Using pictures as vignettes to assess stages of change in weight management.

AIMS: To evaluate the association between descriptions of the stage of change in weight management (using pictures as vignettes) and the changes in the restriction of amount of food and body weight. The goal is to develop counselling methods for helping people to change their lifestyles. METHODS: A total of 74 people at high risk of type 2 diabetes participated in six months of group counselling. The data were collected through questionnaires and video-recordings at the beginning and the end of the counselling process, and were analyzed using both deductive content analysis and statistical analysis. RESULTS: Most of the participants were at the contemplation stage at the beginning of the study, and nearly half were at the action stage at six months. There were associations between progression in the lifestyle change process, the restriction of food amount, and weight changes. Judging from this, the descriptions of the change process of weight management using pictures were well made, because the change process progressed in parallel with the changes in weight and restriction of the amount of food eaten. CONCLUSIONS: Assessing the stages of change in weight management by using pictures as vignettes is easy to carry out, and feasible. The descriptions of the stages of change were parallel with the changes in restriction of food and changes in weight.

Motivators and barriers to exercise among adults with a high risk of type 2 diabetes--a qualitative study.

PURPOSE: Type 2 diabetes (T2D) can be prevented through lifestyle changes. Regular exercise for more than 4 hours per week, combined with weight loss and changes in dietary habits reduces the incidence of T2D. The aim of this study was to describe motivators and barriers to exercise among adults with a high risk of T2D. METHODS: Altogether, 74 subjects participated in a study on the Effectiveness and Feasibility of Activating Counseling Methods and Videoconferences in Dietary Group Counseling of Subjects with high risk of T2D. The qualitative data were gathered from video-recorded group counselling sessions and were analysed using content analysis. RESULTS: Enjoyment from exercise, social relationships related to exercise, encouragement from others, benefits to health, and the aim of weight control motivated subjects to exercise. The wish to join people with an active lifestyle, admiration of active friends and willingness to serve as an example for children reflected why exercise was an important value in life. The barriers to exercise were weather/season, health problems, lack of time, work-related factors and lack of interest. CONCLUSIONS: Adults with high risk of T2D experienced many individually meaningful motivators. They experienced few barriers to exercise and highlighted the motivators. Thus, we present that they had a positive attitude towards increasing exercise during participation to counselling. The results can be used when developing counselling methods because they provide concrete content for counselling discussion such as importance of work-related factors, family exercise, time management skills and social support for regular exercise.

Feasibility of videoconferencing in lifestyle group counselling.

OBJECTIVES: The rapid increase in the prevalence of type 2 diabetes (T2D) has created an urgent need to develop new practices to prevent and treat it. One possibility is to provide specialists services to remote areas through videoconferencing (VC). Therefore, the aim was to study the feasibility of short-term group counselling by a clinical nutritionist (4 sessions at 1.5-hour each at 2-week intervals from baseline, and the session 5 at 6 months) performed by videoconferencing (VC). STUDY DESIGN: We recruited 74 subjects at high risk of T2D, and compiled 5 VC groups (each group included 5-9 subjects, total n=33) and 6 face-to-face groups (FF, total n=44). The subjects were also asked to participate in a follow-up visit 15 months after the last counselling session. METHODS: Data were collected by a questionnaire (satisfaction with group counselling via videoconferencing), by theme interviews (experiences on group counselling) and by metabolic measures (laboratory tests). RESULTS: Only one of the 74 subjects dropped out during the first 6 months. The proportion of subjects who had received social support from group peers was higher in the videoconferencing group than in the face-to-face groups (p=0.001). The experiences of group counselling transmitted by videoconferencing were positive. Waist circumference decreased significantly at 0 to 6 months of counselling (p<0.01), and was significantly lower at 21 months than at baseline in FF groups (p=0.015). However, no significant differences were observed in most of the measurements between VC and face-to-face groups. CONCLUSIONS: Short-term group counselling by a clinical nutritionist through videoconferencing is a feasible way and a practical model to provide specialists services to remote areas, and thus can be used as an option to diminish inequality related to restricted health care services in sparsely inhabited areas.

Pedometer use among adults at high risk of type 2 diabetes, Finland, 2007-2008.

INTRODUCTION: A pedometer helps adults exercise more, but sedentary adults need instruction and advice to be motivated to use one. We conducted this qualitative study to describe the experiences of participants at high risk of type 2 diabetes who began using a pedometer. METHODS: A total of 74 people at high risk of type 2 diabetes participated in 6 months of group counseling. From April 2007 to April 2008, we collected data through questionnaires, theme interviews (n = 22) and video recordings of counseling sessions. From October 2007 through June 2008, we analyzed the data. RESULTS: Pedometers were useful tools for observing levels of exercise, setting personal goals for walking, and helping evaluate whether daily goals were met. Negative experiences were associated with functional failures, pedometers' unsuitability for exercise other than walking, and the goal of 10,000 steps, which some participants considered too high. CONCLUSION: Sedentary adults can be motivated to use a pedometer if we inform them that regular users find it a useful instrument for increasing their level of exercise. These adults should set realistic goals for walking and receive adequate instructions for using pedometers.

Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review.

The aim of this systematic review was to identify the reported barriers to regular exercise among adults either at high risk or already diagnosed with type 2 diabetes (T2D), because of the importance of exercise in the prevention of T2D. We searched the MEDLINE, Cinahl and PsycINFO databases. All potentially relevant articles were reviewed by two researchers, and 67 titles were found, of which 13 papers met inclusion criteria. Internal and external barriers to exercise were identified among adults either at high risk of T2D or already diagnosed. Internal barriers were factors which were influenced by the individual's own decision-making, and external barriers included factors which were outside of the individual's own control. It is important for counselling to identify the internal and external barriers to regular exercise. In this way, the content of counselling can be developed, and solutions to the barriers can be discussed and identified. Further research on the barriers to regular exercise is needed.