Coaching Service Research Articles

Effectiveness of NSW health get healthy telephone coaching in adults screened from general practices

BackgroundThe effectiveness of the NSW Health “Get Healthy Information and Coaching Service®”(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake.MethodsMen and women aged 40–70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the “Zinc In Preventing the Progression of pre-Diabetes” (ZIPPeD) trial (ACTRN12618001120268).ResultsThe self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol.ConclusionsThe potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program’s effectiveness and cost-effectiveness.

The effect of zinc supplementation on glucose homeostasis: a randomised double-blind placebo-controlled trial

AimsThe burden and health costs of Type 2 Diabetes Mellitus continue to increase globally and prevention strategies in at-risk people need to be explored. Previous work, in both animal models and humans, supports the role of zinc in improving glucose homeostasis. We, therefore, aimed to test the effectiveness of zinc supplementation on glycaemic control in pre-diabetic adults.MethodsWe conducted a randomized, double-blind, placebo-controlled trial across 10 General Practitioner (GP) practices in NSW, Australia. The trial is known as Zinc in Preventing the Progression of pre-Diabetes (ZIPPeD)Study. Pre-diabetic (haemoglobin A1c [HbA1c] 5.7–6.4%, 39–46 mmol/mol) men and women (N = 98) were all assigned to a free state government telephone health coaching service (New South Wales Get Healthy Information and Coaching Service) and then randomised to either daily 30 mg zinc gluconate or placebo. Blood tests were collected at baseline, 1, 6 and 12 months for the primary outcomes (HbA1c, fasting blood glucose (FBG)); secondary outcomes included Homeostasis Model Assessment 2 (HOMA 2) parameters, lipids, body weight, height, waist circumference, blood pressure and pulse.ResultsThe baseline-adjusted mean group difference at 6 months, expressed as treatment–placebo, (95% CI) was −0.02 (−0.14, 0.11, p = 0.78) for HbA1c and 0.17 (−0.07, 0.42; p = 0.17) for FBG, neither of which were statistically significant. There were also no significant differences between groups in any of the secondary outcomes. Zinc was well tolerated, and compliance was high (88%).ConclusionWe believe our results are consistent with other Western clinical trial studies and do not support the use of supplemental zinc in populations with a Western diet. There may still be a role for supplemental zinc in the developing world where diets may be zinc deficient.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12618001120268. Registered on 6 July 2018.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial

BackgroundPeople with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so.MethodsA parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index.DiscussionThis study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease.Trial registrationThe Australian New Zealand Clinical Trials Registry ACTRN12620000351910. Retrospectively registered on 12 March 2020

Cross-Cultural Effects in Adoption Patterns of a Mobile Coaching Service for studies

This study applied an adoption model, inspired by the Technology Acceptance Model (TAM) and Multipurpose Information Appliances Adoption Model (MIAAM), to compare key variables explaining adoption patterns of a mobile coaching app that guides and encourages students via a technology-based platform. This article constitutes a pioneer effort to compare adoption behaviors across a developed country and an emerging country (France and Mexico) with differences in level of use of mobile apps. A multi-group structural equation modelling approach was used to test the causal structure of the conceptual model. Results confirmed significant differences and similarities across samples and identified critical factors. Perceived usefulness was found to be the most important driver with mediating effects. Organizations implementing coaching services with an improved perceived usefulness could boost their adoption rates.

Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition

Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n = 5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference −0.623 kg, p = .034) and daily vegetable intake (adjusted mean difference −0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.

Promoting the get healthy information and coaching service (GHS) in Australian-Chinese communities: facilitators and barriers.

