Facilitators and barriers to a dietitian-implemented blended care weight-loss intervention (SMARTsize): a qualitative study

W. H. Heideman, F. C. Rongen, C. Bolleurs, E. Govers, W. Kroeze, I. H.M. Steenhuis*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Dietitians play an important role in the intervention and prevention of being overweight and obesity. More and more blended care interventions are being implemented. The present study aimed to evaluate the delivery by Dutch dietitians of a multicomponent, evidence-based weight-loss programme (SMARTsize), including counselling for relapse prevention. The aim of this qualitative study was to identify facilitators and barriers to the delivery of SMARTsize.

METHODS: Nine semi-structured interviews were conducted with 10 dietitians who participated in a larger implementation study. Each interview was recorded and transcribed verbatim. Determinants of theory of implementation, including characteristics of the user, the innovation, organisational context and setting, and innovation strategy guided interviews and analysis. Data were coded and analysed using the framework approach.

RESULTS: According to dietitians, the SMARTsize intervention had a positive influence on patients. The main implementation facilitators were the availability of implementation materials, such as a manual, training in relapse prevention and social support from other dietitians. The main barriers to implementation were organisation and financial reimbursement of cooking classes, the belief that patients need more individual counselling in the starting phase, and the unsuitability for people with low levels of health literacy.

CONCLUSIONS: Most dietitians considered that implementation of the SMARTsize intervention consisting of e-health, written information and cooking classes and face-to-face counselling is challenging but feasible. Further development of the SMARTsize intervention and implementation tools is needed to lower experienced barriers. It is also recommended that a version of the intervention to be developed that is suitable for patients with lower levels of health literacy.

Original languageEnglish
Pages (from-to)338-348
Number of pages11
JournalJournal of Human Nutrition and Dietetics
Issue number3
Early online date20 Mar 2019
Publication statusPublished - 1 Jun 2019

Bibliographical note

© 2019 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.


  • implementation
  • multi-component intervention
  • qualitative
  • SMARTsize
  • weight loss


Dive into the research topics of 'Facilitators and barriers to a dietitian-implemented blended care weight-loss intervention (SMARTsize): a qualitative study'. Together they form a unique fingerprint.

Cite this