A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: a Randomized Controlled Trial

Oddone, Eugene Z.; Gierisch, Jennifer M.; Sanders, Linda; Fagerlin, Angela; Sparks, Jordan B; McCant, Felicia; May, Carrie L.; Olsen, Maren K.; Damschroder, Laura J.

doi:10.1007/s11606-018-4398-6

Cited by 34 publications

(36 citation statements)

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“…While reading and numeric literacy are known to be associated with patient activation, and health coaching has been shown to increase patient activation, there are no prior studies that specifically examine differential effects of health coaching on low reading or numeric literacy populations. 14,15,31,45 There is some data suggesting that patients with high numeric literacy are more likely and willing to engage in shared decision-making-it is possible then that the telephone calls with the coaches resulted in increased patient activation in this group. 46 Nevertheless, the discrepancy noted between the results of enrollment in prevention programs and PAM scores raises the question of which factors aside from patient activation are contributing to the differential effects of health coaching on enrollment in patients with low numeracy.…”

Section: Discussionmentioning

confidence: 99%

“…35 Results of ACTIVATE showed higher rates of enrollment in prevention programs (51 vs 29%, OR = 2.5; 95% CI 1.7, 3.9; p < 0.0001) and greater mean increase in patient activation measure (PAM) scores at 6 months (mean difference 2.5; 95% CI 0.2, 4.7; p = 0.03) in the intervention group compared to the usual care group. 31…”

Section: The Activate Trialmentioning

confidence: 99%

“…The coaching intervention tested in ACTIVATE resulted in a greater than twofold rate of enrollment in prevention services compared to controls. 31 In this secondary analysis, we hypothesized that the intervention effect would be stronger among Veterans with low health literacy (specifically, reading and numeric literacy) as compared to those with high health literacy.…”

Section: Introductionmentioning

confidence: 99%

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Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

et al. 2019

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BACKGROUND: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI − 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI − 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (− 4.6; 95% CI − 9.1, − 0.15; p = 0.04). CONCLUSIONS:We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.GOV IDENTIFIER: NCT01828567KEY WORDS: telephone coaching; health risk assessment; health literacy; health numeracy.

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Section: Discussionmentioning

confidence: 99%

Section: The Activate Trialmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

et al. 2019

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“…12 The Department of Veterans Affairs (VA) recently completed a trial in which 417 veterans receiving primary care services at one of three VA locations were randomized to complete an HRA followed by telephone-based health coaching, or to complete an HRA without health coaching. 13 Over 6 months, compared to patients in the HRA-alone group, patients who completed the HRA + coaching program had 2.5 times greater odds of enrolling in prevention programs, the trial's main outcome. There was no difference in Framingham risk score at 6 months, a secondary outcome of the trial and its main health outcome.…”

Section: Introductionmentioning

confidence: 96%

Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial

et al. 2020

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BACKGROUND: Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. OBJECTIVE: To compare VA health care expenditures among veterans who participated in a behavioral intervention trial that randomized patients to complete a HRA followed by health coaching (HRA + coaching) or to complete the HRA without coaching (HRA-alone). DESIGN: Four-hundred seventeen veterans at three Veterans Affairs (VA) Medical Centers or Clinics were randomized to HRA + coaching or HRA-alone. Veterans randomized to HRA-alone (n = 209) were encouraged to discuss HRA results with their primary care team, while veterans randomized to HRA + coaching (n = 208) received two brief telephone-delivered health coaching calls. PARTICIPANTS: We included 411 veterans with available cost data. MAIN MEASURES: Total VA health expenditures 6 months following trial enrollment were estimated using a generalized linear model with a gamma distribution and log link function. In exploratory analysis, model-based recursive partitioning was used to determine whether the intervention effect on short-term costs differed among any patient subgroups. KEY RESULTS: Most participants were male (85%); mean age was 56, and mean body mass index was 34. From the generalized linear model, 6-month estimated mean total VA expenditures were similar ($8665 for HRA + coaching vs $9900 for HRA-alone, p = 0.25). In exploratory subgroup analysis, among unemployed veterans with good sleep and fair or poor perceived health, mean observed expenditures in the HRA + coaching group were higher than in the HRA-alone group ($12,814 vs $7971). Among unemployed veterans with good sleep and good general health, mean observed expenditures in the HRA + coaching group were lower than in the HRA-alone group ($5082 vs $11,612). CONCLUSIONS: Compared to completing and receiving HRA results, working with health coaches to set actionable health behavior change goals following HRA completion did not reduce short-term health expenditures.

