Cancer and Chronic Disease Prevention
Conditions
Brief summary
The BETTER intervention consists of supportive meetings between a specially trained prevention practitioner nurse and individuals aged 40-64 years to review recommended chronic disease prevention and screening activities (CDPS). The prevention practitioner nurse will assist participants to identify goals for accomplishing CDPS activities in the next 6 months. Promotion, recruitment of participants and delivery of the BETTER intervention will be adapted to meet the needs of the residents through the use of participatory research methods and community engagement strategies. The study population consists of individuals aged 40-64 years living in 10 designated areas or clusters within Durham Region in Oshawa and Whitby. Objectives: 1. Help people in the designated areas identify personal goals related to chronic disease prevention and screening activities. 2. Evaluate whether the prevention practitioner was effective in helping people achieve their goals and explore whether this type of intervention could work in other settings. 3. Share what the investigators learn with government and other public health units in Ontario and across Canada. Some clusters will receive the BETTER intervention right away and other clusters will be in a wait-list control group to receive the intervention 6 months later. Our main outcome is the change in a score that considers the number of preventive health items a person has achieved during the 6 months. The investigators will also be doing in-depth interviews and focus groups with health care providers, community organizations and people who live in the designated areas to understand whether the primary practitioner was effective.
Detailed description
Research has shown that many Ontarians do not participate in all the chronic disease prevention and screening activities that could keep them healthy. Previous studies have found that a prevention practitioner, a nurse who works with health care providers and their practices, can be effective at improving the uptake of chronic disease prevention and screening activities. The goal of this study is to adapt the BETTER intervention from a health care setting with family practice teams to a community-based strategy in designated areas in Durham Region. The BETTER intervention consists of supportive meetings between a specially trained prevention practitioner nurse and individuals aged 40-64 years to review recommended chronic disease prevention and screening activities (CDPS). The prevention practitioner nurse will assist participants to identify goals for accomplishing CDPS activities in the next 6 months. Promotion, recruitment of participants and delivery of the BETTER intervention will be adapted to meet the needs of the residents through the use of participatory research methods and community engagement strategies. Previous work by the researchers identified census dissemination areas in Ontario with: (1) the lowest quintile of median household income, (2) low cancer screening rates, and 3) poor access to primary care services. The study population consists of individuals aged 40-64 years living in 10 designated areas or clusters within Durham Region in Oshawa and Whitby. The investigators will be working closely with local community agencies and primary care providers to identify people who may benefit from this study. Objectives: 1. Help people in the designated areas identify personal goals related to chronic disease prevention and screening activities. 2. Evaluate whether the prevention practitioner was effective in helping people achieve their goals and explore whether this type of intervention could work in other settings. 3. Share what the investigators learn with government and other public health units in Ontario and across Canada. Some clusters will receive the BETTER intervention right away and other clusters will be in a wait-list control group to receive the intervention 6 months later. The investigators will compare the two groups. The study will involve about 120 residents in 10 designated areas. Our main outcome is the change in a score that considers the number of preventive health items a person has achieved during the 6 months. The investigators will also be doing in-depth interviews and focus groups with health care providers, community organizations and people who live in the designated areas to understand whether the primary practitioner was effective.
Interventions
The 'BETTER' prevention practitioner intervention involves assessment of a person's current participation, or lack of participation, among domains of evidence-based chronic disease prevention and surveillance (CDPS) actions. The assessment is followed several days later by a supportive meeting with a prevention practitioner nurse, using principles of shared decision making and health coaching, to establish goals for accomplishing CDPS activities of the individual's choice during the subsequent six months to develop personal goals and targets for participating in CDPS actions during the following six months. In BETTER HEALTH: DURHAM, the prevention practitioner nurse will be a public health nurse from the Durham Region Health Department.
The control arm will receive the prevention practitioner intervention 6 months after the intervention arm. Their outcomes will not be assessed in the study.
Sponsors
Study design
Eligibility
Inclusion criteria
* Males and females aged 40 - 64 years living in sampled low income clusters in Durham region who are English speakers (including illiterate persons). Only one participant per residential household may participate.
Exclusion criteria
* Unable to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite Outcome Measure: Mean Percentage of CDPS Actions at Baseline That Are Subsequently Met at Follow-up | Six months | The primary outcome measure is the mean percentage of the number of eligible CDPS actions at baseline that are subsequently met (by self-report) at follow-up, measured at the patient level. As a function of baseline characteristics, certain individuals are eligible for certain CDPS actions. At follow-up, each patient will be re-evaluated and the number of eligible actions met will be enumerated. Six months after the baseline survey interview, the research assistant will administer the outcome survey on health and CDPS actions to participants in intervention and control clusters alike. All outcomes are self-reports of the completion of CDPS actions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Completion of Individual Actions | Six months | The investigators will report the frequency with which individual CDPS actions were completed, for those actions for which the individual was eligible at baseline |
| Number of Self-referrals | Six months | The investigators will report the frequency with which self-referrals were reported to the prevention practitioner. |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Immediate Intervention Immediate Intervention: The 'BETTER' prevention practitioner intervention involves assessment of a person's current participation, or lack of participation, among domains of evidence-based chronic disease prevention and surveillance (CDPS) actions. The assessment is followed several days later by a supportive meeting with a prevention practitioner nurse, using principles of shared decision making and health coaching, to establish goals for accomplishing CDPS activities of the individual's choice during the subsequent six months to develop personal goals and targets for participating in CDPS actions during the following six months. In BETTER HEALTH: DURHAM, the prevention practitioner nurse will be a public health nurse from the Durham Region Health Department. | 59 |
| Wait List Intervention Wait List Intervention: The control arm will receive the prevention practitioner intervention 6 months after the intervention arm. | 66 |
| Total | 125 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 4 | 5 |
Baseline characteristics
| Characteristic | Immediate Intervention | Wait List Intervention | Total |
|---|---|---|---|
| Age, Continuous | 54.5 years STANDARD_DEVIATION 6.4 | 53.2 years STANDARD_DEVIATION 6.6 | 53.8 years STANDARD_DEVIATION 6.5 |
| Race/Ethnicity, Customized Race/ethnicity Other | 9 Participants | 14 Participants | 23 Participants |
| Race/Ethnicity, Customized Race/ethnicity White | 50 Participants | 52 Participants | 102 Participants |
| Sex: Female, Male Female | 21 Participants | 32 Participants | 53 Participants |
| Sex: Female, Male Male | 38 Participants | 34 Participants | 72 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 59 | 0 / 66 |
| other Total, other adverse events | 0 / 59 | 0 / 66 |
| serious Total, serious adverse events | 0 / 59 | 0 / 66 |
Outcome results
Composite Outcome Measure: Mean Percentage of CDPS Actions at Baseline That Are Subsequently Met at Follow-up
The primary outcome measure is the mean percentage of the number of eligible CDPS actions at baseline that are subsequently met (by self-report) at follow-up, measured at the patient level. As a function of baseline characteristics, certain individuals are eligible for certain CDPS actions. At follow-up, each patient will be re-evaluated and the number of eligible actions met will be enumerated. Six months after the baseline survey interview, the research assistant will administer the outcome survey on health and CDPS actions to participants in intervention and control clusters alike. All outcomes are self-reports of the completion of CDPS actions.
Time frame: Six months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Immediate Intervention | Composite Outcome Measure: Mean Percentage of CDPS Actions at Baseline That Are Subsequently Met at Follow-up | 64.5 percent of actions | Standard Deviation 27.5 |
| Wait List Intervention | Composite Outcome Measure: Mean Percentage of CDPS Actions at Baseline That Are Subsequently Met at Follow-up | 42.1 percent of actions | Standard Deviation 23.8 |
Completion of Individual Actions
The investigators will report the frequency with which individual CDPS actions were completed, for those actions for which the individual was eligible at baseline
Time frame: Six months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Immediate Intervention | Completion of Individual Actions | Waist circumference | 73.6 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | LDL measured | 31.6 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Weight control | 53.8 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Healthy diet score improved | 90.4 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Referral for body mass index greater than 25 | 76.9 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Breast screening | 50 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Smoking cessation | 11.1 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Blood pressure screen | 81.8 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Smoking cessation referral | 59.3 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Colorectal screening | 14.3 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Alcohol control | 66.7 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Physical activity referral | 71.1 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Alcohol cessation referral | 40 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Cervical screening | 25 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Physical activity improved | 62.2 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Blood pressure monitor | 66.7 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Body mass index screening | 72.7 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Nutrition referral | 67.3 percentage of eligible actions |
| Immediate Intervention | Completion of Individual Actions | Fasting blood sugar/A1C screen | 29.0 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Nutrition referral | 29.5 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Fasting blood sugar/A1C screen | 25.0 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Blood pressure screen | 41.7 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Blood pressure monitor | 66.7 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | LDL measured | 26.3 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Breast screening | 0 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Colorectal screening | 0 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Cervical screening | 11.1 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Body mass index screening | 0 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Waist circumference | 1.6 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Weight control | 57.1 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Referral for body mass index greater than 25 | 46.9 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Smoking cessation | 3.6 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Smoking cessation referral | 32.1 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Alcohol control | 52.4 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Alcohol cessation referral | 9.5 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Physical activity improved | 64.3 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Healthy diet score improved | 91.8 percentage of eligible actions |
| Wait List Intervention | Completion of Individual Actions | Physical activity referral | 41.1 percentage of eligible actions |
Number of Self-referrals
The investigators will report the frequency with which self-referrals were reported to the prevention practitioner.
Time frame: Six months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Immediate Intervention | Number of Self-referrals | Blood pressure monitored | 66.7 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Referral for body mass index greater than 25 | 76.9 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Breast cancer screening | 50 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Smoking cessation referral | 59.3 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Blood pressure screen | 81.8 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Alcohol cessation referral | 40 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Colorectal cancer screening | 14.3 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Physical activity referral | 71.1 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | LDL measured | 31.6 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Nutrition referral | 67.3 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Weight control | 53.8 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Cervical screening | 25.0 percentage of eligible actions |
| Immediate Intervention | Number of Self-referrals | Fasting blood sugar/A1C screen | 29.0 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Cervical screening | 11.1 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Fasting blood sugar/A1C screen | 25.0 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Blood pressure screen | 41.7 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Blood pressure monitored | 66.7 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | LDL measured | 26.3 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Breast cancer screening | 0 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Colorectal cancer screening | 0 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Weight control | 57.1 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Referral for body mass index greater than 25 | 46.9 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Smoking cessation referral | 32.1 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Alcohol cessation referral | 9.5 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Physical activity referral | 41.1 percentage of eligible actions |
| Wait List Intervention | Number of Self-referrals | Nutrition referral | 29.5 percentage of eligible actions |