Volume 198 - Issue 8
A cluster randomised controlled trial of vascular risk factor management in general practice
Authors: James A Dunbar, Edward D Janus and Erkki Vartiainen
Med J Aust 2013; 198 (8): 413-414. || doi: 10.5694/mja12.11601
Published online: 20 May 2013
Published online: 20 May 2013
To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) ...
To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) and diabetes can be run successfully in Australian primary care, which raises questions about the design of Harris et al’s intervention.
In 2007, the Council of Australian Governments identified an effective Australian primary care-based diabetes and CVD risk prevention program — the Greater Green Triangle Diabetes Prevention Program2 — which has been shown to change dietary behaviour via an effective theoretical model.3
The Counterweight program used in Harris et al’s intervention — which is based on the obsolete Transtheoretical (Stages of Change) Model (TTM)4 — was aimed at weight reduction, not CVD risk. The measures included fruit and vegetable consumption, not CVD-specific measures such as saturated : polyunsaturated fat ratio and salt intake. The effect of dietary changes could not be measured, so feedback on this could not be provided to participants, which further weakens the intervention.
The aims of the intervention, training, methods of empowerment and tools are unclear. If the training was based on TTM, this might explain the negative results, particularly in light of a number of trials which have shown that TTM does not work or explain behavioural changes.
Further trials are not needed because full-scale implementation of an intervention based on the Greater Green Triangle Diabetes Prevention Program — the Department of Health-funded program Life! Helping You Prevent Diabetes, Heart Disease and Stroke — has already occurred in Victoria.5 General practitioners should not lose confidence in lifestyle modification for prevention of CVD and diabetes.
Competing interests
No relevant disclosures.
References
- Harris MF, Fanaian M, Jayasinghe UW, et al. A cluster randomised controlled trial of vascular risk factor management in general practice. Med J Aust 2012; 197: 387-393. 0_CHDDDCCB
- Laatikainen T, Dunbar J, Chapman A, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health 2007; 7: 249-256. 0_i1142871
- Laatikainen T, Philpot B, Hankonen N, et al. Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project. Prev Med 2012; 54: 157-161. 0_i1142873
- West R. Time for a change: putting the Transtheoretical (Stages of Change) Model to rest. Addiction 2005; 100: 1036-1039. 0_i1142875
- Oldenburg B, Absetz P, Dunbar J, et al. The spread of diabetes prevention programs around the world: a case study from Finland and Australia. Transl Behav Med 2011; 1: 270-282. 0_i1142879