Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults
Abstract
1. Introduction
2. Materials and Methods
2.1. Design
2.2. Ethics Approval and Consent to Participate
2.3. Trial Registration
2.4. Participants
2.5. Intervention
2.5.1. Telemonitoring Measurements
2.5.2. Education
2.5.3. Follow-Up
2.6. Measurements
2.6.1. Baseline Characteristics
2.6.2. Frequency of Self-Monitoring and Goalsetting
2.6.3. Behavioural Determinants
2.6.4. Compliance with Dutch Dietary Guidelines and Guidelines for Physical Activity
2.7. Statistics
3. Results
3.1. Baseline Characteristics
3.2. Changes in Self-Monitoring and Goalsetting and Effects on Behavioural Determinants
3.3. Effect Mediation
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Indirect Effect 1 a,b (a1 × b1) | Indirect effect 2 a,c (a1 × d21 × b2) | Indirect Effect 3 a,d (a2 × b2) | |||||
---|---|---|---|---|---|---|---|
β (SE) | 95% CI | β (SE) | (95% CI) | β (SE) | (95% CI) | N | |
T0–T2 Total DHD-FFQ score | |||||||
Self-monitoring | 0.79 (0.50) | 0.09, 2.11 | 0.07 (0.21) | −0.27, 0.65 | 0.16 (0.47) | −0.61, 1.35 | 141 |
Goalsetting | 0.07 (0.30) | −0.24, 1.06 | 0.04 (0.16) | −0.15, 0.65 | 0.11 (0.26) | −0.15, 1.06 | 140 |
Knowledge | 0.23 (0.37) | −0.28, 1.32 | −0.17 (0.19) | −0.74, 0.07 | −0.18 (0.27) | −1.10, 0.11 | 139 |
PBC HE | 0.05 (0.23) | −0.28, 0.76 | 0.01 (0.11) | −0.20, 0.27 | −0.01 (0.16) | −0.44, 0.28 | 136 |
Attitude HE | −0.03 (0.16) | −0.55, 0.19 | −0.01 (0.06) | −0.19, 0.05 | 0.05 (0.24) | −0.30, 0.80 | 137 |
T0–T2 Fish | |||||||
Self-monitoring | −0.07 (0.11) | −0.36, 0.10 | 0.01 (0.06) | −0.09, 0.14 | 0.02 (0.12) | −0.20, 0.30 | 141 |
Goalsetting | −0.01 (0.07) | −0.23, 0.07 | −0.00 (0.03) | −0.08, 0.06 | −0.00 (0.05) | −0.14, 0.09 | 140 |
Knowledge | 0.09 (0.10) | −0.04, 0.38 | −0.02 (0.06) | −0.17, 0.08 | −0.02 (0.07) | −0.24, 0.08 | 139 |
PBC HE | 0.05 (0.09) | −0.04, 0.35 | −0.02 (0.04) | −0.18, 0.02 | 0.02 (0.06) | −0.04, 0.22 | 136 |
Attitude HE | 0.00 (0.04) | −0.08, 0.09 | −0.00 (0.01) | −0.04, 0.01 | 0.01 (0.05) | −0.06, 0.17 | 137 |
T0–T2 Saturated fatty acids | |||||||
Self-monitoring | 0.31 (0.21) | 0.02, 0.86 | 0.06 (0.09) | −0.05, 0.32 | 0.14 (0.18) | −0.14, 0.59 | 141 |
Goalsetting | 0.05 (0.16) | −0.17, 0.51 | −0.00 (0.06) | −0.18, 0.10 | −0.01 (0.10) | −0.30, 0.15 | 140 |
Knowledge | 0.03 (0.15) | −0.22, 0.40 | −0.03 (0.08) | −0.24, 0.09 | −0.03 (0.10) | −0.35, 0.09 | 139 |
PBC HE | −0.01 (0.10) | −0.29, 0.16 | 0.04 (0.06) | −0.03, 0.27 | −0.04 (0.10) | −0.39, 0.08 | 136 |
Attitude HE | −0.03 (0.12) | −0.46, 0.12 | −0.01 (0.03) | −0.12, 0.02 | 0.03 (0.12) | −0.15, 0.37 | 137 |
T0–T2 Salt | |||||||
Self-monitoring | 0.05 (0.13) | −0.17, 0.37 | 0.02 (0.07) | −0.10, 0.20 | 0.04 (0.15) | −0.23, 0.40 | 141 |
Goalsetting | −0.00 (0.07) | −0.18, 0.12 | 0.01 (0.05) | −0.04, 0.19 | 0.03 (0.08) | −0.05, 0.34 | 140 |
Knowledge | 0.00 (0.11) | −0.21, 0.27 | −0.08 (0.07) | −0.32, 0.01 | −0.08 (0.10) | −0.42, 0.03 | 139 |