Obesity and being overweight are major public health concerns that health coaching can assist people to manage through encouraging self-management and behaviour change. The Get Healthy Information and Coaching Service (GHS) is a telephone health coaching service in Australia that has effectively improved the health of the general population but has had less participation of culturally and linguistically diverse (CALD) populations. The Chinese population is the largest migrant group in Australia with increased risk of diabetes but had reduced access to the GHS program due to communication barriers. The GHS developed a pilot program for Chinese (Mandarin and Cantonese-speaking) communities using bilingual coaches and translated material to address these barriers. Qualitative research was undertaken with Chinese stakeholders (14 interviews) and 11 program participants from the group which had completed the program (2 focus groups in Mandarin and Cantonese) to understand their experiences and the success of promotional activities. This research does not contain the experiences of the people that withdrew from the program. The bilingual program was culturally and linguistically appropriate and addressed risk factors for chronic conditions. Participants formed positive relationships with bilingual coaches who they preferred to interpreters. They felt the program promoted healthy eating, weight and physical activity. Although Chinese stakeholders had concerns about participants' ability to goal set, participants said they met their health goals and were committed to the GHS program. Strategies to enhance the program included promoting the bilingual GHS to the communities and stakeholders. Factors to consider beyond language in adapting the program to the Australian Chinese communities include meeting the heterogenous needs of the older population, ensuring community engagement and addressing cultural beliefs and practices.

Cross-Cultural Effects in Adoption Patterns of a Mobile Coaching Service for Studies

This study applied an adoption model, inspired by the Technology Acceptance Model (TAM) and Multipurpose Information Appliances Adoption Model (MIAAM), to compare key variables explaining adoption patterns of a mobile coaching app that guides and encourages students via a technology-based platform. This article constitutes a pioneer effort to compare adoption behaviors across a developed country and an emerging country (France and Mexico) with differences in level of use of mobile apps. A multi-group structural equation modelling approach was used to test the causal structure of the conceptual model. Results confirmed significant differences and similarities across samples and identified critical factors. Perceived usefulness was found to be the most important driver with mediating effects. Organizations implementing coaching services with an improved perceived usefulness could boost their adoption rates.

Supporting families of children with overweight and obesity to live healthy lifestyles: Design and rationale for the Fitline cluster randomized controlled pediatric practice-based trial

BackgroundOver a third of preadolescent children with overweight or obesity. The American Academy of Pediatrics (AAP) recommends pediatric providers help families make changes in eating and activity to improve body mass index (BMI). However, implementation is challenging given limited time and referral sources, and family burden to access in-person weight management programs. PurposeTo describe the design of a National Heart Blood and Lung Institute sponsored cluster randomized controlled pediatric-based trial evaluating the effectiveness of the Fitline pediatric practice-based referral program to reduce BMI and improve diet and physical activity in children with overweight or obesity. Comparison will be made between brief provider intervention plus referral to (1) eight weekly nutritionist-delivered coaching calls with workbook to help families make AAP-recommended lifestyle changes (Fitline-Coaching), vs. (2) the same workbook in eight mailings without coaching (Fitline-Workbook). MethodsTwenty practices are pair-matched and randomized to one of the two conditions; 494 parents and their children ages 8–12 with a BMI of ≥85th percentile are being recruited. The primary outcome is child BMI; secondary outcomes are child's diet and physical activity at baseline and 6- and 12-months post-baseline. Cost-effectiveness of the two interventions also will be examined. ConclusionThis is the first randomized controlled trial to examine use of a centrally located telephonic coaching service to support families of children with overweight and obesity in making AAP-recommended lifestyle changes. If effective, the Fitline program will provide an innovative model for widespread dissemination, setting new standards for weight management care in pediatric practice.Trial registration: The ClinicalTrials.gov registration number is NCT03143660.

