Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Intervention
2.2. Study Participants
2.3. Study Design
2.3.1. Part 1: Quantitative Data Collection and Analysis
2.3.2. Interaction Scoring Tool
2.3.3. Scoring
2.3.4. Data Analysis
2.3.5. Part 2: Qualitative Data Collection and Analysis
3. Results
3.1. Quantifying the Interaction
3.2. Qualifying the Interaction
3.2.1. Goal Setting as a Process and an Outcome
F1: No, I think I write down a lot of what they say like: I want to, or I have a problem with this, or I never eat lunch or something. And I put that in and then I can go back and read that. Yes, so in some way they have issues, but it is not goals, really. But yes, I try to go back and discuss what they said to me.
M: So, you don’t mention goals?
F2: I definitely write down the goal, for example this client was walking and I asked: Have you been continuing walking and I mention it every ten days, asking specifically what he is doing.
M: Do you think that is important to be specific?
F4: So, I think it is very good to be specific because they have so many stories as well. At the end of the day, you’ll get a long list, they will have done everything in the manual, but you will not have the specific goals right? So, I think that it is good to put them in, the specific goals.
F2: So, I told them: Hey, so, an example of things that you can do for activities would be that you identify healthy recipes to cook and then he says: “Yes, but my wife is the one who cooks, she is my [participant’s] care companion.” She was there, he talked to her that day. “But yes, that is something we can do, yes, I can see something healthy and then tell her.” It seems like she is around when he is talking to me. And they are very active, so I suggested goals, then he said: “Yes, ok, this is something I can do.” And then I wrote it down as a goal.
F1: Well I have one couple who sit down and go through and are super prepared when I talk to them. But I would say that they are maybe an exception…
F4: Yes, and then there is one who has a friend and a daughter so there are three of them who discuss and do things with them. So, you know these are a few of the success stories that I see. And you can see that …they have specific goals and they decide yes, I will do the steps and I promise, I hope that I can do like five thousand steps every day, that’s my goal, we will see if I can achieve that. So, I’ve seen those.
F3: The best chance of anything happening is that they live together. But it seems much more informal. “Yes, yes we discussed it”, there is no, “we sat down and we talked about our goals”. That just doesn’t happen, even in the ones for me who are working, who are living together.
F4: Like for my participants for example I suggest, so how about, I mean have you thought about doing this, doing that, and they are like yes, I have tried that. One participant said that she has tried standing one leg while brushing her teeth and God, that doesn’t work for her because she doesn’t have balance but she decided to stand while talking on the phone. And then, that is just one aspect on top of the walks that she has decided she is going to make, which is great. So, she decided she could, she tried, yes, she tried. But she decided she will do the standing while talking on the phone and then she will take some walks with her husband every day at least for 30 min, and then she will decide, I mean, they will try to increase the time they do the walking. […] This is the thing when you have a situation for them to reflect and that is the situation I’m talking about. So, when they start reflecting upon it then you know an idea pops up and it becomes a goal.
F3: But I’m thinking in general if we have someone who is already very, very physically active and we pass that message on, but in terms of goals, there is no need for particular goals! If I talk to a person who is walking, I don’t know, 15,000 steps a day and who is very active, and he is playing bandy and he is playing this and he is playing that. I don’t think I need to convince him during that particular session. Then I need to inform him of the content of the session and the message of the session. But to then try to get someone who is already very active to start walking upstairs if he already is… it is not my idea of an achievement.
3.2.2. Adaptability and Tailoring of Support
F1: Yes, and they have a lot of things going on… yesterday I talked to someone about “nyckelhålet” [Swedish healthy food label] and she told me: “Yes, when I got my diagnosis, like when was it was one year ago, I had a dietician talk or help, lecturing me about “nyckelhålet” and stuff like that so I know that already. A lot of my people have this.”
F3: I was concerned that it would not be enough or that it would you know… That was not met. People were very happy, and the conversations can go on for as long as you want. I think that I was not expecting this personal, personal relationship to the development which is also what leads me to think that what are we actually delivering? We are delivering this package, but I think for a lot of people it is more than that. Or even other than that, there is this very strong social support factor that I feel that I’m delivering. Not only for diabetes, but for health. Because one person has called me “her personal health”. And I say: Yes, we are here to facilitate but the main thing is to support you in to working with someone else. But also, the fact that people are very lonely and do have a lot of concerns. This is not just a delivery, this is more.
