Effects of telephone-based health coaching on patient-reported outcomes and health behavior change: A randomized controlled trial

Abstract

Objective Telephone based health coaching (TBHC) seems to be a promising approach to foster selfmanagement in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany. Methods Patients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen's single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation. Results Of the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant

Zelen design clinical trials: why, when, and how

“…Over the last 10 years, Zelen designs have been employed to evaluate a range of outreach and care navigation interventions to promote treatment engagement, including postcard or electronic messaging outreach to prevent suicide attempts or self-harm [ 14 , 15 ], eHealth intervention to increase engagement in eating disorder treatment [ 16 ], care navigation to promote advanced care planning in older adults [ 17 ], and assessment plus feedback to improve early adherence to substance use treatment [ 18 ]. Similarly, this design has been used to evaluate health promotion or behavior change interventions, including a text message for HIV prevention [ 19 ], rehabilitation interventions for musculoskeletal conditions [ 20 – 22 ], health coaching to improve chronic illness management [ 23 ], and oral health intervention to prevent early childhood caries [ 24 ]. Zelen designs have also been employed to evaluate programs to prevent re-hospitalization [ 25 ] or reduce frequent emergency department use [ 26 ].…”

Intervensi Health Coaching dalam Meningkatkan Self-Care Management Pasien Heart Failure

“…Dari 5 artikel yang disintesis, didapatkan 3 artikel menggunakan telepon yang membahas self-care management, kualitas hidup, hasil klinis dan status kesehatan pasien HF, menerima perawatan biasa, health coaching, dan booklet tentang HF sebagai panduan dan materi (Dwinger et al, 2020;Tiede et al, 2017;Wang et al, 2017), 1 artikel menggunakan metode diskusi dengan tatap muka langsung yang mengulas selfcare management pasien dengan menggunakan teknik wawancara semi terstruktur dengan pertanyaan terbuka yang berfokus pada pasien (Meeker et al, 2019). Artikel lain menggunakan kombinasi telepon dan tatap muka yang membahas perawatan diri pasien dengan pendekatan motivational interviewing (Vellone et al, 2020).…”

“…Intervensi health coaching dapat dievaluasi dengan jelas dan memadai dengan melihat hasil dari yang menggunakan kelompok kontrol dalam studi. Intervensi kelompok kontrol umumnya terdiri dari perawatan rutin HF dan perawatan standar yang dilakukan oleh perawat (n = 4) (Dwinger et al, 2020;Tiede et al, 2017;Vellone et al, 2020;Wang et al, 2017), perawat dan dokter sebagai penyedia layanan kesehatan di perawatan (n = 1) (Meeker et al, 2019). Dalam 1 studi, kelompok melibatkan pengasuh dalam menerima perawatan standar termasuk materi informasional dan pemeriksaan kesehatan pasien (Vellone et al, 2020).…”

“…Umumnya durasi studi yang dilaksanakan adalah 12 bulan (n = 2). Studi yang menggunakan durasi intervensi paling pendek adalah studi yang dilakukan oleh Wang et al, (2017) yaitu 2 bulan, sedangkan durasi intervensi yang paling panjang adalah studi dengan durasi hingga 12 bulan (Dwinger et al, 2020;Vellone et al, 2020). Perubahan perilaku yang signifikan dilaporkan dalam 2 bulan, 3 bulan, dan 12 bulan.…”

“…Secara keseluruhan, studi menggunakan telepon, tatap muka, dan kombinasi telepon dan tatap muka. Penggunaan media seluler termasuk telepon merupakan metode komunikasi jarak jauh yang lebih efektif dan efisien untuk memantau secara langsung pasien dalam melakukan program yang diberikan (Dwinger et al, 2020). Sejalan dengan penelitian yang menemukan bahwa teknologi seluler dan nirkabel semakin banyak digunakan dalam intervensi perawatan pasien di seluruh dunia dan memungkinkan untuk memfasilitasi akses yang lebih aman dan mudah ke layanan perawatan (Hamilton et al, 2018;Allida et al, 2020).…”