<> "The repository administrator has not yet configured an RDF license."^^ . <> . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention"^^ . "Cardiometabolic diseases, including cardiovascular diseases, diabetes mellitus, and chronic kidney disease, are the leading cause of premature disability and death globally. Lifestyle interventions can be instrumental in improving relevant behavioral risk factors in individuals and, thus, in preventing the development and progression of cardiometabolic diseases. Yet, lifestyle interventions often remain underutilized in primary healthcare settings, their design and implementation can pose challenges, and evaluating their causal impact on health outcomes may not always be straightforward. In my dissertation, I tackle these three aspects across two different contexts, namely English and Thai primary healthcare.\r\nThe first objective (Publication 1) was to quantify the extent to which patients with cardiovascular risk factors were offered lifestyle interventions in English general practices in line with clinical guidelines. In my retrospective cohort study using electronic health data from approximately one-fifth of all general practices in England, results indicated limited lifestyle advice for adult patients who received a new diagnosis of hypertension, hyperlipidaemia, or obesity between 2010 and 2019. The proportion of individuals who had any recorded lifestyle intervention in the 12 months before to 12 months after their diagnosis varied across conditions, ranging from 55.6% for hypertension to 45.2% for hyperlipidemia and 43.9% for obesity.\r\nThe second objective (Publication 2) was to identify current practices for lifestyle interventions for patients diagnosed with hypertension in Thai primary healthcare settings. In my cross-sectional, mixed-method study among stakeholders with relevant knowledge about hypertension care in Thailand (including policy- and decisionmakers, healthcare practitioners, and patients diagnosed with hypertension), respondents agreed that improvements in access to hypertension treatment, in particular in the areas of lifestyle risk factor screening and lifestyle interventions, are needed. Results suggested that lifestyle interventions that are being offered vary substantially in duration, intensity, medium, and content. Special attention may be warranted to ensure access for individuals with low socioeconomic status or health literacy, informal laborers, and populations whose working hours impede receiving care.\r\nClosely related to my findings about current practices in Thai hypertension care, the third objective (Publication 2) was to determine barriers and facilitators for a screening and brief intervention approach targeting lifestyle behaviors among Thai primary health care patients diagnosed with concomitant hypertension and alcohol use. Stakeholder survey results indicated the need for standardized alcohol use assessment, clear guidelines for brief interventions, improved alcohol use monitoring, and a reduction in the stigma associated with heavy alcohol use. Results also underscored the importance of lifestyle interventions being adaptable to the existing conditions in the Thai healthcare system, as well as the importance equitable health services, particularly when considering the inclusion of digital or mobile tools for expanding access to lifestyle interventions.\r\nLastly, the fourth objective (Publication 3) was to establish the transferability of behavior change programs to real-world settings by determining if routine referral to the English Diabetes Prevention Programme leads to improvements in key health outcomes. To this end, I employed several quasi-experimental study designs that allow for a causal interpretation of the treatment effect in electronic health data, using the same data source as for my first objective. In my primary analytical approach, the regression discontinuity design, program referral led to significant improvements in patients9 glycated hemoglobin, body mass index, body weight, serum high-density lipoprotein cholesterol and serum triglycerides levels. Blood pressure and other exploratory health outcomes such as hospitalization for a major adverse cardiovascular event did not significantly improve during the median follow-up period of approximately two years. I confirmed my main finding, the improvement of glycated hemoglobin, with the difference-in-differences design (exploiting the phased roll-out of the program) and with the instrumental variable design (exploiting regional variation in program coverage). This study provides causal, rather than associational, evidence that lifestyle interventions implemented at scale in a national health system can achieve important health improvements and that quasi-experimental study designs are extremely valuable for health policy evaluation.\r\nIn conclusion, while individuals' lifestyle activities are markedly shaped by environmental and social factors, my dissertation clearly shows that there are tangible and achievable advancements in the access, development, implementation, and evaluation of lifestyle interventions aimed at mitigating cardiometabolic disease risk."^^ . "2025" . . . . . . . "Julia Margarete"^^ . "Lemp"^^ . "Julia Margarete Lemp"^^ . . . . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (PDF)"^^ . . . "Lemp_Julia_Dissertation_PDFA.pdf"^^ . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (Other)"^^ . . . . . . "lightbox.jpg"^^ . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (Other)"^^ . . . . . . "preview.jpg"^^ . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (Other)"^^ . . . . . . "medium.jpg"^^ . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (Other)"^^ . . . . . . "small.jpg"^^ . . . "Lifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention (Other)"^^ . . . . . . "indexcodes.txt"^^ . . "HTML Summary of #35849 \n\nLifestyle Interventions in Primary Healthcare: A Path to Cardiometabolic Disease Prevention\n\n" . "text/html" . . . "610 Medizin"@de . "610 Medical sciences Medicine"@en . .