Table 3 Opportunities for refining intervention content based on participant perceptions of behavior change progress

Motivation(planning change)

‘I already meet the standards’ and ‘I’m satisfied with my health/ behavior’ are important motivational barriers

Inclusion of participants with a relatively healthy lifestyle, limiting motivation to change [10, 19]

Increase FINDRISC-value for participant inclusion or additional evaluation of lifestyle prior to invitation

Inability of participants to correctly interpret their lifestyle

Better inform participants about the standards reflecting healthy lifestyle

Introduction of tools for (self)-monitoring of health and lifestyle [21]

Motivation-Action Gap (initiating change)

Significant differences in the number of initiators between study groups for nearly all objectives

The intervention seems to help participants bridge the gap between motivation and action [8, 22]

Continue to stimulate participants to set goals and to develop concrete action plans [8, 14, 22]

A substantial part of the planners do not put their plans into action

Lack of action self-efficacy of non-initiators [23]

Underline the small-step approach of the intervention [15]

Action (achieving change)

A majority of initiators reports to have achieved change for diet and physical activity, AND Large numbers of initiators reported no difficulties achieving change, BUT Modest risk factor reductions [25]

Too optimistic perceptions of participants of lifestyle change success.

Introduction of tools for (self)-monitoring for parti-cipants to reflect on behavior change progress [21]

Guard participant progress towards achieving the project objectives

Provide GPs and nurse practitioners with tools for monitoring participant progress

Continuity (maintaining a new habit on the longer term) is an important barrier for losing weight and increasing physical activity.

Tendency of participants to make too drastic alterations in the lifestyle, easily resulting in relapse [15].

Following the small-step approach: stimulate participants to set intermediate goals [15]

Keep a goal and performance logbook to facilitate continuous evaluation of participant progress [21]

Resisting temptation to snack is an often-mentioned difficulty for the weight loss and dietary objectives.

Participants may have difficulties to control internal and external stimuli [27]

Encourage to avoid cues [27]

Stimulate to engage social support [14, 26]

Support participants to monitor circumstances of habitual behavior to identify future high-risk situations and beforehand develop strategies [21]