Table 4.

Opportunities for refining intervention delivery on different health care levels

Level	Finding	Opportunity for intervention delivery
Participant	* High attendance rates in our study compared to others [11,12,22]	* Use of organisational elements that can contribute to participant compliance:
		- Immediately plan next appointment during consultations
		- Persons who do not show up are contacted by the practice assistant
		- Assign 1provider in the practice who is responsible for coordination / planning of the consultations.
	* Lack of participant motivation experienced by providers as a major barrier for intervention implementation	* Stimulate participant motivation to change unhealthy habits:
		- In-depth analysis of (barriers for ) participant behavioural change to reveal starting points for refining intervention content[5,6,23].
		- More attention for environmental factors promoting unhealthy behaviour[24]
		- Counselling based on shared decision making to enlarge participant empowerment[25]
		- More effort into stimulating participants to engage social support[5,23,26].
Professional	* Lower participant satisfaction with GP guidance than with nurse practitioner guidance.	* Role for the nurse practitioner as the key player in guiding participant lifestyle change [29,30]
	* Lower self-efficacy of GPs regarding dietary counselling compared to nurse practittioners.
	* Lack of specialistic nutritional knowledge reported by nurse practitioners	* Introduce elements to fill gaps in knowledge and/or skills of nurse practitioners
	* Nearly 40 % of the nurse practitioners report limited self-efficacy for dietary counselling	- Referral to skilled supporting staff, like dieticians[5]
		- Extend motivational interviewing course towards a specialized prevention manager training[31], including modules to enlarge the knowledge of nutrition and physical activity in diabetes prevention.
Organisation	* Lack of counselling time and financial reimbursement regarded by providers as major bottlenecks for intervention implementation	* Consider and investigate prevention strategies that could increase cost-effectiveness [6], such as:
	* Modest diabetes risk reduction compared to studies in experimental settings [8,11,12,26].	- More stringent criteria for participant inclusion, based on risk[6,11]and / or motivation[27]
		- Group-counselling[8-11]
		- A more tailor-made or patient-centred intervention structure[6,35]
		- Integration of lifestyle interventions for different disorders[36]