PBC HE | −0.06 (0.09) | −0.37, 0.04 | 0.02 (0.04) | −0.02, 0.15 | −0.02 (0.06) | −0.23, 0.04 | 136 |
Attitude HE | 0.01 (0.05) | −0.05, 0.16 | −0.00 (0.02) | −0.05, 0.02 | 0.01 (0.07) | −0.10, 0.20 | 137 |
T0–T2 Alcohol | |||||||
Self-monitoring | 0.04 (0.04) | −0.02, 0.17 | 0.01 (0.04) | −.0.05, 0.11 | 0.02 (0.08) | −0.13, 0.20 | 141 |
Goalsetting | −0.00 (0.03) | −0.10, 0.05 | 0.00 (0.02) | −0.01, 0.06 | 0.01 (0.02) | −0.01, 0.09 | 140 |
Knowledge | −0.00 (0.03) | −0.08, 0.05 | 0.01 (0.03) | −0.03, 0.11 | 0.01 (0.04) | −0.03, 0.15 | 139 |
PBC HE | 0.01 (0.02) | −0.01, 0.07 | 0.01 (0.02) | −0.01, 0.11 | −0.01 (0.04) | −0.18, 0.03 | 136 |
Attitude HE | 0.00 (0.03) | −0.02, 0.10 | −0.00 (0.02) | −0.08, 0.01 | 0.01 (0.08) | −0.07, 0.31 | 137 |
T0–T2 Vitamin D | |||||||
Self-monitoring | 0.00 (0.04) | −0.07, 0.08 | −0.01 (0.03) | −0.06, 0.06 | −0.01 (0.06) | −0.14, 0.11 | 141 |
Goalsetting | −0.00 (0.02) | −0.07, 0.03 | −0.00 (0.01) | −0.05, 0.01 | −0.01 (0.02) | −0.09, 0.01 | 140 |
Knowledge | 0.01 (0.03) | −0.05, 0.08 | 0.03 (0.04) | −0.01, 0.16 | 0.04 (0.05) | −0.01, 0.24 | 139 |
PBC HE | 0.02 (0.0.3) | −0.01, 0.12 | −0.02 (0.03) | −0.12, 0.01 | 0.02 (0.05) | −0.03, 0.17 | 136 |
Attitude HE | 0.00 (0.02) | −0.03, 0.08 | −0.00 (0.00) | −0.02, 0.01 | 0.00 (0.02) | −0.03, 0.06 | 137 |
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Construct | Questionnaire Items | Answering Options (1–5) | Crohnbach’s Alpha T0 |
---|---|---|---|
Self-monitoring |
| Never/a single time/a couple of times/every week/everyday | 0.77 |
Goalsetting |
| Never/a single time/a couple of times/every week/everyday | 0.67 |
Perceived behavioural control healthy eating |
| Totally disagree–totally agree Totally disagree–totally agree Difficult–easy No control–complete control | 0.70 |
Perceived behavioural control physical activity |
| Totally disagree–totally agree Totally disagree–totally agree Difficult–easy No control–complete control | 0.71 |
Attitude healthy eating | Healthy eating in the coming month is for me... | foolish–wise pleasant–unpleasant bad–good harmful–helpful unnecessary–necessary unenjoyable–enjoyable | 0.70 |
Attitude physical activity | Physical activity in the coming month is for me... | foolish–wise pleasant–unpleasant bad–good harmful–helpful unnecessary–necessary boring–interesting | 0.80 |
Intervention Group (n = 97) | Control Group (n = 107) | p-Value a | |||
---|---|---|---|---|---|
Mean | SD | Mean | SD | ||
Age (years) | 78.4 | 7.2 | 81.0 | 7.9 | 0.02 |
BMI (kg/m2) | 29.2 | 4.5 | 27.7 | 5.4 | 0.04 |
Number of diagnoses | 1.5 | 1.5 | 1.3 | 1.3 | 0.26 |
MMSE score | 28.6 | 1.5 | 25.8 | 1.9 | 0.69 |
Katz-15 score | Mdn | IQR | Mdn | IQR | |
1.0 | 0–4 | 1.0 | 0–3 | 0.69 | |
Percentage | Percentage | ||||
Sex (male) | 35 | 23.4 | 0.09 | ||
Education level b | 0.08 | ||||
Low | 17.5 | 10.3 | |||
