responsiveness
group session
In total, 95% of participants were satisfied with the group sessions (Supplementary Table 5, Additional file 6). Focus group participants expressed satisfaction with the content, quantity and duration of the sessions, and the ability to ask questions. In the survey, only seven participants expressed dissatisfaction or disagreement with three or more questions about the usefulness of group sessions. When asked about specific sessions, 60% of participants felt that session 3 (information about processed foods and introduction to physical activity) was most helpful for lifestyle changes, followed by session 1 (49%; cooking workshop); This was followed by session 4 (38%; motor test). and relaxation exercises) (Supplementary Table 6, Additional file 6). In total, 40% of participants said no session was the least helpful. In short, I think all sessions were helpful. Coaches also felt that the group sessions were a very useful part of the overall intervention (Supplementary Table 5, Additional file 6), which is why the cooking workshops and exercise tests were particularly important (Supplementary Table 6) , Additional file 6).
Group settings
According to focus group participants, group settings were perceived to be an essential, if not the most important, part of lifestyle interventions. Participants and coaches found the group sessions to be fun and an opportunity to share experiences and tips, ask questions, and support and inspire each other. Coaches also noted that advice shared among participants was often more persuasive than advice provided by coaches. The group setting also gave participants a sense of social pressure, which generally increased motivation, although some were discouraged if they did not experience similar positive outcomes.
“…I don't think we could have done this whole change without doing it with the group…We really did it for each other and championed it together…No, I I don't think they could have done it individually.'' (#416, FG2)
In all focus groups, participants indicated that the format in which the group sessions were held (live, online, hybrid) influenced their satisfaction. However, overall perceived usefulness was similar for all forms of intervention. While participants in the hybrid format preferred live interaction, some, including those in the online format, considered online sessions to be a good alternative during the COVID-19 pandemic, eliminating the need for commuting. I enjoy it. Coaches said a hybrid format would have been ideal as it would reduce the need for travel while allowing for live interaction, increasing feasibility and number of participants. Informative sessions such as nutrition, sleep, and relaxation exercises are considered suitable for online use, while live instruction is preferred for physical exercises.
group dynamic
Group dynamics vary from group to group and depend on a variety of factors. Overall, 86% of the participants felt that they were part of a group, and 76% felt that they could talk to group members about things that were important to them (Table 3). In focus groups, participants who did not feel connected to their group members often indicated that this aspect of the intervention was lacking, but not all felt a need for group connection.
One of the main factors influencing group dynamics was whether group sessions were held live, online, or in a hybrid format. Participants who did the live intervention felt more connected to the group (19% (live) vs. 49% (online) did not feel connected to the group) and to each other (52% (live) vs. 19% (online)) more personal connections with other participants in the group than those following the hybrid and online versions (Supplementary Table 7, Additional file 6). Participants also found it easier to share what was important to them in live and hybrid formats compared to online versions. Similarly, coaches indicated that groups that spent more time together live had better group dynamics.
The diversity of the group in terms of age, diagnosis, occupation, living situation, etc. was generally well received by the participants, who found it valuable as it provided a wide range of perspectives and advice. But she knew at least one other participant with the same diagnosis, and some wanted to share a common experience. Coaches noticed wide variation in knowledge, ability, and physical condition among participants. They felt that more individualized instruction could improve the effectiveness of the intervention, especially in the movement part. Additionally, coaches considered gender diversity and larger group size (approximately 8 participants) to be beneficial to group dynamics.
Tools, activities, and guidance
Of all the tools and activities provided, participants found the Fitbit tracker and dietary information in the binder to be the most helpful. In comparison, fasting protocols, individual consultations with physical therapists, and WhatsApp groups were considered the least helpful. Details of participants' and coaches' views and experiences regarding the tools and activities used in the intervention are provided in Supplementary Table 4, Additional file 6.
During the focus groups, participants reflected positively on the coaching they received during the intervention and found their coaches to be enthusiastic, patient, kind, understanding, friendly, and easily accessible. Several participants stated that their coach's enthusiasm, feeling heard, and being taken seriously were motivating factors.
“…I thought everyone was kind, proactive, and enthusiastic. And I think that's the secret to success in this business. People are enthusiastic, genuinely interested in you, and want to work with you.” That's what I think.'' (#760, FG1)
Additionally, participants were satisfied with their ability to ask questions as well as the answers and information they received from their coaches (Supplementary Table 5, Additional file 6). Participants felt that the instruction was enjoyable and did not feel oppressive or forced. A few participants also appreciated that the coaches, many of whom eat plant-based diets themselves, were able to share their personal experiences and practical tips. The perceived usefulness of the different behavior change techniques used is listed in Supplementary Table 3, Additional file 6.
