Digital Health Coaching Research Articles

Health promotion and disease prevention in the education of health professionals: a mapping of European educational programmes from 2019

BackgroundHealth professionals face barriers in carrying out effective health promotion and disease prevention. To indicate what are the needs for curriculum development in educational programmes, this study aims to provide an overview of how various health professionals are currently trained in health promotion and disease prevention at different educational levels.MethodsIn 2019, a descriptive mapping exercise was performed focusing on European programmes for different health and healthcare professionals at the three levels of education (undergraduate, postgraduate, and continuous professional development [CPD]). Data were collected by a self-developed online survey that was distributed using a modified snowball method.ResultsA total of 186 educational programmes of 17 different health professionals were analysed, implemented in 31 countries (60% were undergraduate, 30% postgraduate and 10% CPD programmes). Nearly all programmes indicated that expected outcomes were defined on knowledge (99%), skills (94%) and behaviours/attitudes (89%) regarding health promotion and disease prevention. A multidisciplinary approach was reported to be applied by 81% of the programmes. Traditional teaching methods such as lectures (97%) and assignments (81%) were dominant, while e-learning was less frequently used (46%). Digitalization in health promotion and digital health coaching were the least addressed topics in most programmes.ConclusionsHealth promotion and disease prevention are reported at all surveyed levels of education for a broad spectrum of health professionals. Educational programmes cover contents on knowledge, skills, and behaviours. There is a need for capacity building and joint development in health promotion education. Specifically, there is a need to include digitalisation and novel teaching in the educational programmes of health promotion and disease prevention.

Abstract 13360: Impact of Goal Setting in a Digital Health Coaching Program for Participants With Type 2 Diabetes

Introduction: Cardiovascular disease remains one of the most common causes of death in people with diabetes. We retrospectively explored how a digital health coaching (DHC) program with goal-driven engagement for individuals with type 2 diabetes mellitus (T2DM) influenced outcomes at 3 months. Methods: This retrospective analysis included de-identified results from overweight/obese individuals who participated in a 3-month DHC program tailored for people with diabetes, whose main goal was medication adherence. Participants were referred through employer programs, payor programs, or physicians. Changes in biometric variables and diabetes-related quality of life were assessed at 3 months. Results: Over one year (January 1, 2021, to December 31, 2021), 182 participants engaged and completed the DHC program. Participants were predominantly women (79%), with an average age of 50, and racially/ethnically diverse (51% white, 49% non-white). Of this cohort, 24% lived in rural areas, and 44 participants had low medication adherence scores at baseline. At 3 months, there were significant decreases in diabetes distress score (27.14% reduction in diabetes distress; 2.91 to 2.12, p<0.001) and HbA1c (6.44% improvement; 7.61 to 7.12, p-0.0017). In addition, members with low medication adherence scores had a larger improvement than all members, with the main cohort improving the medication adherence score by 5.4% (10.34 to 10.90, p=0.058) and the low medication adherence group improving by 18.07% (7.55 to 8.91, p=0.007). Members with low medication adherence scores at baseline had significantly larger improvement than all other members, with 12.67% more improvement than members overall. Conclusions: Participants in the program showed improved outcomes for HbA1c and diabetes-related quality of life measures at 3 months. Engaging patients in DHC can help improve outcomes in populations at-risk of low adherence.

170-OR: Outcomes of a Digital Health Coaching Program Integrating Food Delivery for a Population of Adults with T2DM at Risk of Food Insecurity

Background: Recent reviews suggest that concurrent Type 2 Diabetes Mellitus (T2DM) and food insecurity contributes to poorer outcomes, including worse glycemic control and increased healthcare use. We present outcomes from a real-world program involving digital health coaching (DHC) and bi-weekly food delivery for individuals with T2DM screened for food insecurity. Methods: Individuals with T2DM were enrolled in a payor-supported DHC program and screened for food insecurity through social worker, provider, or payor records. A retrospective analysis compared data from baseline to 3-months of enrollment to evaluate T2DM-related outcomes. Results: Of the 1093 individuals who completed baseline assessments, 75% completed 3 months of DHC. This population was primarily female (74%) , racially/ethnically diverse (38% Black, 54% white, 8% other or multi-racial) , with an average age of 53. At 3 months, there were significant improvements in mean scores on the Diabetes Distress Score (2.76 to 2.09, p<0.001) , HbA1c (8.22 to 7.52, p<0.001) , and USDA Food Security Survey (2.49 to 1.39, p<0.001) among evaluable participants (n=710) . Conclusions: A DHC program with integrated food delivery demonstrated promising results, suggesting that addressing basic needs such as food security may contribute to improved clinical and quality of life outcomes for individuals with T2DM. Disclosure S.Rutland: Employee; Pack Health. J.Moore: None. V.T.Tran: None. M.Allison: None. B.Burton: None. D.Patel: None.