Potential direct secondary care cost benefits of HealthyWeightHub - Virtual Hospital 2.0 digital lifestyle intervention

HealthyWeighHub (HWH) is a 12-month coaching and education service designed to help patients with obesity make permanent life changes, launched and expanded gradually in Helsinki University Hospital (HUS) Healthvillage since 2016.&#x0D; We examined the direct secondary care cost benefits of HWH, measured with potential capacity freed (PCF) compared to conventional group coaching (CGC). Costs included health care, patient co-payments and travelling expenses. First, we evaluated the PCF actualized in the first two years from 2016 to 2018 in the HUS Specific Catchment Area (HUS ERVA). Then, we predicted the PCF at Finnish national level, if HWH was implemented gradually over the five years from 2018 to 2022, aimed at treating 1 % of adults with obesity annually in 2022.&#x0D; HWH’s actualized PCF was €2.69 million compared to CGC in the first two years in HUS ERVA. If the patients who received CGC had been treated with HWH instead, total PCF could have been €3.71 million. At Finnish national level, providing CGC to 1 % of adults with obesity was predicted to cost €28.0 million (€5.08 per capita) annually in 2022. With HWH predicted cost was €7.31 million (€1.33 per capita), meaning an annual PCF of €20.7 million (€3.75 per capita) in 2022 and cumulative five-year PCF of €57.5 million (€10.43 per capita). Compared to CGC, HWH is estimated to enable treatment of approximately 3.8-times more patients with obesity at the same cost.&#x0D; HWH can be more affordable than CGC and a potentially efficient tool to combat the obesity epidemic. Future evaluations should examine HWH’s effectiveness and impact on the indirect costs associated with weight loss and long-term illness.

Telephone-Based Coaching and Prompting for Physical Activity: Short- and Long-Term Findings of a Randomized Controlled Trial (Movingcall).

This study analyzed the short- and long-term efficacy of telephone coaching and short message service (SMS) prompting for physical activity (PA) promotion. Two-hundred-and-eighty-eight adults (age: 42 ± 11 years) were assigned randomly to three intervention arms: The intervention groups received 12 bi-weekly telephone calls with (coaching and SMS group) or without (coaching group) additional SMS prompts (n = 48 SMS). The control group received a single written PA recommendation. Self-reported and objective moderate-to-vigorous physical activity (MVPA) levels were assessed by a structured interview and by accelerometer at baseline, after the intervention (6 months), as well as after a no-contact follow-up (12 months). At post-test, self-reported MVPA increased by 173 min/week (95% CI 95 to 252) in the coaching group and by 165 min/week (95% CI 84 to 246) in the coaching and SMS group compared to control. These group differences remained similar in the follow-up test. For the objectively assessed MVPA, the coaching group increased by 32 min/week (95% CI 0.1 to 63) and the coaching and SMS group by 34 min/week (95% CI 1.6 to 66) compared to the control group. In the follow-up test, the objective MVPA levels of the intervention groups no longer differed from baseline, but group differences persisted as the control group decreased below baseline. Additional SMS prompts did not result in a further increase in PA. Telephone coaching can be considered an effective tool for PA promotion.

Zinc in Preventing the Progression of pre-Diabetes (ZIPPeD Study) \u2013 study protocol for a randomised placebo-controlled trial in Australia

BackgroundDiabetes is increasing in incidence, morbidity and treatment costs globally, hence prevention strategies need to be explored. Animal studies and some human data have shown that zinc can improve glycaemic control, but the impact of this effect in a pre-diabetic population remains uncertain. This study is designed to investigate whether zinc gluconate and lifestyle coaching can improve glucose handling and ultimately reduce diabetes incidence in an at-risk pre-diabetic population in Australia.Methods/designThe study will be a randomised, placebo-controlled, double-blind clinical trial. The study will be conducted at the Hunter New England Local Health District New South Wales (NSW), Australia. Pre-diabetic (haemoglobin A1c [HbA1c] 5.7–6.4) male and female participants (n = 410) aged 40–70 years will be recruited through the Diabetes Alliance Network, a collaboration of diabetes specialists and general practitioner practices. All participants will be given routine care to encourage healthy lifestyle changes using a telephone coaching service (Get Healthy Information and Coaching Service, NSW Health) and then randomised to receive a supplement, either zinc gluconate (equivalent to 30 mg of elemental zinc) or placebo of identical appearance for 12 months. The identity of the supplements will be blinded to both research personnel and the participants. Participants will be asked to complete medical, lifestyle and dietary surveys and will have baseline and final visits at their general practitioner practice. Primary outcomes will be HbA1c and insulin sensitivity collected at baseline and at 1, 6 and 12 months; secondary outcomes will include fasting blood glucose, fasting cholesterol, blood pressure and body mass index. The primary efficacy endpoint will be judged at 6 months.DiscussionThis study will generate new evidence about the potential for health coaching, with or without zinc supplementation, to improve glucose handling and ultimately to reduce progression from pre-diabetes to diabetes.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12618001120268. Registered on 6 July 2018.

