The SALUD programme gives people with type-2 diabetes more control over their health

More and more people are getting diabetes. In the Netherlands, this currently amounts to approximately 1.1 million type-2 diabetes patients. Their body no longer responds well to insulin. Their blood sugar gets too high, and they develop problems with the heart, eyes, and kidneys. “With a healthy diet, people can control the disease or even reverse it altogether,” says Kristel Polhuis, researcher in Health and Society. “But many people find it hard to maintain a strict diet. In addition, most lifestyle programmes, also for diseases other than diabetes, devote little attention to the day-to-day reality into which people have to fit this healthy lifestyle. And that while a person's living situation largely determines how much space and time they have for change. This is often a barrier to healthy eating and being able to take good care of yourself.”

Health is about more than not being sick

That is why the researchers joined forces with diabetes patients, GPs, dieticians, and practice support workers to develop a new programme that focuses on day-to-day life and takes a broad perspective on health. Polhuis: “Health is about more than not being sick. It is also about vitality, feeling good about yourself, having a supportive social network, and being able to organise your life the way you want. This requires a holistic perspective on the full range of physical, emotional, mental, social, and spiritual factors that can support a healthy lifestyle. The conversations that we had with people with diabetes prior to developing the programme also made it clear that healthy eating is related to how a person experiences their life. For example, if people have a loving social network and experience little stress, they find it easier to maintain a healthy diet.”

The SALUD programme promotes a healthy lifestyle that is aligned with people’s day-to-day life by inviting them to set their own goals and challenging them to take small steps. Steps that are achievable in combination with a busy family or a job, for example. Or steps that help people do something about their busy lives. A lifestyle coach guides participants through the programme, which consists of 12 weekly online sessions. Polhuis: “For some, the goal is to lose 5 kilos while for others, the first goal is to get extra help from a partner. The most important thing is that the changes are permanent, because that is what brings health benefits. Participants share their experiences and form a social network.”

The lifestyle coach empowers participants

The lifestyle coach works towards empowering participants, allowing them to flourish and giving them confidence that they can do it themselves. “In addition to setting their own goals, we get participants to work on their nutrition skills. Think about cooking a healthy meal for yourself. People experience success and they enjoy it. They get compliments from the coach and other participants, and gain self-confidence.”

A better grip on health

Kristel Polhuis and her colleagues investigated the effect of SALUD on the participants' eating behaviour and health. Participants were divided into two groups. The intervention group followed the online SALUD programme, while the control group was offered regular diabetes care. “Measurements show that the SALUD programme had a strong effect on people's resilience, and on how they coped with difficult situations by mobilising the right resources. People experienced social support from peers who were in the same situation and people close to them. A fruitful interaction between people and their social environment. And most people had more control over their lives and hence their health. That is a strong predictor for long-term healthy eating. We also observed improvement in weight and nutritional intake. However, I should mention that we also saw an improvement in weight in the control group, although the improvement was less marked than in the group that followed the SALUD programme.”

The SALUD programme is in line with WUR's strategic theme: a healthy lifestyle in a healthy environment. According to Polhuis, there is a lot of focus in healthcare on lifestyle, and the available lifestyle interventions are quite good. It is just that they still lack the holistic perspective and focus on everyday life. “For example, it is important to implement social support in the healthcare system. Participants in our study benefited so much from sharing their experiences with peers and family. You could, for instance, offer group consultations or start a walking group, and work to create a safe and health-promoting environment where people can share their experiences without feeling judged. The SALUD programme works.”