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Hafleen N, D'Silva C, Mansfield E, Fierheller D, Chaze F, Parikh A, Martel S, Malhotra G, Mutta B, Hasan Z, Zenlea I. "I Am the Last Priority": Factors Influencing Diabetes Management Among South Asian Caregivers in Peel Region, Ontario. Can J Diabetes 2024; 48:312-321. [PMID: 38583768 DOI: 10.1016/j.jcjd.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE In this study, we aimed to identify sociocultural and systemic factors influencing diabetes management among South Asian (SA) caregivers in Peel Region, Ontario. METHODS Twenty-one semistructured interviews were conducted with SA caregivers using a qualitative descriptive design. Data were analyzed using thematic analysis and intersectionality analysis. RESULTS Themes identified included 1) prioritizing family caregiving over diabetes self-management; 2) labour market impacts on diabetes self-management; and 3) challenges navigating Canadian health and social service systems. SA caregivers described social, economic, and systemic challenges impacting type 2 diabetes management. Systemic factors influencing diabetes management included discrimination and inequities in labour policies and lack of social and health resources funding. Recommendations by caregivers included whole-family, community-based, culturally tailored approaches to diabetes prevention and management strategies. CONCLUSIONS Providing support with system navigation, encouraging family-based approaches, and addressing the social determinants of health could be beneficial for supporting SA families with diabetes management and prevention.
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Affiliation(s)
- Nuzha Hafleen
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Chelsea D'Silva
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Occupational Health, University of Toronto, Toronto, Ontario, Canada
| | - Dianne Fierheller
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Ferzana Chaze
- Faculty of Applied Health and Community Studies, Sheridan College, Brampton, Ontario, Canada
| | - Amish Parikh
- Department of Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sara Martel
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute of Communication, Culture, Information, and Technology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | | | - Baldev Mutta
- Punjabi Community Health Services, Mississauga, Ontario, Canada
| | | | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Su R, Whitmore C, Alliston P, Tanzini E, Kouzoukas E, Marttila J, Dragonetti R, Selby P, Sherifali D. Demystifying diabetes health coaching: A scoping review unveiling the 'who' and 'where' of health coaching for adults with type 2 diabetes. Diabet Med 2024; 41:e15327. [PMID: 38597813 DOI: 10.1111/dme.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Type 2 diabetes (T2D) is a complex chronic condition that requires ongoing self-management. Diabetes health coaching interventions provide personalized healthcare programming to address physical and psychosocial aspects of diabetes self-management. AIMS This scoping review aims to explore the contexts and settings of diabetes health coaching interventions for adults with T2D, using the RE-AIM framework. METHODS A search was completed in MEDLINE, PsycINFO, Emcare, Embase and Cochrane. Included citations described adults with exclusively T2D who had received a health coaching intervention. Citations were excluded if they focused on any other types of diabetes or diabetes prevention. RESULTS A total of 3418 records were identified through database and manual searches, with 29 citations selected for data extraction. Most health coaching interventions were delivered by health professionals, many employed lay health workers and a few included peer coaches. While many health coaching interventions were delivered remotely, in-person intervention settings were distributed among primary care, community health settings and non-healthcare sites. CONCLUSION The findings of this review suggest that diabetes health coaching may be implemented by a variety of providers in different settings. Further research is required to standardize training and implementation of health coaching and evaluate its long-term effectiveness.
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Affiliation(s)
- Rita Su
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carly Whitmore
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Paige Alliston
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elise Tanzini
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Erika Kouzoukas
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jennifer Marttila
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rosa Dragonetti
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Moreira AM, Marobin R, Escott GM, Rados DV, Silveiro SP. Telephone calls and glycemic control in type 2 diabetes: A PRISMA-compliant systematic review and meta-analysis of randomized clinical trials. J Telemed Telecare 2024; 30:809-822. [PMID: 35611521 DOI: 10.1177/1357633x221102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS In-depth and updated systematic reviews evaluating telephone calls in type 2 diabetes (T2DM) management are missing. This study aimed to assess the effect of this intervention on glycemic control in T2DM patients when compared with usual care. METHODS We systematically searched for randomized controlled trials (RCT) on T2DM using Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and LILACS, up to March 2021. The Risk of Bias 2.0 (Rob 2.0) tool and GRADE were used for the quality evaluation. The intervention effect was estimated by the change in glycated hemoglobin (HbA1c). PROSPERO registry CRD42020204519. RESULTS 3545 references were reviewed and 32 were included (8598 patients). Telephone calls, all approaching education, improved HbA1c by 0.33% [95% CI, -0.48% to -0.18%; I2 = 78%; p < 0.0001] compared to usual care. A greater improvement was found when the intervention included pharmacologic modification (-0.82%, 95% CI, -1.42% to -0.22%; I2 = 92%) and when it was applied by nurses (-0.53%, 95% CI, -0.86% to -0.2%; I2 = 87%). Meta-regression showed no relationship between DM duration and HbA1c changes. CONCLUSION The telephone call intervention provided a benefit regarding T2DM glycemic control, especially if provided by nurses, or if associated with patient education and pharmacological treatment modification.