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“…Without active adherence and engagement by participants, the mHealth intervention is unlikely to be effective [ 30 ]. A potential strategy to increase adherence and engagement with, and effectiveness of mHealth interventions, is to add health coaching, including telephone-based lifestyle coaching delivered by humans [ 31 - 35 ]. Health coaching is a patient-centered, collaborative model grounded in theories of health behavior change where coaches work in partnership with patients using motivational interviewing, goal setting, and problem solving as key strategies.…”

Section: Introductionmentioning

confidence: 99%

Effect of Adding Telephone-Based Brief Coaching to an mHealth App (Stay Strong) for Promoting Physical Activity Among Veterans: Randomized Controlled Trial

et al. 2020

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Background Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions using wearable devices are appealing to users and can be effective especially with personalized coaching support. We developed Stay Strong, a mobile app tailored to US veterans, to promote physical activity using a wrist-worn physical activity tracker, a Bluetooth-enabled scale, and an app-based dashboard. We tested whether adding personalized coaching components (Stay Strong+Coaching) would improve physical activity compared to Stay Strong alone. Objective The goal of this study is to compare 12-month outcomes from Stay Strong alone versus Stay Strong+Coaching. Methods Participants (n=357) were recruited from a national random sample of US veterans of recent wars and randomly assigned to the Stay Strong app alone (n=179) or Stay Strong+Coaching (n=178); both programs lasted 12 months. Personalized coaching components for Stay Strong+Coaching comprised of automated in-app motivational messages (3 per week), telephone-based human health coaching (up to 3 calls), and personalized weekly goal setting. All aspects of the enrollment process and program delivery were accomplished virtually for both groups, except for the telephone-based coaching. The primary outcome was change in physical activity at 12 months postbaseline, measured by average weekly Active Minutes, captured by the Fitbit Charge 2 device. Secondary outcomes included changes in step counts, weight, and patient activation. Results The average age of participants was 39.8 (SD 8.7) years, and 25.2% (90/357) were female. Active Minutes decreased from baseline to 12 months for both groups (P<.001) with no between-group differences at 6 months (P=.82) or 12 months (P=.98). However, at 12 months, many participants in both groups did not record Active Minutes, leading to missing data in 67.0% (120/179) for Stay Strong and 61.8% (110/178) for Stay Strong+Coaching. Average baseline weight for participants in Stay Strong and Stay Strong+Coaching was 214 lbs and 198 lbs, respectively, with no difference at baseline (P=.54) or at 6 months (P=.28) or 12 months (P=.18) postbaseline based on administrative weights, which had lower rates of missing data. Changes in the number of steps recorded and patient activation also did not differ by arm. Conclusions Adding personalized health coaching comprised of in-app automated messages, up to 3 coaching calls, plus automated weekly personalized goals, did not improve levels of physical activity compared to using a smartphone app alone. Physical activity in both groups decreased over time. Sustaining long-term adherence and engagement in this mHealth intervention proved difficult; approximately two-thirds of the trial’s 357 participants failed to sync their Fitbit device at 12 months and, thus, were lost to follow-up. Trial Registration ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID) RR2-10.2196/12526

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A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: a Randomized Controlled Trial

Abstract: NCT01828567.

Cited by 34 publications

References 29 publications

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial

Effect of Adding Telephone-Based Brief Coaching to an mHealth App (Stay Strong) for Promoting Physical Activity Among Veterans: Randomized Controlled Trial

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