Telephone based coaching for adults at risk of diabetes: impact of Australia's Get Healthy Service.

The Get Healthy Information and Coaching Service (GHS), an effective 6-month telephone-based healthy lifestyle coaching service, includes a population-targeted diabetes prevention module (DPM) tailored for adults at risk for type 2 diabetes. This study determined DPM's reach and impact on anthropometric and lifestyle risk factors. Pre-post evaluation design examined self-reported anthropometric (body weight, waist circumference) and lifestyle risk factors (physical activity and dietary behaviors) of DPM participants. Descriptive and chi-square analyses were performed on sociodemographic variables. Behavioral changes were assessed using matched pairs analysis, independent samples analysis, and multivariate analysis. There were 4,222 DPM participants (76.0% female; 75.9% aged ≥ 50; 95.4% spoke English at home). The DPM included higher proportions of older adults (≥50) (75.9% vs. 46.5%; p < .001), retirees (28.7% vs. 18.5%; p < .0001), less educated (33.3% vs. 24.9%; p < .0001), more disadvantaged (41.7% vs. 34.8%; p < .001) and living in regional or rural areas (43.2% vs. 39.8%; p < .001) than the GHS program. DPM participants reported significant improvements at six months for all anthropometric (-3.3 kg weight; -1.2 BMI units; -4.3 cm waist circumference) and behavioral risk factors (+0.2 fruit serves/day; +0.7 vegetables serves/day; -0.2 sweetened drinks/day; -0.2 takeaway meals/week; +1.1 30-min walking sessions/week; +0.7 30-min moderate activity sessions/week; +0.2 20-min vigorous activity sessions/week). Nearly one-third (31.1%) of participants lost ≥5% body weight. The DPM reached priority population groups, those typically underrepresented in diabetes prevention programs and resulted in clinically relevant improvements in anthropometric and lifestyle risk factors in adults at increased risk for type 2 diabetes.

VP59 The MedicineWise App: Extended Applications Beyond Medicine Management

IntroductionThe MedicineWise app is a free consumer health and medicine management app developed by NPS MedicineWise. With 107,000+ downloads and 78,000+ active sessions per month, the MedicineWise app's core functions include: keeping track current medicines lists, medicine dose reminders and recording health conditions, allergies, test results and other health information. Recent enhancements also enabled the app to deliver featured health- and medicine-related content to users based on their medicines and/or health conditions. The goal is to maximise the MedicineWise app's capabilities by personalizing to users’ needs and combining with health professional interventions when needed, to encourage better delivery of health and medicines information and improve medication adherence and health outcomes.MethodsA number of personalized medicines management service offerings were created by combining a technology solution using the MedicineWise app (including the app's core functions as well as added targeted content delivery capability) with a humanistic solution (a health professional-mediated phone-based coaching service). MedicineWise app features were developed iteratively using a human-centred design approach. Consumers were involved in the design, prototyping and testing stages before the features moved to technical-build stage.ResultsThree use-cases will be presented to demonstrate how the MedicineWise app was used to provide personalized medicines management service offerings. These include: (1) curating relevant content and delivering push notifications to users for health conditions including asthma, rheumatoid arthritis and osteoporosis; (2) providing a triaged medication adherence support program with escalating levels of intervention for heart failure patients; and (3) collecting user-reported medication usage data and data monitoring by health professionals to provide support for heart failure patients.ConclusionsThe utility of MedicineWise app can be extended to provide personalized medicines management service offerings in the consumer health care space.