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Affiliation(s)
- Ana Marina Moreira
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Roberta Marobin
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gustavo Monteiro Escott
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- TelessaúdeRS, RS, Brazil
| | - Sandra Pinho Silveiro
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Yehualashet FA, Kessler D, Bizuneh S, Donnelly C. Feasibility of diabetes self-management coaching program for individuals with type 2 diabetes in the Ethiopian primary care setting: a protocol for a feasibility mixed-methods parallel-group randomized controlled trial. Pilot Feasibility Stud 2024; 10:59. [PMID: 38589966 PMCID: PMC11000297 DOI: 10.1186/s40814-024-01487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Diabetes mellitus is the third most prevalent chronic metabolic disorder and a significant contributor to disability and impaired quality of life globally. Diabetes self-management coaching is an emerging empowerment strategy for individuals with type 2 diabetes, enabling them to achieve their health and wellness goals. The current study aims to determine the feasibility of a diabetes self-management coaching program and its preliminary effectiveness on the clinical and psychosocial outcomes in the Ethiopian primary healthcare context. METHODS The study will employ a mixed-method feasibility randomized controlled trial design. Forty individuals with type 2 diabetes will be randomly allocated to treatment and control groups using block randomization. The primary feasibility outcomes include acceptability, eligibility, recruitment, and participant retention rates, which will be computed using descriptive analysis. The secondary outcomes are self-efficacy, self-care activity, quality of life, and glycated hemoglobin A1c. For normally distributed continuous variables, the mean difference within and between the groups will be determined by paired sample Student t-test and independent sample Student t-test, respectively. Non-parametric tests such as the Mann-Whitney U test, the Wilcoxon signed rank test, and the Friedman analysis of variance test will determine the median difference for variables that violated the normality assumption. A repeated measure analysis of variance will be considered to estimate the variance between the baseline, post-intervention, and post-follow-up measurements. A sample of 10 volunteers in the treatment group will participate in the qualitative interview to explore their experience with the diabetes self-management coaching program and overall feasibility. The study will follow a qualitative content analysis approach to analyze the qualitative data. Qualitative and quantitative findings will be integrated using a joint display technique. DISCUSSION Evidence reveals diabetes self-management coaching programs effectively improve HbA1c, self-efficacy, self-care activity, and quality of life. This study will determine the feasibility of a future large-scale randomized controlled trial on diabetes self-management coaching. The study will also provide evidence on the preliminary outcomes and contribute to improving the diabetes self-management experience and quality of life of individuals with type 2 diabetes. TRIAL REGISTRATION The trial was registered online at ClinicalTrials.gov on 12/04/2022 and received a unique registration number, NCT05336019, and the URL of the registry is https://beta. CLINICALTRIALS gov/study/NCT05336019 .
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Affiliation(s)
- Fikadu Ambaw Yehualashet
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada.
- College of Medicine and Health Sciences, The University of Gondar, Gondar, Ethiopia.
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada
| | - Segenet Bizuneh
- College of Medicine and Health Sciences, The University of Gondar, Gondar, Ethiopia
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada
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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Sherifali D, Whitmore C, Naeem F, Melamed OC, Dragonetti R, Kouzoukas E, Marttila J, Tang F, Tanzini E, Ramdass S, Selby P. Technology-Enabled Collaborative Care for Type-2 Diabetes and Mental Health (TECC-D): Findings From a Mixed Methods Feasibility Trial of a Responsive Co-Designed Virtual Health Coaching Intervention. Int J Integr Care 2024; 24:12. [PMID: 38370569 PMCID: PMC10870944 DOI: 10.5334/ijic.7608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 02/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Type-2 diabetes (T2D) is a complex chronic condition associated with a lower quality of life due to disease specific distress. While there is growing support for personalized diabetes programs, care for mental health challenges is often fragmented and limited by access to psychiatry, and integration of care. The use of communication technology to improve team based collaborative care to bridge these gaps is promising but untested. Methods We conducted an explanatory sequential mixed methods study to assess the feasibility and acceptability of the co-designed Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D) program. Participants included adults aged ≥18 years who had a clinical diagnosis of T2D, and self-reported mental health concerns. Results 31 participants completed the 8-week virtual TECC-D program. Findings indicate that the program is feasible and acceptable and indicate that there is a role for virtual diabetes and mental health care. Discussion The TECC-D program, designed through an iterative co-design process and supported by innovative, responsive adaptations led to good uptake and satisfaction. Conclusion The TECC-D model is a feasible and scalable care solution that empowers individuals living with T2D and mental health concerns to take an active role in their care.
