Evaluation of the Effectiveness and Implementation of the BETTER Women Peer Health Coaching Program

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


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

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