Feasibility
The feasibility of eating more unprocessed, plant-based foods varies by individual and depends on a variety of factors including previous diet, affinity for cooking, adequate protein and iron intake, cost, and social support. It depends. The transition was easy for those who were already increasing their plant-based diet or cooking for themselves frequently, but some meat eaters say the transition isn't difficult. There were also opinions.
“…I was a big meat eater, eating 1-2 pounds of cheese a week, a lot of eggs, a lot of dairy products. I stopped doing that from day one and became a complete vegan. I have to say I was surprised. It didn't require any effort at all.” (#461, FG4)
Participants said that plant-based cooking, especially unprocessed dishes, is time-consuming and requires more creativity. Some participants felt that food prices were high, while others said they were the same or even cheaper depending on the products purchased. Participants also said that it is often more difficult to eat at restaurants or on vacation.
Overall, social support had a significant impact on the feasibility of the intervention for participants. Among those with a partner (74%) or children (72%), 89% of their partner's girlfriend and 76% of their child's girlfriend are now eating more plant-based diets, compared to 47% and 38% of their girlfriend, respectively. has started moving his body more. Both participants and coaches stated that the involvement of partners and children made it easier to continue with the intervention because participants felt supported and the intervention became more practical.
“…I enlisted my wife, she cooked with me, and she was very supportive. Yes, it was a huge support, because I was basically a straw man. Because I'm a man. So I was very happy that she helped me.'' (#714, FG1)
Factors that influence exercise and stress management behaviors include previous habits, symptoms, disease activity, and the COVID-19 pandemic. While COVID-19 has given some people an advantage by giving them more time to cook and reducing travel time with online meetings, working from home, closing gyms and canceling group workouts has made it easier for some people to stay active. Some people find it difficult to move and feel less stimulated to move their bodies. The coaches also noted that the COVID-19 pandemic has increased stress for participants, especially those with rheumatoid arthritis who are taking immunosuppressive medications. Finally, the coaches felt that the overall motivation of the participants was high, higher than that of the average patient not receiving the intervention.
Overall intervention satisfaction
Focus group participants described the intervention as “very good,” “great,” “very complete,” and “a positive experience.” Participants will receive information on lifestyle topics, including the rationale for making healthy lifestyle changes and insights on how to monitor your progress and, most importantly, listen to your body. I was able to get it.
“…I found it to be very complete and really covers all aspects. Because everything is important, relaxation is important, exercise is important, taking small steps is important, nutrition is also important. But social contact is also important. So I think [it covered] It's the whole picture. ” (#303, FG 3)
When asked how likely participants would be to recommend an intervention to another person based on their diagnosis, the mean response was 9.2 (SD 1.4; n = 102), 10 is “very likely”. Multiple participants expressed gratitude for the intervention because their symptoms were reduced and they felt healthier. However, some said they were satisfied with the intervention, even though they did not see any effect on their symptoms.
“I am very grateful to have been able to participate. And it was also very rewarding for me. In fact, I would like everyone to take part in this kind of intervention. I really wish rheumatologists would do that… “…I wanted to at least give rheumatology patients the option to participate in such interventions. Yes, that would be nice.” (#602, FG4)
Coaches were satisfied with the intervention, giving it a score of 7.5 out of 10 (the highest possible score). Key elements of the intervention include a multidisciplinary approach, a broader reach through group settings, an emphasis on long-term lifestyle changes, providing insight and education, and encouraging participants to actively do and experience new things. It was to be encouraged.
“…the content is very solid. I like the variety. It's really nice to look at all parts of health holistically, not just food.” (#294, Nutritionist)
However, due to the scale and diversity of the intervention, some participants did not have the time or ability to engage with all elements of the intervention. Although this intervention encouraged participants to change their lifestyle all at once, various coaches suggested that making small changes over a long period of time may be more beneficial.
Sports coaches were satisfied with the practical information given, group discussions and lessons on observing physical boundaries. Also, movement practice during sessions and as homework was considered one of the main stimuli for participants to become more active. However, sports coaches wanted more feedback from participants to better tailor their sessions. Finally, education and group exercises were considered important components of the relaxation and sleep intervention. However, the sheer scale of the intervention has left little time to focus on behavioral change in these components.
perceived effectiveness
The intervention encouraged participants to eat a more plant-based diet (92%), eat less processed food (86%), exercise more (79%), and get better sleep. I feel better equipped (66%) and able to relax better. consciously (72%) (Supplementary Table 8, Additional file 6). Participants’ intentions to continue with the intervention in the future are listed in Supplementary Table 8, Additional file 6. Many participants felt that the intervention was effective in improving health outcomes. Some people see results within a few weeks, others take weeks or months, and some people experience no or only partial effects.