Formative research to promote the Get Healthy Information and Coaching Service (GHS) in the Australian-Chinese community.

The free, telephone-based Get Healthy Information and Coaching Service (GHS) has made sustained improvements in healthy behaviours and weight change in the Australian population, but there is poor uptake of the GHS by culturally and linguistically diverse communities. This formative research study explored the Australian-Chinese community's awareness, perceptions and experiences of the GHS and their knowledge and cultural beliefs about healthy lifestyles. Conducted in Sydney, Australia, the research included 16 Chinese community-stakeholder interviews, a cross-sectional survey of 253 Chinese community members; and a review of Chinese participant GHS data. The study revealed poor uptake (<1%) and awareness (16%) of the GHS, but good intent (86%) to use it. The need for culturally appropriate and relevant information on healthy eating and physical activity was identified. Employment of a bilingual, bicultural coach, redesign and translation of written resources and targeted promotion in partnership with community organisations were recommended.

A Fully Automated Conversational Artificial Intelligence for Weight Loss: Longitudinal Observational Study Among Overweight and Obese Adults.

BackgroundType 2 diabetes is the most expensive chronic disease in the United States. Two-thirds of US adults have prediabetes or are overweight and at risk for type 2 diabetes. Intensive in-person behavioral counseling can help patients lose weight and make healthy behavior changes to improve their health outcomes. However, with the shortage of health care providers and associated costs, such programs do not adequately service all patients who could benefit. The health care system needs effective and cost-effective interventions that can lead to positive health outcomes as scale. This study investigated the ability of conversational artificial intelligence (AI), in the form of a standalone, fully automated text-based mobile coaching service, to promote weight loss and other health behaviors related to diabetes prevention. This study also measured user acceptability of AI coaches as alternatives to live health care professionals.ObjectiveThe objective of this study was to evaluate weight loss, changes in meal quality, and app acceptability among users of the Lark Weight Loss Health Coach AI (HCAI), with the overarching goal of increasing access to compassionate health care via mobile health. Lessons learned in this study can be applied when planning future clinical trials to evaluate HCAI and when designing AI to promote weight loss, healthy behavior change, and prevention and self-management of chronic diseases.MethodsThis was a longitudinal observational study among overweight and obese (body mass index ≥25) participants who used HCAI, which encourages weight loss and healthy diet choices through elements of cognitive behavioral therapy. Weight loss, meal quality, physical activity, and sleep data were collected through user input and, for sleep and physical activity, partly through automatic detection by the user’s mobile phone. User engagement was assessed by duration and amount of app use. A 4-question in-app user trust survey assessed app usability and acceptability.ResultsData were analyzed for participants (N=70) who met engagement standards set forth by the Centers for Disease Control and Prevention criteria for Diabetes Prevention Program, a clinically proven weight loss program focused on preventing diabetes. Weight loss (standard error of the mean) was 2.38% (0.69%) of baseline weight. The average duration of app use was 15 (SD 1.0) weeks, and users averaged 103 sessions each. Predictors of weight loss included duration of AI use, number of counseling sessions, and number of meals logged. Percentage of healthy meals increased by 31%. The in-app user trust survey had a 100% response rate and positive results, with a satisfaction score of 87 out of 100 and net promoter score of 47.ConclusionsThis study showed that use of an AI health coach is associated with weight loss comparable to in-person lifestyle interventions. It can also encourage behavior changes and have high user acceptability. Research into AI and its application in telemedicine should be pursued, with clinical trials investigating effects on weight, health behaviors, and user engagement and acceptability.