Strengthening the Impact of Digital Cognitive Behavioral Interventions Through a Dual Intervention: Proficient Motivational Interviewing-Based Health Coaching Plus In-Application Techniques.

BackgroundThe COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum in increasing overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight into the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes versus simply monitoring engagement metrics. Motivational interviewing (MI) is a collaborative, goal-oriented communication approach that pays particular attention to the language of change and is an effective engagement approach to help people manage mental health issues. However, this approach has been traditionally used for in-person or telephonic interventions, and less is known about the application of MI to digital interventions.ObjectiveWe sought to provide a dual intervention approach and address multiple factors across two levels of engagement to operationalize a dCBI that combined cognitive behavioral therapy–based techniques and MI-based interactions between the digital health coach (DHC) and user.MethodsWe reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions.ResultsWe tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a noncoached intervention (P<.001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by the DHC-to-user message exchange ratio (P<.001); (3) the DHC-to-user message exchange ratio was correlated with more engagement in app activities (r=0.28, 95% CI 0.23-0.33); (4) DHCs with demonstrated MI proficiency elicited a greater amount of “change talk” from users than did DHCs without MI proficiency (H=25.12, P<.001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (P=.02).ConclusionsTo our knowledge, this pilot was the first of its kind to test the application of MI to digital coaching protocols, and it demonstrated the value of MI proficiency in digital health coaching for enhanced engagement and health improvement. Further research is needed to establish coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes.

A Pilot Feasibility Study of Digital Health Coaching for Men With Prostate Cancer.

Prostate cancer is the most common cancer among men in the United States. The majority of prostate cancer treatment occurs in the ambulatory setting, and patients and their caregivers take on significant responsibility for monitoring and managing treatment and disease-related toxicity. Digital health coaching has shown promise as a tool to positively influence outcomes. We completed a single-arm pilot study to assess the feasibility of digital health coaching in men with prostate cancer. Men with a history of prostate cancer requiring treatment in the past 2 years were eligible for inclusion. Participants engaged in a 12-week health coaching program, consisting of a combination of at least one telephone call and up to four digital nudges (defined as content delivered via text, e-mail, or app on the basis of the participant's preference) per week. Prostate cancer-specific content addressed one of the following topics each week: fatigue, pain management, healthy eating, exercise, managing incontinence, sexual health, managing stress and anxiety, financial toxicity, goal setting during treatment, managing side effects, communicating with the health care team, and medication adherence. Services were provided at no cost to the participant. A hundred patients were consented for the study, and 88 enrolled. The feasibility threshold of 60% was met with 63 of the 88 enrolled individuals completing the 3-month program (proportion = 71.6%; 90% CI, 62.6 to 79.4; P = .016). Digital health coaching for men with prostate cancer is feasible. These findings support further evaluation of digital health coaching for men with prostate cancer in larger randomized controlled trials.

Improving Cancer Care Through Digital Health Coaching.

Improving Cancer Care Through Digital Health Coaching.

Digital Health Coaching for Type 2 Diabetes: Randomized Controlled Trial of Healthy at Home.

Digital health coaching is an intervention for type 2 diabetes mellitus (T2DM) that has potential to improve the quality of care for patients. Previous research has established the efficacy of digital interventions for behavior change. This pilot study addresses a research gap in finding effective and accessible behavioral interventions for under-resourced individuals with T2DM. We examined the impact of Healthy at Home, a 12-week phone and SMS-based (short message service) digital health coaching program, on insulin resistance which is an upstream marker for T2DM progression. We compared this intervention to usual diabetic care in a family medicine residency clinic in a randomized controlled trial. Digital health coaching significantly improved participants' calculated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) by −0.9 ± 0.4 compared with the control group (p = 0.029). This significance remained after controlling for years diagnosed with T2DM, enrollment in Medicaid, access to food, baseline stage of change, and race (p = 0.027). Increasing access to digital health coaching may lead to more effective control of diabetes for under-resourced patients. This study demonstrates the potential to implement a personalized, scalable, and effective digital health intervention to treat and manage T2DM through a lifestyle and behavioral approach to improve clinical outcomes (http://clinicaltrials.gov, NCT04872647).

Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial.

BackgroundThe traditional informed consent (IC) process rarely emphasizes research participants’ comprehension of medical information, leaving them vulnerable to unknown risks and consequences associated with procedures or studies.ObjectiveThis paper explores how we evaluated the feasibility of a digital health tool called Virtual Multimedia Interactive Informed Consent (VIC) for advancing the IC process and compared the results with traditional paper-based methods of IC.MethodsUsing digital health and web-based coaching, we developed the VIC tool that uses multimedia and other digital features to improve the current IC process. The tool was developed on the basis of the user-centered design process and Mayer’s cognitive theory of multimedia learning. This study is a randomized controlled trial that compares the feasibility of VIC with standard paper consent to understand the impact of interactive digital consent. Participants were recruited from the Winchester Chest Clinic at Yale New Haven Hospital in New Haven, Connecticut, and healthy individuals were recruited from the community using fliers. In this coordinator-assisted trial, participants were randomized to complete the IC process using VIC on the iPad or with traditional paper consent. The study was conducted at the Winchester Chest Clinic, and the outcomes were self-assessed through coordinator-administered questionnaires.ResultsA total of 50 participants were recruited in the study (VIC, n=25; paper, n=25). The participants in both groups had high comprehension. VIC participants reported higher satisfaction, higher perceived ease of use, higher ability to complete the consent independently, and shorter perceived time to complete the consent process.ConclusionsThe use of dynamic, interactive audiovisual elements in VIC may improve participants’ satisfaction and facilitate the IC process. We believe that using VIC in an ongoing, real-world study rather than a hypothetical study improved the reliability of our findings, which demonstrates VIC’s potential to improve research participants’ comprehension and the overall process of IC.Trial RegistrationClinicalTrials.gov NCT02537886; https://clinicaltrials.gov/ct2/show/NCT02537886

Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer.

102 Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.

P-132: Trial in progress: a mixed methods approach to understanding treatment experience of individuals receiving standard of care Isatuximab using patient reported, wearable, and digital health outcomes

<h3>Background</h3> Relapsed/refractory multiple myeloma (R/R MM) is associated with potential for decreased quality of life and increased symptom burden. As new therapeutic approaches emerge for the R/R MM population, further insight is needed regarding the treatment experience of individuals in the real-world setting. Patient reported outcomes (PROs) have demonstrated utility not only in tracking symptom burden during treatment, but also improving outcomes, including overall survival for individuals from whom PROs are collected and responded to in the clinical setting. The use of multimodal data sources, informed by PROs, may provide a richer understanding of the real-world experience of R/R MM, its management, and its impact on quality of life. Through the triangulation of qualitative and quantitative data, this trial-in-progress aims to evaluate the experience of adults with R/R MM receiving standard of care isatuximab in the real-world setting. <h3>Methods</h3> Fifty adults with R/R MM receiving standard of care isatuximab will be enrolled across 2 sites, The University of California San Francisco and The University of Texas MD Anderson Cancer Center. Consented participants will be enrolled in a 3-month digital health coaching program through which ePROs, and activity data from wearable devices, will be collected. PRO measures include the Patient's Qualitative Assessment of Treatment- Real World (PQAT-RW), Patient Global Impression of Change/Severity (PGIC/S), FACT-G (Item GP5-side effect bother), EORTC-QLQ-C30, QLQ-MY20, EQ5D. Demographic, as well as clinical data, including treatment history, healthcare utilization, and co-morbidities, will be collected via each participant's electronic health record. These data will be complemented by qualitative data from a purposefully selected cohort of study participants for which a focus on treatment experience will be assessed, ranging from infusion burden to toxicity management, to overall quality of life. Triangulation of data will be used to evaluate the treatment experience of individuals on standard of care isatuximab specifically, and R/R MM generally. Outcomes will be analyzed with attention to the relationship between demographics, including race and ethnicity, and treatment experience as reflected in both the qualitative and quantitative data. <h3>Conclusions</h3> As the treatment landscape continues to evolve, insights into the experience of individuals in the real-world setting are important to recognize challenges and to optimize the management of R/R MM. By capturing insights via diverse PRO tools including both validated measures of quality of life and symptom burden, as well as physical activity and qualitative data, this study seeks to enhance the literature and implications for clinical practice for individuals receiving treatment for R/R MM in the real-world setting.

