Pilvikki Absetz

Tampere University | UTA

Introduction: India currently has more than 74.2 million people with Type 2 Diabetes Mellitus (T2DM). This is predicted to increase to 124.9 million by 2045. In combination with controlling blood glucose levels among those with T2DM, preventing the onset of diabetes among those at high risk of developing it is essential. Although many diabetes pre...

This study aimed to unravel experiences, identify barriers to self management of diabetes and hypertension and solicit solutions for enhancing chronic disease self management from patients and their healthcare providers. This was a qualitative study which collected data from eight in-depth interviews conducted with healthcare providers and four foc...

Despite its positive effects on physical activity promotion, the motivational style of interaction by health professionals is not easily taken up, as shown by meta-analyses of training courses. The concerns professionals experience for taking up novel skills remain an open question. Preservice physical education teachers were offered a 16-h trainin...

Background Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burde...

Background No real-world randomised controlled trials (RCTs) have explored the effectiveness of lifestyle interventions based on multiple behaviour change theories and using combined digital and group-based face-to-face delivery to improve risk factors for type 2 diabetes (T2D). Methods We conducted a one-year, multi-centre, unblinded, pragmatic R...

Easier recognition and enhanced visibility of healthy options supposedly increase healthy choices, but real-world evidence remains scarce. Addressing this knowledge gap, we promoted nutritionally favourable foods in a workplace cafeteria with three choice-architectural strategies—priming posters, point-of-choice nutrition labels, and improved produ...

Objective: To describe the design, delivery and evaluation of the 3rd Global Alliance for Chronic Diseases (GACD) Implementation Science School (ISS), delivered virtually in 2020 for the first time. Methods: Since 2014, GACD has supported the delivery of more than ten Implementation Science Workshops for more than 500 international participants. It...

The impact of lifestyle interventions on diabetes and mental health conditions have been documented among people with diabetes. However, the mental health benefits of lifestyle interventions designed for diabetes prevention have not been systematically investigated among people at high risk of diabetes, particularly in low- and middle-income countr...

Health systems in many low- and middle-income countries are struggling to manage type 2 diabetes (T2D). Management of glycaemia via well-organized care can reduce T2D incidence, and associated morbidity and mortality. The primary aim of this study was to evaluate the effectiveness of facility plus community care interventions (integrated care), com...

Background: Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D. Methods: This study (n=2684, 80%...

Background There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Au...

Background Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. Obje...

Background: Immigrants have a higher risk of developing chronic diseases than the general population, but there is a lack of knowledge about appropriate counseling models to promote their health. This study aimed to explore Asian and Russian immigrants' perspectives in Finland on healthy lifestyle and healthy lifestyle counseling to improve the qu...

Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model a...

Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for...

Background Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabet...

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type...

Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse background...

Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, ta...

Background Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an i...

The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta‐analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2‐h glucose, HbA1c), anthropome...

Background: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabe...

Background Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory,...

This study aims to describe the prevalence of depression and anxiety among a population sample of people at high risk for type 2 diabetes in Kerala, India, and examine the relationship between depressive symptoms, anxiety, and incident Type 2 Diabetes Mellitus (T2DM) over a two-year period. We used data from the Kerala Diabetes Prevention Program,...

BACKGROUND Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. OBJE...

Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model a...

Background. Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory,...

Background Depression is a highly prevalent mental disorder with major public health effects globally. It impairs the quality of life and reduces the ability to work and function, leading to increasing costs of sick leaves and disability pensions. Current treatment strategies focus on biological and psychological pathways while understating the rol...

Background: Cross-cultural evidence on the factorial structure and invariance of the PHQ-9 and the GAD-7 is lacking for South Asia. Recommendations on the use of unit-weighted scores of these scales (the sum of items' scores) are not well-founded. This study aims to address these contextual and methodological gaps using data from a rural Indian po...

Background: The Mental Health First Aid (MHFA) training program has been widely implemented in many high-income countries. Evidence on the adaptation of this and other similar programs in resource-constrained settings like China is very limited. This study aimed to explore the views of key stakeholders on the implementation issues and contextual fa...

Research has shown that workplace health promotion (WHP) efforts can positively affect employees' health risk accumulation. However, earlier literature has provided insights of health risk changes in the short-term. This prospective longitudinal quasi-experimental study investigated trends in health risks of a comprehensive, eight-year WHP program...

Background: School-based interventions that increase physical activity (PA) in a sustainable way are lacking. Systematic and participatory, theory and evidence-based intervention development may enhance the effectiveness of complex behavioural interventions in the long term. However, detailed descriptions of the intervention development process are...

Background This prospective longitudinal quasi-experimental study investigated trends in health risks of a multiyear comprehensive workplace health promotion (WHP) program. Methods A comprehensive, eight-year WHP program was implemented emphasizing lifestyle behaviors as key targets in 2010-2013 and environmental supports focused on stress manageme...

Background: Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from high-income countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. Methods: The Kerala Diabet...

Koronaviruksen leviämisen ehkäiseminen vaatii ihmisiä omaksumaan monia totutusta poikkeavia tapoja, kuten fyysisen etäisyyden pitämistä ja tiheää käsienpesua. Viranomaisten antamien suositusten ja ohjeiden noudattamista on mahdotonta kaikilta osin valvoa ja osa varotoimenpiteistä saattaa jatkua hyvinkin pitkään, joten ohjeiden toimivuus on huomatta...

