Trial of an Individualised Intervention for the Prevention of Stroke (TIIPS)- using health and wellness coaching

Health and wellness coaching (HWC) intervention: HWC is a multidimensional psychological behaviour change intervention aimed at improving self-management of lifestyle behaviour and maintaining health and wellbeing. It fosters ongoing self-directed learning, delivering a cost-effective intervention in person or by telephone, and by medical or non-medical personnel, thus saving cost and increasing the scope of implementation. Individuals who receive HWC have increased perceived health status, improved medication adherence, and physical activity, with significantly improved health outcomes shown in patients following myocardial infarction. There is no prescribed level of participation engagement (as the aim is to self-empower the participant to make their own changes), but each session will allow the participant to set their own goals, which will be noted and discussed in the next session. Research staff will attend an intensive 4-week coaching course, at Momentum Coaching (www.coachmomentum.co.nz), with two sessions in the first two weeks and 4 which includes training in core coaching competencies and code of ethics, developed by the International Coach Federation (ICF) to support greater understanding of the skills and approaches used in the coaching profession. The initial intervention will occur after the baseline assessment, to ensure the participant meets all the study criteria, and to collect all baseline health information. Following this, the participant will be randomised, and be informed of their group allocation to HWC. The designated coach (matched to the participant by the coach trainer, based on health and demographic information), will contact the participant to make an appointment to have the first session in person, (usually at the participant's home). The first session is expected to last about 1 hour. After this, further appointments are made to have the remaining sessions by video call (Zoom, or other options that suit the participant). These sessions are expected to last about 30 minutes. The intervention will combine educational material and intensive HWC coaching. The educational material is existing evidence-based information (booklets) on healthy eating guidelines for the prevention of cardiovascular disease including stroke, from the NZ Heart Foundation, Life After Stroke, an information guide on how to manage after stroke, including secondary prevention, from the New Zealand Stroke Foundation, and information about the Stroke Riskometer App, a free app that informs people about their personal risk of stroke, risk factors and how to manage them, including using goal setting and reminders, how to recognise stroke, and what to do if someone is having a stroke. No new material will be produced by the study team. Participants allocated to the HWC group will have 12 individual coaching sessions over 6 months with trained HWC coaches, of which 4 sessions are carried out weekly, 6 sessions fortnightly and the remaining two sessions monthly. The initial two sessions and the final session will be conducted face-to-face and the remaining coaching sessions via telephone. Between the final coaching session and the 12-month assessment, HWC participants will receive a short monthly telephone call from their coach to encourage maintenance of behaviour change. Coaching sessions will take up to 1 hour initially, with later sessions lasting about 30 minutes. Interventional Group participants will be provided with tools to assist with behaviour changes. The details of each session will be recorded in the study database (REDCap), (Session number, date, coach name etc, plus whether or not the session took place, and if missed, reasons for this). Coaches will also complete a self-evaluation form after each session on REDCap to evaluate and reflect on how each session went. Participants will also be invited to reflect on the sessions in an open format, which will be recorded on teh REDCap database.