The Influence of Baseline Hemoglobin A1c on Digital Health Coaching Outcomes in Adults With Type 2 Diabetes: Real-World Retrospective Cohort Study.

BackgroundDigital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes is yet to be evaluated in a real-world setting.ObjectiveThe purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline hemoglobin A1c (HbA1c) to better understand which populations may experience the greatest clinical and psychosocial benefit.MethodsA retrospective cohort study design was used to evaluate program effect in a convenience sample of participants in a 12-week digital health coaching program administered by Pack Health. Participants were referred through their health care provider, payer, or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text, and/or email. Self-reported HbA1c and weight were collected at baseline and completion. Physical and mental health were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the Diabetes Distress Scale-2. Changes in HbA1c, weight, BMI, and physical and mental health were analyzed within three participant cohorts stratified by baseline HbA1c level.ResultsParticipants with complete HbA1c data sets (n=226) were included in the analysis. The sample population was 71.7% (162/226) female, with 61.5% (139/226) identifying as white and 34.1% (77/226) as black. Most participants (184/226, 81.4%) reported a baseline HbA1c ≥7%, and 20.3% (46/226) were classified as high risk (HbA1c >9%). Across HbA1c cohorts, the mean baseline BMI was 35.83 (SD 7.79), and the moderate-risk cohort (7% ≤ HbA1c ≤ 9%) reported the highest mean value (36.6, SD 7.79). At 12 weeks, patients reported a significant decrease in HbAlc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate-risk cohort showing the greatest reduction (−0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest-risk cohort showed the greatest improvements in diabetes distress (−0.76; P=.005).ConclusionsAcknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline HbA1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high HbA1c experienced the greatest HbA1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching.

579-P: Behavioral Outcomes of a Digital Health Coaching Program Stratified by Baseline A1C: A Real-World Retrospective Analysis

Background: The 2021 ADA Standards of Medical Care suggest digital health coaching (DHC) programs can be beneficial in treating diabetes. As programs expand, it is increasingly important to understand expected benefits for diverse populations. Studies have shown greater clinical impact for patients with suboptimal baseline health, yet little is known about the influence of health on behavioral outcomes. In this real-world study, we analyzed trends in lifestyle change by baseline A1c following exposure to a T2DM DHC program. Methods: The 12-week DHC program, including patient-centered phone, email and/or text interactions, was delivered to T2DM patients. Retrospective analysis of patient reported data at baseline and program completion was conducted to evaluate impact on engagement in CDC recommended physical activity and healthy meal consumption (defined by USDA MyPlate guidelines). Outcomes were analyzed for 3 cohorts stratified by baseline A1c (&amp;lt;7% 7-9%, &amp;gt;9%) using Wilcoxon matched-pairs signed rank tests and paired proportion tests. Results: Individuals who completed all measures (n=130) were included in the study. A majority (82.30%) reported a baseline A1c ≥ 7%, and 27.69% were high-risk (A1c &amp;gt; 9%). Across all cohorts, there were significant improvements in the percent of participants adherent to CDC guidelines, median weekly activity minutes and number of healthy meals (p&amp;lt;0.01). For subgroup analyses, weekly activity minutes improved the most for the A1c &amp;lt; 7% cohort (50 minutes; p&amp;lt;0.01). Change to weekly healthy meals was greatest for those with an A1c ≥ 7%. Conclusions: Outcomes suggest that DHC can improve lifestyle behaviors among all individuals with T2DM, irrespective of baseline A1c, with those at an elevated glycemic risk reporting the greatest dietary benefit and those with the lowest risk reporting the greatest shift in physical activity. If confirmed, findings may inform DHC referral strategies and individualized behavioral goals. Disclosure M. Martin: Consultant; Self; PACK HEALTH. J. Patterson: None. V. T. Tran: None. B. B. Oconnor: Employee; Self; Pack Health. M. Allison: None. D. Patel: None.

Exploring the role of digital health coaching for men with prostate cancer.

TPS1586 Background: Toxicity leading to impaired quality of life is common among men receiving treatment for Prostate Cancer (PCa). Digital interventions may be beneficial in enhancing health self-efficacy in managing symptom burden. This study evaluates the feasibility and preliminary outcomes of digital health coaching intervention on men with PCa. Methods: This pilot study aims to recruit up to 100 adult, English-speaking men with PCa who in the last 2 years have required active treatment, defined as cancer management via active surveillance, surgery, radiation, androgen deprivation, chemotherapy, hormonal therapy, immunotherapy or a combination of these modalities. Men will be enrolled across the catchment area of Jefferson Health using social media and a variety of other outreach tools approved by the Institutional Review Board. Consented patients are enrolled in a 3-month digital health coaching program which combines weekly calls with up to 4 nudges of evidence-based content delivered via text or email weekly. The program focuses on a weekly health topic, such as physical, mental, social, or financial health, and managing symptoms, and empowers participants to set health goals of importance to them. Primary endpoints include feasibility, defined as 60% of participants completing the 3-month program. The main secondary endpoints measured are health self-efficacy as measured by the Cancer Behavior Inventory-Brief (CBI-B), quality of life, as measured by the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), financial toxicity as measured by the Comprehensive Score of Financial Toxicity (COST) and physical and mental health as measured by the Patient Reported Outcomes Measurement Information System-Global Health 10 (PROMIS-10). Outcomes are captured on enrollment and monthly through program completion for a total of 4 data points. Summary statistics will be used to describe patient demographic and clinical characteristics of the study population. Summary statistics will also be used to describe CBI, EPIC-CP, PROMIS and COST by assessment time. The change in CBI-B scores from baseline to 3 months will be calculated along with 95% confidence intervals. Additional LMMs will be created to assess the relationship between self-efficacy (CBI) and quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10).

511 IMPLEMENTATION OF DIGITAL BEHAVIORAL THERAPY FOR ANXIETY AND DEPRESSION IN PATIENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS (FGIDS) DURING THE COVID ERA

Introduction Patients with FGIDs suffer from anxiety and depression and exhibit increased sensitivity to stressors. Cognitive behavioral therapy (CBT) is known to help improve mood, increase stress resiliency, and reduces FGID symptom severity but faces substantial barriers to implementation. Integrating behavioral health technology into medical clinic workflows could overcome these barriers. We evaluated the feasibility and initial impact of a digital CBT (dCBT) tool as a lower-barrier, first-line intervention for reducing emotional distress in FGID patients. Methods Patients seen at an integrated behavioral-neurogastroenterology clinic exhibiting or reporting symptoms of anxiety and/or depression during their encounter (in-person or telemedicine visit between March 1-Oct 31, 2020) were offered access to a dCBT app called RxWell, which consists of 40 CBT techniques and is supported by digital health coaches who communicate with patients via within-app texts. Patients completed anxiety (GAD7) and depression (PHQ8) measures at the baseline visit and monthly via the app. The study outcomes include changes in GAD7 and PHQ8 scores over a 3-month period. The app prescription was used as first line behavioral intervention, and was supplemented by sessions with behavioral providers, as clinically indicated. Results RxWell was e-prescribed during ~17% of all patient visits during the study period (77% by GI providers). Of the 298 FGID patients (mean age 43 yrs [sd 16 yrs]; 73.2% women; Table 1) who were prescribed RxWell, 54% downloaded the app and completed more than 3 dCBT techniques (mean number 15 [sd 28]). Further, 43% of RxWell users communicated with their digital health coaches. About 25% of the cohort met with a behavioral therapist, and of these, 16% met with a psychiatrist. Mean baseline GAD7 scores (11.6 [sd 5.5]) and PHQ8 scores (11.2 [sd 6]) indicated moderate severity. There was a significant improvement in GAD7 (mean change 3.7 [t 5.1, df 47; p Conclusion We demonstrate the feasibility of implementing dCBT in the care of FGID patients with moderate anxiety and depressive symptom scores. The use of the dCBT app is associated with clinically and statistically significant mood symptom reductions within 3 months, and supplementation with digital health coaching further enhanced these benefits. These preliminary results suggest that dCBT is a viable strategy to improve FGID patient access to effective behavioral therapy. Download : Download high-res image (72KB) Download : Download full-size image Table 1 . FGID diagnoses within our population. Download : Download high-res image (71KB) Download : Download full-size image Table 2 . Difference between baseline and follow up scores for patients using dCBT.

Abstract PS9-21: Patient reported outcomes of newly diagnosed women with breast cancer enrolled in a digital health coaching program

Abstract Background: With breast cancer (BC) treatment primarily managed in the ambulatory setting opportunities exist to provide support services to individuals that enhance their ability to manage side effects of treatment and their overall health outcomes. The aim of this randomized control trial was to evaluate the effect of a digital health coaching program on patient reported outcomes (PROs) and experience of women with BC undergoing chemotherapy treatment in the ambulatory setting. Methods: Women newly diagnosed with BC were randomized to receive either a 3-month digital health coaching intervention or standard of care support services provided by the treating hospital. PROs were captured at baseline and monthly for 3 months. The primary objective compared Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale scores between arms at the 3-month assessment. Secondary objectives evaluated the PROMIS physical and mental subscales, and the MD Anderson Symptom Inventory (MDASI) for differences between arms and over time. Summary statistics were used to describe demographic and baseline clinical characteristics by arm. Linear mixed effects models were used to assess PROMIS and MDASI over time. Statistical analysis were performed using Stata/MP v15.0. Results: A total of 210 subjects were randomized to the control arm and 208 to the digital health coaching intervention. A significant time (Table 1) but not intervention effect was observed. The mean (SD) of the PROMIS physical health t-score for the control arm was 43.9 (4.7) and 44.1 (4.3) for the intervention arm (p = 0.699). The mean (SD) of the PROMIS mental health t-score for the control arm was 45.3 (5.4) and 45.1 (5.0) for the intervention arm (p = 0.742). The mean (SD) of MDASI severity score for the control arm was 2.4 (1.6) and was 2.5 (1.8) for the intervention arm (p = 0.715). The mean (SD) of the MDASI interference for the control arm was 2.6 (2.3) and was 2.8 (2.3) for the intervention arm (p = 0.633). Of 208 individuals randomized to the intervention, the majority (n=195; 94%) preferred engagement by phone, email and text. Participants averaged 9.17 calls with a mean duration of 13.04 minutes per call, 12.3 outbound texts to and 3.8 inbound texts from the participant, and a 47% email open rate over the course of 12-weeks. Conclusions: Study results suggest that while digital health coaching did not produce a statistically significant improvement in PRO over the course of the first 3 months of treatment, it did result in engagement that could be leveraged during and potentially beyond primary treatment for women with BC. PRO scores reflected minimal symptom burden and high global health at baseline before the start of treatment, which predictably declined over the course of treatment. Results informed the development of a currently enrolling expansion trial for individuals with diverse treatment types to evaluate which population receives the greatest benefit. Given the need for increasing engagement using telehealth solutions, the optimization of digital health coaching for individuals with BC is timely and increasingly relevant to promote optimal health self-efficacy and PROs. Table 1. Linear Mixed Models of PROMIS and MDASI Scores Over TimePROMISEffectBeta95% LB95% UBp-valuePhysicalTime&amp;lt;0.00130-0.88-1.50-0.260.00660-0.74-1.390.090.02690-1.88-2.53-1.22&amp;lt;0.001Intervention0.12-0.730.980.980MentalTime&amp;lt;0.00130-3.53-4.22-2.85&amp;lt;0.00160-3.94-4.66-3.22&amp;lt;0.00190-4.64-5.36-3.92&amp;lt;0.001Intervention-0.25-1.130.630.583MDASIEffectBeta95% LB95% UBp-valueSeverityTime&amp;lt;0.001301.170.991.35&amp;lt;0.001600.990.811.18&amp;lt;0.001901.261.061.45&amp;lt;0.001Intervention-0.08-0.330.160.499InterferenceTime&amp;lt;0.001301.321.081.58&amp;lt;0.001601.190.921.46&amp;lt;0.001901.561.291.83&amp;lt;0.001Intervention-0.09-0.420.240.587 Citation Format: Kelly J Brassil, Bryan Fellman, Brett Wisse, Diana Urbauer, Valerie Shelton, Carolyn Harty, Mazi Rasulnia. Patient reported outcomes of newly diagnosed women with breast cancer enrolled in a digital health coaching program [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-21.

Digital Coaching Strategies to Facilitate Behavioral Change in Type 2 Diabetes: A Systematic Review

In this systematic review, we focus on the clinical impact of digital tools for providing health coaching, education, and facilitating behavior in patients with prediabetes or type 2 diabetes. Our approach was designed to provide insights for clinicians and health care systems that are considering adopting such digital tools. We searched the CINAHL, Scopus, and Ovid/MEDLINE databases using PRISMA guidelines for studies that reported digital coaching strategies for management and prevention of type 2 diabetes published from January 2014 to June 2019. Articles were reviewed by 2 independent blinded reviewers. Twenty-one articles met inclusion criteria. We found that 20 of 21 studies in our analysis showed statistically significant improvements in at least one measure of diabetes control including HbA1c, weight loss, fasting blood glucose, and BMI. Studies that reported weight loss percentage from baseline at 1 year reported values ranging from -3.04% to -8.98%, similar to outcomes with traditional coaching in the Diabetes Prevention Program (N = 4). Additionally, all studies that included a comparison group of in-person or telephone-based coaching showed statistically better or similar outcomes in the digital coaching group (N = 5). The evidence reported in this systematic review suggests that digital health coaching offers a promising strategy for long-term management and prevention of type 2 diabetes in diverse populations with similar benefits to in-person or telephone-based health coaching. We argue that, with the potential to treat large numbers of individuals in diverse geographic locations, digital coaching offers a promising solution to the rapid increase in diabetes prevalence.

Digital engagement preferences of individuals aged 65 and older with cancer.

289 Background: Recent reviews suggest that digital solutions play a prominent role in the context of geriatric oncology. While interventions ranging from remote monitoring to nutrition and physical activity support have demonstrated feasibility in older adults (aged 65 and older), little is known about facilitators and barriers to eHealth uptake in older adults diagnosed with cancer. Insights into the digital engagement preferences of older adults with cancer may help to inform which platforms may be best aligned to optimal engagement and outcomes. Methods: A retrospective analysis was conducted to examine patient engagement preferences (phone, text and/or email) among older adults with cancer enrolled in a digital health coaching program. Descriptive statistics were used to summarize patient characteristics. Chi-square tests were used to evaluate differences in patient engagement preferences by race. Results: Of 513 individuals, the majority (n = 308; 60%) preferred information be provided by phone, email and text, while 20% (n = 105) requested content by phone and text only. Less than 10% of the sample requested content via phone only (n = 45; 8%), phone and email, (n = 31; 6%), email only (n = 11, 2%), or by email and text (n = 9; 2%). Interestingly, adults aged 65 and older had a significant predisposition to phone only communication (8.77%) compared to 2.25% in the general oncology population (p &lt; 0.001). Among adults aged 65 and older with a phone preference, there were on average 8.39 calls over the course of the program with an average of 9.51 minutes per call over the course of 12-weeks. For those with text message preference, there were an average of 14.17 outbound and 8.30 inbound texts over the 12-week engagement, and for those with email preference a 62.38% open rate was observed. Retention over a three month coaching period was highest among those engaged via phone, text and email (56.17%), and email only (54.55%). Race was significantly related to engagement preference, with black members twice as likely (p &lt; 0.001) to choose phone and text, and three times as likely (p &lt; 0.001) to choose phone only compared with white members. However, no differences emerged between race and retention. Conclusions: Engagement preference was associated with differences in retention and race. Our results highlight the importance of offering different mechanisms for patient engagement and the need for attention to specific demographic differences such as race, which may impact access to and preference for engagement types when employing digital health solutions for older adults with cancer.

Digital Health Coaching Programs Among Older Employees in Transition to Retirement: Systematic Literature Review.

BackgroundThe rapid increase of the aging population is pushing many national governments to reshape retirement legislation in order to extend older adults’ working life. Once retired, older adults can be invaluable resources for the community as family carers, as volunteers, or by returning to work. Healthy aging is one of the main conditions for being able to work longer and being active after retirement. The latter, indeed, represents a very sensitive life transition, which can entail psychological and social difficulties. Interventions for promoting older workers’ health and well-being and supporting the transition to retirement are on the top of the policy agenda of most European countries. Recently, computer-based and digital health interventions have been seen as promising means to reach this purpose.ObjectiveThis systematic literature review aimed to explore studies on digital health coaching programs for older workers that followed a user-centered design approach and evaluated their effectiveness in providing older adults with guidance for adopting a healthy lifestyle and being active in the community.MethodsThe search identified 1931 papers, and 2 relevant articles were selected by applying specific eligibility criteria.ResultsTo our knowledge, only few digital health coaching programs have targeted the population of older workers to date; there is an insufficient number of studies on the efficacy of such programs. The results show the difficulties of assessing the efficacy of digital coaching itself and with respect to older employees. The 2 studies suggest that digital health programs for workplaces can improve various aspects of older employees’ well-being; however, they considered health mainly from a physical perspective and neglected contextual, social, psychological, and cultural factors that can influence older workers’ health and general well-being. Future digital health coaching programs should adopt the healthy aging paradigm as a multidimensional lens for interpreting the impact of eHealth technology on aging and retirement. The literature around this issue remains at an embryonic state, and this gap needs to be filled by further investigations that apply a user-centered approach for designing the technology, test innovative research methodologies, and adopt new technical solutions for high-quality interaction design.ConclusionsFurther digital health coaching programs aimed at supporting healthy and active living for older workers and retirees are necessary. The user-centered design approach is recommended in order to fully address the users’ health needs and the technological requirements throughout development. Moreover, the healthy aging perspective allows inclusion of physical, social, and psychological factors influencing the transition from work to retirement, as well as the experiences and interactions of individuals with the technology.

A Digital Coach Promoting Healthy Aging among Older Adults in Transition to Retirement: Results from a Qualitative Study in Italy

Global aging and increasing multimorbidity are questioning the sustainability of healthcare systems. Healthy aging is at the top of the world political agenda, as a possible means for hindering the collapse of care systems. In the aging process, the transition to retirement can lead to an improvement or a deterioration of physical and psychological health. Digital health coaching technology can support older adults at this stage, but what must be the role of such a solution in promoting healthy aging and shaping sustainable care? This qualitative study, carried out in Italy in 2019, involved 15 older workers, retirees, and colleagues. Based on a user-centered design approach, this study aims at gathering older adults’ feelings on a digital health coaching technology for exploring this solution’s potential in promoting healthy aging. Findings highlighted that the digital health coach may help older adults improve several health determinants, e.g., physical activity, cognitive capabilities, and social life, but it can also entail the risk of stigma and break people’s privacy. The latter can be guaranteed by technology customization and codesign. Further research on the digital health coach benefits to boost healthy aging is needed to understand its potential for shaping future sustainable healthcare.

Mapping of education of health professionals in health promotion; a European survey

Abstract Health behaviours comprise over half of risk of Non-communicable Diseases. Lifestyle interventions need collaborative approaches in healthcare; this makes health professionalś knowledge and skills in advocating lifestyle interventions crucial. However less is known about educational programs of professionals in Europe about health promotion. So, a project commissioned by Consumers, Health, Agriculture and Food Executive Agency (Chafea) in years 2018-2020 was carried out in all EU countries. Over 15 professions were included in this study. Information was obtained from national education providers, European associations of health professionals and national authorities. Study questions included: 1) how are health professionals being trained in health promotion in the EU? 2) what competencies professions require? 3) what methods are used? 4) what are the good practices? A three-stage data collection and analyses were carried out in order to answer these questions: a) desk research b) on-line survey for education content, methods and practices c) good practices assessment. Final report is to be concluded and published in April 2020, but first indications show that a) there are guidelines of competencies in health promotion in different levels of education (graduate, post-graduate and continuous professional development) b) good practices were found in all health professions b) all health professions provide description of health promotion competencies, c) traditional teaching methods (lectures and assignments) are most often used and d) there is a need for of digital health coaching and health economics practices. There is a need for capacity building and joint development in the European countries. Willingness to create European network of faculties, education regulators and professional associations is obvious and all parties acknowledge the need for support developing good practices and improving professional competencies in health promotion. Key messages There was a need for mapping of educational programs of professionals in Europe about health promotion. There is a need for capacity building and joint development in the European countries.