Moderate | 55.7 | 49.5 | |||
High | 26.8 | 40.2 | |||
Civil status | 0.11 | ||||
Married | 42.3 | 27.1 | |||
Single | 7.2 | 13.1 | |||
Divorced | 7.2 | 10.3 | |||
Widowed | 43.3 | 49.5 | |||
Living alone | 55.7 | 74.8 | 0.004 | ||
Born in the Netherlands | 96.9 | 90.7 | 0.07 | ||
Desire to lose weight | 52.7 | 39.4 | 0.07 | ||
Nutritional status | 0.45 | ||||
Normal nutritional status | 79.2 | 83.8 | |||
At risk of undernutrition | 19.8 | 16.2 | |||
Undernourished | 1.0 | 0.0 | |||
Type of care | |||||
Domestic care | 78.4 | 80.4 | 0.72 | ||
Personal care | 32.0 | 29.9 | 0.75 | ||
Nursing care | 9.3 | 2.8 | 0.05 | ||
Individual support | 3.1 | 0.9 | 0.27 | ||
Informal care | 32.0 | 11.2 | <0.001 |
Intervention Group | Control Group | Linear Mixed Models | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
T0 | T1 | T2 | T0 | T1 | T2 | β T1 (95% CI) | β T2 (95% CI) | N | |||||||
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | ||||
Self-monitoring | 2.9 | 1.2 | 3.5 | 0.9 | 3.3 | 1.1 | 3.1 | 1.2 | 3.1 | 1.2 | 3.0 | 1.3 | 0.49 (0.19, 0.80) ** | 0.50 (0.20, 0.80) ** | 199 |
Goalsetting | 2.7 | 1.2 | 3.0 | 1.1 | 2.8 | 1.2 | 3.0 | 1.1 | 3.0 | 1.3 | 2.9 | 1.2 | 0.25 (−0.05, 0.55) | 0.19 (−0.10, 0.48) | 199 |
Knowledge a | 7.3 | 2.1 | 8.2 | 1.9 | 8.3 | 1.8 | 7.5 | 2.0 | 7.5 | 2.1 | 7.6 | 2.2 | 0.51 (−0.09, 1.12) | 0.51 (0.04, 0.99) * | 198 |
PBC HE b | 4.1 | 0.7 | 4.2 | 0.7 | 4.2 | 0.6 | 4.3 | 0.6 | 4.1 | 0.8 | 4.3 | 0.7 | 0.16 (−0.02, 0.33) | 0.08 (−0.09, 0.25) | 188 |
PBC PA | 3.7 | 0.8 | 3.8 | 0.9 | 3.9 | 0.9 | 4.0 | 0.9 | 3.8 | 1.0 | 3.9 | 0.9 | 0.19 (−0.03, 0.41) | 0.26 (0.08, 0.45) ** | 199 |
Attitude HE c | 4.7 | 0.5 | 4.7 | 0.5 | 4.7 | 0.5 | 4.6 | 0.5 | 4.6 | 0.5 | 4.6 | 0.6 | −0.01 (−0.18, 0.16) | 0.00 (−0.17, 0.17) | 188 |
Attitude PA d | 4.5 | 0.6 | 4.4 | 0.8 | 4.5 | 0.7 | 4.5 | 0.7 | 4.4 | 0.8 | 4.5 | 0.7 | −0.04 (−0.29, 0.22) | −0.05 (−0.26, 0.15) | 190 |
Indirect Effect 1 a,b (a1 × b1) | Indirect Effect 2 a,c (a1 × d21 × b2) | Indirect Effect 3 a,d (a2 × b2) | |||||
---|---|---|---|---|---|---|---|
β (SE) | 95% CI | β (SE) | (95% CI) | β (SE) | (95% CI) | N | |
T0–T2 Fruit | |||||||
Self-monitoring | 0.16 (0.10) | 0.02, 0.45 | 0.02 (0.04) | −0.04, 0.13 | 0.04 (0.08) | −0.11, 0.24 | 141 |
Goalsetting | 0.03 (0.08) | −0.08, 0.27 | −0.00 (0.03) | −0.09, 0.03 | −0.01 (0.04) | −0.15, 0.03 | 140 |
Knowledge | 0.17 (0.14) | −0.01, 0.57 | −0.02 (0.05) | −0.15, 0.05 | −0.02 (0.06) | −0.21, 0.04 | 139 |
PBC HE | 0.01 (0.05) | −0.05, 0.18 | 0.02 (0.03) | −0.01, 0.13 | −0.02 (0.05) | −0.20, 0.04 | 136 |
Attitude HE | −0.00 (0.04) | −0.09, 0.07 | 0.00 (0.01) | −0.01, 0.03 | −0.00 (0.05) | −0.12, 0.07 | 137 |
T0–T2 Vegetables | |||||||
Self–monitoring | −0.07 (0.11) | −0.11, 0.35 | −0.06 (0.05) | −0.22, 0.01 | −0.12 (0.11) | −0.39, 0.04 | 141 |
Goalsetting | 0.01 (0.06) | −0.05, 0.22 | −0.00 (0.03) | −0.07, 0.05 | −0.00 (0.05) | −0.12, 0.08 | 140 |