IntroductionThe burden of type 2 diabetes is growing rapidly in sub-Saharan Africa. Healthy eating has been shown to prevent the disease but is challenging to maintain. Self-determination theory offers a motivational framework for maintaining a healthy diet based on evidence from western settings. This study aims to assess whether self-determinatio...

BACKGROUND Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an i...

Nudge interventions aim at changing people's behaviour by altering the choice architecture of environments. Workplaces provide an appropriate setting for these interventions, since the majority of adults make a remarkable proportion of daily dietary choices there. Using the baseline data of a choice architectural “StopDia at Work” study, we here ai...

Introduction: Sub-Saharan Africa is experiencing a rapid growth of type 2 diabetes (T2D) and its related burden. Regular physical activity (PA) is a successful prevention strategy but is challenging to maintain. Self-determination theory (SDT) posits that more autonomous forms of motivation are associated with more sustainable behavior change. Evi...

Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, resear...

Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and...

Recent neuroscience research has delineated key psychological components of reward: wanting, liking and learning. Each component is further divided into explicit and implicit processes. While explicit processes are consciously experienced, implicit processes are not always directly accessible to conscious inspection. In the present study, we invest...

A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, i...

Objective: To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients. Data sources/study setting: Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health reco...

Objective: To investigate participation and effectiveness of a multiyear comprehensive workplace health promotion (WHP) program. Methods: Participation and effectiveness data came from employer and vendor systems. Health data came from health risk assessments (HRA) and biometric screenings. Participation and effectiveness were analyzed using des...

Background: Type 2 diabetes can be prevented through lifestyle changes, but sustainable and scalable lifestyle interventions are still lacking. Habit-based approaches offer an opportunity to induce long-term behavior changes. Objective: The purposes of this study were to describe an internet-based lifestyle intervention for people at risk for ty...

BACKGROUND Type 2 diabetes can be prevented through lifestyle changes, but sustainable and scalable lifestyle interventions are still lacking. Habit-based approaches offer an opportunity to induce long-term behavior changes. OBJECTIVE The purposes of this study were to describe an internet-based lifestyle intervention for people at risk for type 2...

Background: Data on participant recruitment into diabetes prevention trials are limited in low- and middle-income countries (LMICs). We aimed to provide a detailed analysis of participant recruitment into a community-based diabetes prevention trial in India. Methods: The Kerala Diabetes Prevention Program was conducted in 60 polling areas (elect...

Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk...

Themes identified to describe methodology or approach used to assess context at each context level. FGDs: Focus Group Discussions; NGO: Non-governmental organizations; OOP: Out-of-pocket; STAR: Socio-Technical Allocation of Resources; EPOCH: Environmental Profile of a Community's Health; HAP: Household Air pollution; NCDs: Non-communicable diseases...

Themes identified to describe how contextual lessons are incorporated into the intervention. SE: social economic; SMS: Short Message Service; T2DM:Type II Diabetes Mellitus; TASSH: Task-shifting strategy for hypertension. (DOCX)

Themes identified to describe how contextual lessons are incorporated into the implementation process. *This table is populated with data from the open-ended questions in the semi-structured interviews to illustrate how teams reported addressing context based on the different themes identified. FGDs: Focus Group Discussions; TASSH: Task-shifting st...

(quantitative and qualitative) and codebook. (XLSX)

Definitions for the components of the Socio-ecological Levels of Context framework. (DOCX)

Background: School-based interventions that sustainably increase physical activity (PA) are lacking. Systematic and participatory, theory and evidence-based intervention development may enhance effectiveness of complex behavioral interventions. Aims: To illustrate a stepwise process to develop intervention targeting PA and sedentary behavior (SB) a...

The burden of type 2 diabetes is increasing rapidly, not least in Sub-Saharan Africa, and disadvantaged populations are disproportionally affected. Self-management is a key strategy for people at risk of or with type 2 diabetes, but implementation is a challenge. The objective of this study is to assess the determinants of self-management from an i...

Background The StopDia study is based on the convincing scientific evidence that type 2 diabetes (T2D) and its comorbidities can be prevented by a healthy lifestyle. The need for additional research is based on the fact that the attempts to translate scientific evidence into actions in the real-world health care have not led to permanent and cost-e...

This paper reports on the use of reciprocal learning for identifying, adopting and adapting a type 2 diabetes self-management support intervention in a multisite implementation trial conducted in a rural setting in a low-income country (Uganda), a periurban township in a middle-income country (South Africa) and socioeconomically disadvantaged subur...

Purpose: Motivational interaction could help physical education (PE) teachers foster students’ motivation and engagement. We investigated pre-service PE teachers’ experiences of learning and using motivational interaction after a training course.Method: Narrative analysis was employed to analyse individual interviews (N=19). Results: Expressed adva...

Creating active classroom environments and reducing excessive student sitting requires changes in teachers' behaviours. This study examines a teacher training intervention, which aimed to increase the extent to which teachers use strategies to interrupt prolonged periods of students' sitting, as well as strategies to reduce total sitting time. The...

Creating active classroom environments and reducing excessive student sitting requires changes in teachers’ behaviours. This study examines a teacher training intervention, which aimed to increase the extent to which teachers use strategies to interrupt prolonged periods of students’ sitting, as well as strategies to reduce total sitting time. The...

Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews...

Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews...