The effectiveness of two home-based interventions for older adults in managing chronic diseases

Examining the effectiveness of two home-based chronic disease management interventions for Hong Kong community-dwelling older adults: health coaching program and Buurtzorg nursing program

Status

Active, not recruiting

Phases

Unknown

Study type

Interventional

Source

ISRCTN

Registry ID

ISRCTN73836238

Enrollment

2800

Registered

2023-11-08

Start date

2021-04-01

Completion date

Unknown

Last updated

2026-06-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Patients with any of the following health conditions, including hypertension, hyperlipidaemia, diabetes mellitus, heart diseases, chronic obstructive pulmonary disease (COPD), elevated blood pressure and/or blood glucose, central obesity, and chronic pain. Nutritional, Metabolic, Endocrine

Interventions

Current interventions as of 17/12/2024: The study involves a 12-week multicentre interventional and multi-stage multi-arm trial, aiming at examining the effectiveness of two home-based healthcare in

Eligibility

Sex/Gender

All

Age

60 Years to 104 Years

Inclusion criteria

Inclusion criteria: 1. Aged 60 years or above 2. Community-dwelling 3. Referred by collaborating non-government organisations 4. Residing in Hong Kong 5. Able to communicate in Cantonese, Mandarin or English 6. With at least one of the following health conditions: 6.1. Hypertension 6.2. Hyperlipidaemia 6.3. Diabetes 6.4. Heart disease 6.5. Chronic obstructive pulmonary disease (COPD) 6.6. Elevated blood pressure and/or glucose 6.7. Central obesity 6.8. Chronic pain

Exclusion criteria

Exclusion criteria: 1. Aged 59 or below 2. Residing outside Hong Kong 3. Having no health conditions as listed in “Participant Inclusion Criteria” 4. Adverse home environment, such as woodlouse and/or severe hygienic problem 5. Diagnosed with mental disorder, such as schizophrenia and/or depression 6. Unstable mental conditions, such as violent tendency and/or paranoid delusion 7. Not able to communicate in Cantonese, Mandarin and English 8. Have severe hearing problem which cannot be corrected by hearing aids

Design outcomes

Primary

Measure	Time frame
Current primary outcome measure as of 17/12/2024: All the outcomes in health coaching groups (HC-HP and HC-LW) are assessed before (Time 1) and immediately after (Time 2) the intervention. The primary outcome measures include: 1. Patient activation is measured by the Patient Activation Measure (Judith et al., 2004). 2. Engagement in health-promoting behaviours is measured using the physical activity and nutrition subscales of the Chinese version of the short-form Health-Promoting Lifestyle Profile-II (Teng et al., 2010; Chung et al., 2023). The utilisation of medical services in Buurtzorg nursing group and individual control group, including hospitalisation, length of stay, and emergency room visits, is recorded assessed before (Time 1) and immediately after (Time 2) the intervention. _____ Previous primary outcome measure: All the outcomes in health coaching groups (HC-SW and HC-non-SW) are assessed before (Time 1) and immediately after (Time 2) the intervention. The outcome measures include: 1. Engagement in health-promoting behaviours is measured using the physical activity and nutrition subscales of the Chinese version of the short-form Health-Promoting Lifestyle Profile-II (Teng et al., 2010; Chung et al., 2023). 2. Self-care functional capacity is measured using the Katz’s Index of ADL (Katz et al., 1963) and Lawton’s Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969). 3. Cognitive function is measured using the 5-min Montreal Cognitive Assessment (Wong et al., 2015). 4. Social engagement is measured using the short-form Lubben Social Network Scale (Lubben et al., 2006). 5. Loneliness is measured using the short-form UCLA Loneliness Scale (Hoghes et al., 2004; Liu et al., 2020). 6. Risk of depression is measured using the brief version of Geriatric Depression Scale (van Warwijk et al., 1995). 7. Medication-taking behaviours are measured by the Morisky Medication Adherence Scale (Morisky et al., 2008). 8. Quality of life is measured by t	—

Measure

Time frame

Current primary outcome measure as of 17/12/2024: All the outcomes in health coaching groups (HC-HP and HC-LW) are assessed before (Time 1) and immediately after (Time 2) the intervention. The primary outcome measures include: 1. Patient activation is measured by the Patient Activation Measure (Judith et al., 2004). 2. Engagement in health-promoting behaviours is measured using the physical activity and nutrition subscales of the Chinese version of the short-form Health-Promoting Lifestyle Profile-II (Teng et al., 2010; Chung et al., 2023). The utilisation of medical services in Buurtzorg nursing group and individual control group, including hospitalisation, length of stay, and emergency room visits, is recorded assessed before (Time 1) and immediately after (Time 2) the intervention. _____ Previous primary outcome measure: All the outcomes in health coaching groups (HC-SW and HC-non-SW) are assessed before (Time 1) and immediately after (Time 2) the intervention. The outcome measures include: 1. Engagement in health-promoting behaviours is measured using the physical activity and nutrition subscales of the Chinese version of the short-form Health-Promoting Lifestyle Profile-II (Teng et al., 2010; Chung et al., 2023). 2. Self-care functional capacity is measured using the Katz’s Index of ADL (Katz et al., 1963) and Lawton’s Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969). 3. Cognitive function is measured using the 5-min Montreal Cognitive Assessment (Wong et al., 2015). 4. Social engagement is measured using the short-form Lubben Social Network Scale (Lubben et al., 2006). 5. Loneliness is measured using the short-form UCLA Loneliness Scale (Hoghes et al., 2004; Liu et al., 2020). 6. Risk of depression is measured using the brief version of Geriatric Depression Scale (van Warwijk et al., 1995). 7. Medication-taking behaviours are measured by the Morisky Medication Adherence Scale (Morisky et al., 2008). 8. Quality of life is measured by t

—

Secondary

Measure	Time frame
Current secondary outcome measures as of 17/12/2024: The primary outcome measures for the two health coaching groups include: 1. Risk of depression is measured using the brief version of Geriatric Depression Scale (van Warwijk et al., 1995). 2. Physiological outcomes are indicated by body mass index, and blood pressure. For Buurtzorg nursing group, the secondary measure includes satisfaction towards intervention, which is measured by ten self-developed satisfaction items a month after the intervention. _____ Previous secondary outcome measures: The satisfaction towards intervention is measured using ten self-developed satisfaction items a month after the intervention.	—

Measure

Time frame

Current secondary outcome measures as of 17/12/2024: The primary outcome measures for the two health coaching groups include: 1. Risk of depression is measured using the brief version of Geriatric Depression Scale (van Warwijk et al., 1995). 2. Physiological outcomes are indicated by body mass index, and blood pressure. For Buurtzorg nursing group, the secondary measure includes satisfaction towards intervention, which is measured by ten self-developed satisfaction items a month after the intervention. _____ Previous secondary outcome measures: The satisfaction towards intervention is measured using ten self-developed satisfaction items a month after the intervention.

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Countries

Hong Kong

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Jun 21, 2026