Knowledge | −0.07 (0.09) | −0.32, 0.06 | −0.01 (0.05) | −0.11, 0.08 | −0.01 (0.06) | −0.18, 0.08 | 139 |
PBC HE | −0.01 (0.07) | −0.25, 0.06 | −0.01 (0.03) | −0.13, 0.02 | 0.02 (0.05) | −0.04, 0.21 | 136 |
Attitude HE | −0.01 (0.07) | −0.23, 0.07 | 0.00 (0.01) | −0.01, 0.04 | −0.00 (0.05) | −0.13, 0.08 | 137 |
T0–T2 Dietary fibre | |||||||
Self-monitoring | −0.07 (0.07) | −0.27, 0.03 | 0.03 (0.04) | −0.02. 0.14 | 0.07 (0.07) | −0.05, 0.26 | 141 |
Goalsetting | −0.00 (0.03) | −0.08, 0.05 | 0.01 (0.02) | −0.02, 0.09 | 0.02 (0.04) | −0.02, 0.15 | 140 |
Knowledge | 0.02 (0.06) | −0.06, 0.22 | 0.01 (0.03) | −0.04, 0.10 | 0.1 (0.04) | −0.04, 0.14 | 139 |
PBC HE | 0.05 (0.05) | −0.03, 0.20 | −0.01 (0.02) | −0.08, 0.01 | 0.01 (0.03) | −0.02, 0.13 | 136 |
Attitude HE | 0.00 (0.03) | −0.05, 0.06 | 0.00 (0.01) | −0.00, 0.03 | −0.00 (0.02) | −0.09, 0.03 | 137 |
T0–T2 Protein | |||||||
Self-monitoring | −0.25 (0.19) | −0.76, 0.00 | 0.00 (0.08) | −0.16, 0.18 | 0.00 (0.17) | −0.37, 0.34 | 141 |
Goalsetting | −0.04 (0.12) | −0.42, 0.12 | 0.01 (0.06) | −0.05, 0.23 | 0.04 (0.09) | −0.05, 0.37 | 140 |
Knowledge | −0.07 (0.12) | −0.44, 0.07 | 0.12 (0.09) | 0.006, 0.41 | 0.12 (0.13) | −0.04, 0.52 | 139 |
PBC HE | 0.06 (0.09) | −0.04, 0.40 | −0.02 (0.04) | −0.17, 0.02 | 0.02 (0.07) | −0.05, 0.28 | 136 |
Attitude HE | 0.01 (0.07) | −0.08, 0.23 | 0.00 (0.01) | −0.01, 0.06 | −0.01 (0.06) | −0.20, 0.08 | 137 |
T0–T2 Physical activity | |||||||
Self-monitoring | −0.02 (0.16) | −0.40, 0.29 | −0.04 (0.08) | −0.27, 0.07 | −0.10 (0.17) | −0.52, 0.18 | 141 |
Goalsetting | −0.02 (0.08) | −0.32, 0.07 | −0.00 (0.05) | −0.51, 0.07 | −0.01 (0.08) | −0.25, 0.10 | 140 |
Knowledge | −0.10 (0.13) | −0.49, 0.07 | −0.04 (0.07) | −0.24, 0.05 | −0.04 (0.09) | −0.35, 0.05 | 139 |
PBC PA | −0.04 (0.10) | −0.31, 0.10 | 0.07 (0.08) | −0.01, 0.34 | 0.16 (0.13) | −0.02, 0.51 | 137 |
Attitude PA | −0.003 (0.05) | −0.14, 0.07 | 0.001 (0.02) | −0.04, 0.06 | 0.008 (0.05) | −0.06, 0.17 | 133 |
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Van Doorn-van Atten, M.N.; De Groot, L.C.P.G.M.; De Vries, J.H.M.; Haveman-Nies, A. Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults. Nutrients 2018, 10, 1062. https://doi.org/10.3390/nu10081062
Van Doorn-van Atten MN, De Groot LCPGM, De Vries JHM, Haveman-Nies A. Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults. Nutrients. 2018; 10(8):1062. https://doi.org/10.3390/nu10081062
Chicago/Turabian StyleVan Doorn-van Atten, Marije N., Lisette C. P. G. M. De Groot, Jeanne H. M. De Vries, and Annemien Haveman-Nies. 2018. "Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults" Nutrients 10, no. 8: 1062. https://doi.org/10.3390/nu10081062
APA StyleVan Doorn-van Atten, M. N., De Groot, L. C. P. G. M., De Vries, J. H. M., & Haveman-Nies, A. (2018). Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults. Nutrients, 10(8), 1062. https://doi.org/10.3390/nu10081062