Physical Activity Coaching Service for COPD Patients

Introduction : Today over 65M people worldwide are diagnosed with COPD1. Integrated care strategies over the long trajectory of COPD disease range from interventions aimed at smoking cessation, promoting regular exercise and activity, optimizing pharmacotherapy and collaborative self-management2. An important self-care behavior is physical activity (PA). Research shows that higher levels of PA go hand in hand with a reduced risk for exacerbations, and thus (re)hospitalization, but also mortality3, 4, 5. On their own, patients find it difficult to be physically active and could benefit greatly from an integrated care solution addressing PA. Description of integrated care case : We developed an automated PA coaching service, that employs a coaching model grounded in behavior change theory to support COPD patients in becoming or staying active (e.g. after pulmonary rehabilitation (PR)). Exploratory research with patients and PR specialists clearly showed a need to address this topic. The coaching service addresses specifically the needs and capabilities of COPD patients. It provides feedback to enhance insight, and encourages activity and exercise through goal setting, daily and weekly coaching messages. It is currently in trial at Ciro+ (a PR center) in the Netherlands, where we are looking at efficacy of the service to support patients in maintaining a high PA level after intensive PR. In addition, a pilot study is running in the US where we are looking to support patients to increase PA. Targeted population and stakeholders : The automated coaching service targets COPD patients in all GOLD stages to support this self-management behavior at home. Such a service could also be attractive for healthcare organizations like rehabilitation centers to 1) extend their reach to the home environment while patients are in PR; 2) reach patients that are not eligible for PR; 3) reduce the duration (and cost) of PR by replacing part of PR with an automated service; and 4) extend their offering beyond PR. Health insurers could profit from potentially lower (re)admissions as COPD patients are empowered to stay active. Highlights and timeline : Intermediate results of the study in the Netherlands show promising trends: patients using the service are maintaining a higher activity level at home than patients that are not. In addition, we see encouraging levels of engagement and usage of the service. The study is expected to complete in 2017. US pilot and we are currently looking at the data and expect equally positive trends. Conclusions and (preliminary results) : The coaching system employs an evidence-based coaching rationale that is flexible enough to cater to activity maintenance as well as increase. In addition, it is not condition-specific and can be amended to coach other chronic conditions like HF, as well as healthy but vulnerable groups (e.g. the elderly). We envision such a service to fit into any home self-management telehealth system or stand-alone if activity is the only area of self-care attention. Lessons learned : A strong multidisciplinary team as well as close collaboration with clinical sites and partners is essential for discussion, trials and patient contact. References : 1- WHO http://www.who.int/respiratory/copd/en/ 2- R. ZuWallack et al. Integrated Care: What does this Mean for the COPD Patient?, iMedPub Journals, Vol.1 No.3:15, 2016 3- Pitta Et al. Characteristics of physical activity in daily Life in chronic obstructive pulmonary disease. 2005; Am J. Resp. Crit. Care Med. 4- Gimeno-Santos et al, . Determinants and outcomes of physical activity in patients with COPD: a systematic review., Thorax 2014; 69: 731–739. 5- Garcia-Aymerich et al. Regular physical activity reduces hospital admissions and mortality in chronic obstructive pulmonary disease: a population based cohort study. 2006; Thorax.

Evaluating the effectiveness of a healthy lifestyle clinician in addressing the chronic disease risk behaviours of community mental health clients: study protocol for a randomised controlled trial

BackgroundPeople with a mental illness experience a greater morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of modifiable health risk behaviours such as smoking, poor nutrition, physical inactivity and harmful alcohol consumption contribute substantially to this disparity. Despite clinical practice guidelines recommending that mental health services routinely provide care to address these risk behaviours, the provision of such care is consistently reported to be low internationally and in Australia. This protocol describes a randomised controlled trial that aims to assess the effectiveness of allocating a clinician within a community mental health service to the specific role of providing assessment, advice and referral for clients’ chronic disease risk behaviours.Methods/designApproximately 540 clients of one community mental health service will be randomised to receive either usual care for chronic disease risks provided in routine consultations or usual care plus an additional face-to-face consultation and follow-up telephone call with a ‘healthy lifestyle clinician’. The clinician will assess clients’ chronic disease risk behaviours, provide advice to change behaviours, and refer at-risk clients to free telephone coaching services (New South Wales (NSW) Quitline and NSW Get Healthy Information and Coaching Service) for specialist behaviour change care. The primary outcomes, regarding referral to and client uptake of the telephone services, will be obtained from the respective services. Telephone interviews of clients at baseline and at 1 and 6 months post baseline follow-ups will assess secondary outcomes: receipt of any assessment, advice and referral from the mental health service; satisfaction with the receipt of such care; satisfaction with the receipt of any care provided by the telephone services; interest and confidence in and perceived importance of changing risk behaviours; and risk behaviour status.DiscussionThis study will add to the limited literature regarding effective strategies to address chronic disease prevention among the higher risk population of community mental health clients. The results will inform the development of future policies and service delivery initiatives to address the high prevalence of chronic disease risk behaviours among people with a mental illness.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616001519448. Registered on 3 November 2016.