F2: And obviously the sessions that I do in Spanish feel more comfortable because it feels that it has a better flow. In terms of when they say something for example, sometimes the participants in Swedish just say something and stop and then it’s like they don’t want to continue talking about it, while the participants in Spanish, they just want to go on and on about one specific little thing.
4. Discussion
5. Strengths and Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Session | Title | Content |
---|---|---|
1 | Introductory session | Getting to know the program. Why work with a care companion to make lifestyle changes? |
2 | Increase physical activity in daily life and reduce sedentary lifestyle | The importance of physical activity and how this can be increased in daily life |
3 | Healthy eating: Regular, balanced and healthy | The importance of regular, balanced and healthy meals |
4 | Physical activity through the life course | Discussion on how physical activity levels have changed over the years |
5 | Fruit and vegetables | The importance of eating fruit and vegetables every day |
6 | Increasing your daily physical activity | Discussion on current situation and potential possibilities for improvements |
7 | Sugar | How sugar consumption can be decreased in daily life |
8 | Finding a physical activity that suits you | Discussion of options/choices to physical activity |
9 | Healthy lifestyle—moving forward | How has it been to try to change to a healthier lifestyle and how can this be maintained? |
Factor 1 | Factor 2 | Factor 3 | ||
---|---|---|---|---|
Statement | Collaborative Relationship | Delivery of Intervention Content | Strength-Based Behavioral Coaching | |
5.4 | The session holds a positive atmosphere | 0.97 | ||
5.2 | The participant engages with the facilitator during the session | 0.89 | ||
5.1 | The participant shows interest in the session | 0.83 | ||
4.1 | The facilitator works with the participant to identify his/her strengths | 0.58 | ||
6.7 | The facilitator used the session guide to conduct the session | 0.83 | ||
6.3 | The facilitator encouraged the participant to work on the sessions specific suggested tasks | 0.69 | ||
6.4 | The facilitator encouraged the participant to set goals | 0.64 | ||
6.1 | The facilitator informed the participant about the content of the session | 0.60 | ||
6.6 | The facilitator demonstrated knowledge pertaining to the content of the session | 0.54 | ||
6.9 | The facilitator gave the participant the opportunity to ask questions | 0.85 | ||
4.4 | The facilitator gave sufficient time for participant reflection and response | 0.74 | ||
5.6 | The participant shares experiences with the facilitator | 0.56 | ||
4.3 | The facilitator verbally reflects on participant’s talk | 0.49 | ||
4.5 | The facilitator summarizes participant’s talk | 0.44 | ||
Eigenvalue | 5.0 | 1.7 | 1.3 | |
Variance explained | 57% | 19% | 15% | |
Cronbach’s alpha | 0.89 | 0.83 | 0.74 |
Collaborative Relationship | Delivery of Intervention Content | Strength-Based Behavioral Coaching | |
---|---|---|---|
Median (IQR) | Median (IQR) | Median (IQR) | |
Total (n = 40) | 75 (69–81) | 81 (76–94) | 75 (70–78) |
Comparison between facilitators (F) | 75 (75–81) | 94 (85–100) | 76 (70–80) |
F1 (n = 10) | |||
F2 (n = 10) | 75 (59–75) | 75 (73–75) | 70 (65–75) |
F3 (n = 12) | 78 (72–97) | 81 (79–92) | 75 (71–80) |
F4 (n= 8) | 78 (70–84) | 81 (78–90) | 73 (70–75) |
p-value | 0.1465 | 0.0017 * | 0.2079 |
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Timm, L.; Karlsson, I.; Sidney Annerstedt, K.; Absetz, P.; Forsberg, B.C.; Daivadanam, M.; Mølsted Alvesson, H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients 2021, 13, 3862. https://doi.org/10.3390/nu13113862
Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Mølsted Alvesson H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients. 2021; 13(11):3862. https://doi.org/10.3390/nu13113862
Chicago/Turabian StyleTimm, Linda, Ida Karlsson, Kristi Sidney Annerstedt, Pilvikki Absetz, Birger C. Forsberg, Meena Daivadanam, and Helle Mølsted Alvesson. 2021. "Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes" Nutrients 13, no. 11: 3862. https://doi.org/10.3390/nu13113862
APA StyleTimm, L., Karlsson, I., Sidney Annerstedt, K., Absetz, P., Forsberg, B. C., Daivadanam, M., & Mølsted Alvesson, H. (2021). Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients, 13(11), 3862. https://doi.org/10.3390/nu13113862