure in which they work.

The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to October 2008: a review.

BACKGROUND: Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. OBJECTIVE: To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance practices of PCPs. METHOD: A review of articles published from 1995 to October 2008 (n = 111). RESULTS: It was found that 45% of the articles in this review included theories or theoretical models of behaviour change. No difference in proportion of model use was found with time. Model use differed between type of study. In 29% of the articles, the Transtheoretical Model was used. Little was found on authors' views on theoretical model applicability. CONCLUSIONS: Forty-five per cent of the articles on nutrition guidance practices of PCPs published from 1995 to October 2008 included theories or theoretical models of behaviour change. It would be beneficial for nutrition behaviour change research if more researchers use theoretical models and report on applicability of the selected theory, to increase effectiveness of nutrition guidance by PCPs.

A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007.

BACKGROUND: One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. OBJECTIVE: Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. METHODS: This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, van Woerkum CMJ, Fieren CJ, van t'Hof MA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29-36.) demonstrated that 'noticing patients' overweight and guidance of treatment' was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). RESULTS: This analysis shows both similarity and differences in working mechanism of determinants of noticing patients' overweight and guidance of treatment between 1997 and 2007. The backbone of the mechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. CONCLUSIONS: The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients' overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.

Written nutrition communication in midwifery practice: what purpose does it serve?

OBJECTIVE: to obtain an in-depth understanding of verbal and written nutrition communication in Dutch midwifery practice. DESIGN, SETTING AND PARTICIPANTS: data were collected by recording 12 initial antenatal consultations (12 weeks into the pregnancy) with primiparous women from four Dutch midwifery practices spread over The Netherlands, followed by two semi-structured qualitative interviews with the women. The interviews were undertaken on the day after the consultation and two weeks later. FINDINGS: analysis of the recordings revealed that a nutrition brochure was offered in an information pack, but it was not used or referred to by the midwives. Verbally, clients were informed about healthy nutrition in general terms. Specific, personally relevant nutrition-related questions and motivators of nutrition behaviour were rarely clarified and addressed. Midwives tried to create a good relationship with their clients by being friendly, complimentary, confirmative and supportive. Women appreciated talking about nutrition with the midwife because of her expertise. The subsequent interviews with the women revealed, however, that nutrition communication took place relatively late in pregnancy at a point when women were more interested in 'hearing the baby's heart beat'. Furthermore, clients seldom looked through the nutrition brochure at home. KEY CONCLUSION: the provision of a nutrition brochure does not serve any real purpose. IMPLICATIONS FOR PRACTICE: to reach optimal synergy between verbal and written nutrition communication in midwifery practice, midwives should actively refer to a nutrition brochure in addition to verbal communication. Moreover, health organisations should realise that the provision of nutrition brochures to midwives does not mean that these brochures will be used as an integral part of midwives' nutrition communication with clients.

Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective.

OBJECTIVES: To examine whether preconception and pregnancy could be an occasion triggering women's interest, search and need for both general and pregnancy-specific nutrition-related information, in order to: (i) provide a greater understanding of the life course perspective (in this case on nutrition behaviours and pregnancy) and (ii) to contribute to the rationale of nutrition interventions aimed at women of child-bearing age. METHODS: Data were collected in a cross-sectional study with the aid of a face-to-face interview. The sample consisted of four groups each of about 100 Dutch nulliparous women each: women trying to conceive and women in the first, second or third trimester of their first pregnancy. RESULTS: Pregnant women were more interested in nutrition information than before preconception and before pregnancy, especially the first-trimester group. The frequency of search for nutrition information differed significantly between the groups: the first-trimester group searched for information most frequently. Women wanting to conceive and women in their third trimester of pregnancy found significantly more pregnancy-specific information topics than women in their first and second trimester of pregnancy. Women wanting to conceive had significantly higher needs for general and specific nutrition-related topics compared to pregnant women. Overall, the Internet, the midwife and books were the favourite information sources. CONCLUSIONS: The study provided indications that preconception and pregnancy are moments in life that lead to an increased interest, need and search for particularly pregnancy-specific nutrition-related information. This should be borne in mind when healthy nutrition promotion activities are being developed.