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For interventions to be successful, it is important to influence \u201cbehavioral mechanisms\u201d such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36\u2009months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Participants (n\u2009=\u2009962) with overweight and prediabetes who had achieved \u22658% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There was no increase in the participants\u2019 self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319241248223","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T06:36:18Z","timestamp":1719297378000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1034-1613","authenticated-orcid":false,"given":"Maija","family":"Huttunen-Lenz","sequence":"first","affiliation":[{"name":"University of Education Schw\u00e4bisch Gm\u00fcnd, Schw\u00e4bisch Gm\u00fcnd, Germany"}]},{"given":"Sylvia","family":"Hansen","sequence":"additional","affiliation":[{"name":"University of Cologne, Cologne, Germany"}]},{"given":"Anne","family":"Raben","sequence":"additional","affiliation":[{"name":"University of Copenhagen, Frederiksberg, Denmark"},{"name":"Copenhagen University Hospital\u2014Steno Diabetes Center Copenhagen, Herlev, Denmark"}]},{"given":"Margriet","family":"Westerterp-Plantenga","sequence":"additional","affiliation":[{"name":"Maastricht University, Maastricht, The Netherlands"}]},{"given":"Tanja","family":"Adam","sequence":"additional","affiliation":[{"name":"Maastricht University, Maastricht, The Netherlands"}]},{"given":"Ian","family":"Macdonald","sequence":"additional","affiliation":[{"name":"University of Nottingham, Nottingham, UK"},{"name":"Nestle Research, Lausanne, Switzerland"}]},{"given":"Gareth","family":"Stratton","sequence":"additional","affiliation":[{"name":"Swansea University, Swansea, West Glamorgan, UK"}]},{"given":"Nils","family":"Swindell","sequence":"additional","affiliation":[{"name":"Swansea University, Swansea, West Glamorgan, UK"}]},{"given":"J. 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