Evaluation of the implementation of Get Healthy at Work, a workplace health promotion program in New South Wales, Australia

Issue addressed Get Healthy at Work (GHaW) is a statewide program to reduce chronic disease risk among NSW workers by helping them make small changes to modifiable lifestyle chronic disease risk factors and create workplace environments that support healthy lifestyles. It has two primary components: a workplace health program (WHP) for businesses and online or face-to-face Brief Health Checks (BHCs) for workers. In this paper, we discuss our evaluation to identify areas for improvement in the implementation of WHP and to assess the uptake of BHCs by workers. Methods Routinely collected WHP and BHC program data between July 2014 and February 2016 were analysed. A baseline online survey regarding workplace health promotion was conducted with 247 key contacts at registered GHaW worksites and a control group of 400 key contacts from a range of businesses. Seven telephone interviews were conducted with service provider key contacts. Results As at February 2016, 3133 worksites (from 1199 businesses) across NSW had registered for GHaW, of which 36.8% started the program. Similar proportions of GHaW (34.0%) and control (31.7%) businesses had existing WHPs. BHCs were completed by 12740 workers, and of those whose risks were assessed, 78.9% had moderate or high risk of diabetes and 33.6% had increased or high risk of cardiovascular disease. Approximately half (50.6%) of eligible BHC participants were referred to Get Healthy Information and Coaching Service (GHS) and 37.7% to Quitline. The uptake of face-to-face BHCs compared with online was significantly higher for males, people aged over 35 years, those undertaking less physical activity and those less likely to undertake active travel to work. Service providers suggested that the program's structured five-step pathway did not offer adequate flexibility to support worksites' progress through the program. Conclusions During the evaluation period, a substantial number of NSW worksites registered for GHaW but their progress was slow because of the limited flexibility offered by the program model. So what? Workplace-based health promotion programs have potential to reach people at risk of chronic disease, but the implementation of such programs need to be more flexible than traditional health promotion programs in terms of delivery modes and timeframes.

The Examination of the Effectiveness of the Workplace Personal Assistance Service and Job Coaching Service Systems to Promote “Employment Retention” for Severe People with Disabilities

The Examination of the Effectiveness of the Workplace Personal Assistance Service and Job Coaching Service Systems to Promote “Employment Retention” for Severe People with Disabilities

The reach and flow of health information in two Aboriginal communities: a social network analysis.

The aim of the present paper was to explore how social networks enable dissemination of health information within two Aboriginal communities in New South Wales. The study design was modelled on a social network analysis socio-centric model. Data collection was conducted primarily by Aboriginal community members who were trained as community researchers. Participants reported on their patterns of interaction and who they provided or received health information from, and awareness of the Aboriginal Enhancement of the Get Healthy Information and Coaching Service. In total, 122 participants across two sites participated in the study. Aboriginal Community Controlled Health Services (ACCHSs) and Aboriginal Community Controlled Health Organisations (ACCHOs) were cited as the main provider of health information in both sites. Between-ness, degree and closeness centrality showed that certain community members, ACCHS and ACCHO within the two communities in the present study were considerable enablers [actors] in enhancing the reach and flow of health information to their respective Aboriginal community. There is potential for future health-promotion activities to be increasingly targeted and effective in terms of reach and influence, if guided by local Aboriginal organisations and by key Aboriginal community members within and across family networks and communities.