Official Title
BETTER Women: Community-Based, Primary Care-Linked Peer Health Coaching to Achieve Evidence-Based Preventive Care Goals - A Pragmatic, Wait-List Controlled Effectiveness-Implementation Trial
Summary:
The Building on Existing Tools To improvE cancer and chronic disease pRevention and screening
in primary care (BETTER) Program allows patients in primary care to have a dedicated visit
with a prevention practitioner to discuss chronic disease prevention and cancer screening. A
prevention practitioner is a health professional, working in primary care, who has received
additional training to discuss chronic disease prevention and screening and develop health
goals with patients through shared decision-making. Previous studies have shown that this
approach increases the number of prevention and screening actions completed by program
participants. However, maintenance of health behaviour changes is difficult without on-going
support. There is also some evidence that peer-delivered coaching can improve health outcomes
in community settings. As such, the BETTER Women program extends the BETTER program by
focusing on 45 to 60-year-old women and providing time-limited support for health behaviour
change through peer health coaches. Peer health coaches are volunteers - trained in
techniques to support health behaviour change - who support women to achieve their health
goals over a 6-month period. In this study, the investigators will explore whether patients
who participate in the BETTER Women program (the peer health coaching extension) are more
likely to increase the number of prevention and screening actions that they complete after
one year, compared to women who participate in the BETTER program but do not get peer health
coaching until one year later. The investigators will also examine the implementation of the
program to learn about factors that affect various aspects of the success and sustainability
of the program.
Trial Description
Primary Outcome:
- Increased targeted behaviours from baseline
Secondary Outcome:
- Goal achievement
- Breast cancer screening status
- Cervical cancer screening status
- Colorectal cancer screening status
- Diet status
- Improvement in diet
- Diet management
- Physical activity status
- Improvement in physical activity
- Physical activity management
- Smoking status
- Improvement in smoking
- Smoking management
- Alcohol use status
- Improvement in alcohol use
- Alcohol use management
- Up-to-date measurement of glycated haemoglobin (HbA1c)
- HbA1c control
- HbA1c
- Glycemic management
- Up-to-date measurement of blood pressure (BP)
- BP control
- Systolic BP
- Diastolic BP
- Hypertension management
- Up-to-date assessment of low-density lipoprotein (LDL) cholesterol
- LDL control
- LDL
- LDL cholesterol management
- Up-to-date assessment for obesity
- BMI control
- Management of obesity
While the BETTER program has been shown to successfully increase the number of preventive
care and screening actions completed by patient participants after six months, it is known
that it is difficult to maintain new health behaviours in the long-term. Unfortunately, it is
not feasible to fund health professionals to offer repeated follow-up visits over the time
needed to turn initial behaviour changes into long-term habits. Therefore, the investigators
are building upon the existing BETTER program by adding a peer health coaching extension that
will provide time-limited coaching for patients who want support as they work towards
achieving preventive health goals. This approach takes advantage of growing awareness of the
role of lay health coaches in improving and extending the quality and value of primary care.
This is a three-site, pragmatic, wait-list-controlled, randomized, Type 1 hybrid
effectiveness-implementation trial with blinded outcome collection after 12 months. One site
will be an urban, academic, hospital-based clinic; the second will be a clinic serving a
greater proportion of patients from rural areas; and the third site will be a suburban clinic
with a large South Asian population. Following receipt of the BETTER program (a single visit
with a prevention practitioner), investigators will invite women who are 40-65 years old to
receive behaviour change support for six months from a peer health coach (PHC). PHCs will do
a 24-hr training course, which includes special techniques to support health behaviour
change, before they are matched to a patient. At the suburban site, only South Asian PHCs
will be recruited and this work is being guided by a South Asian Community Advisory Council
made up of members of various community organizations in that region. Patients who enroll in
BETTER Women will be randomized to receive peer health coaching either immediately
(intervention group) or after a 12-month delay (wait-list control group).
Effectiveness of the program will be assessed by evaluating for each patient, how many of a
set of target chronic disease prevention and screening actions were completed at one year, in
comparison to baseline. Investigators will also assess whether patients achieved the health
goals that they set with their prevention practitioners, physiological markers of health, as
well as habits and behaviours related to diet, physical activity, smoking and alcohol use.
These outcomes will be collected via electronic surveys administered at baseline, 3-, 6-, and
12-months post enrollment as well as through extraction of data from the patients' electronic
medical records and BETTER program documents. These outcomes will be compared between the two
groups of patients in the study.
An embedded process evaluation will be conducted during the trial to examine the
implementation of the program. The process evaluation will include collection of program
data, electronic surveys administered to patients as well as qualitative interviews with
intervention group patients, peer health coaches and prevention practitioners. Investigators
will examine how acceptable the program was to patients; whether and why any adaptations were
made; how well the program was utilized; how well the PHCs delivered the intervention (e.g.,
what behaviour change techniques were used); how engaged patients and PHCs were with the
program; and mechanism(s) of action. Ultimately, investigators expect to gain an
understanding of the program's sustainability, acceptability, cost-effectiveness, and factors
that might impact future attempts at spread and scale.
Investigators expect to see that women in the intervention group (i.e., those who had a PHC)
will complete more preventive and screening actions after one year. Investigators also expect
to see that women in the intervention group will make more progress on achieving health goals
and making lifestyle changes which reduce the risk of chronic diseases and cancers, that the
intervention will increase women's access to resources in their primary care clinics and
community, as well as improve the women's ability to maintain healthy behaviours.
View this trial on ClinicalTrials.gov