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Affiliation(s)
- Diana Sherifali
- School of Nursing, McMaster University, Hamilton ON Canada
- Population Health Research Institute, Hamilton ON Canada
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton ON Canada
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Osnat C. Melamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
| | - Erika Kouzoukas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | | | - Frank Tang
- Diabetes Action Canada, Toronto ON Canada
| | - Elise Tanzini
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto ON Canada
- Office of Social Accountability and Community Engagement, McGill University, Montreal QC Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
- Department of Psychiatry, University of Toronto, Toronto ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON Canada
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7
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Moore M. Ground Zero in Lifestyle Medicine: Changing Mindsets to Change Behavior. Am J Lifestyle Med 2023; 17:632-638. [PMID: 37711351 PMCID: PMC10498987 DOI: 10.1177/15598276231166320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 09/16/2023] Open
Abstract
The aspiration of lifestyle medicine practitioners is a healthy population engaged daily in lifestyle behaviors that generate the vitality needed to live a good life. That said, we are aware that there is a high population prevalence of low readiness to change behavior. This article proposes that we can improve readiness to change by shifting our expert mindsets to coaching mindsets. We focus first on helping others mobilize resources that improve readiness to change, including motivation and confidence-rather than beginning with expert education and training on new skills and behaviors. We call this coaching activity tilling the (patient's) ground, which then germinates an interest in a mindset shift from an unresolved state (e.g., I don't have time to exercise) to a new state (e.g., I might feel better and be more productive, if I exercise). In a generative conversation, moving from unresolved to resolved improves confidence in behavior change. This mindset shift is called integration-connecting and integrating an unresolved state to new thoughts, ideas, or perspectives (the ah-hah experience). We use the ground zero metaphor in multiple ways, and invite readers to till their own ground, generate potential, and enable integration as role models.
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Affiliation(s)
- Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA; Institute of Coaching, McLean is Belmont, MA NBHWC is San Diego, CA; and National Board for Health and Wellness Coaching, San Diego, CA, USA
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8
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Mavragani A, Sherifali D, Dragonetti R, Ashfaq I, Veldhuizen S, Naeem F, Agarwal SM, Melamed OC, Crawford A, Gerretsen P, Hahn M, Hill S, Kidd S, Mulsant B, Serhal E, Tackaberry-Giddens L, Whitmore C, Marttila J, Tang F, Ramdass S, Lourido G, Sockalingam S, Selby P. Technology-Enabled Collaborative Care for Concurrent Diabetes and Distress Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Feasibility Study. JMIR Res Protoc 2023; 12:e39724. [PMID: 36649068 PMCID: PMC9890354 DOI: 10.2196/39724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use of communication technology could reduce these gaps in diabetes care created by the pandemic and also provide support for psychological distress. OBJECTIVE The purpose of this study is to test the feasibility of an innovative co-designed Technology-Enabled Collaborative Care (TECC) model for diabetes management and mental health support among adults with T2D. METHODS We will recruit 30 adults with T2D residing in Ontario, Canada, to participate in our sequential explanatory mixed methods study. They will participate in 8 weekly web-based health coaching sessions with a registered nurse, who is a certified diabetes educator, who will be supported by a digital care team (ie, a peer mentor, an addictions specialist, a dietitian, a psychiatrist, and a psychotherapist). Assessments will be completed at baseline, 4 weeks, and 8 weeks, with a 12-week follow-up. Our primary outcome is the feasibility and acceptability of the intervention, as evident by the participant recruitment and retention rates. Key secondary outcomes include assessment completion and delivery of the intervention. Exploratory outcomes consist of changes in mental health, substance use, and physical health behaviors. Stakeholder experience and satisfaction will be explored through a qualitative descriptive study using one-on-one interviews. RESULTS This paper describes the protocol of the study. The recruitment commenced in June 2021. This study was registered on October 29, 2020, on ClinicalTrials.gov (Registry ID: NCT04607915). As of June 2022, all participants have been recruited. It is anticipated that data analysis will be complete by the end of 2022, with study findings available by the end of 2023. CONCLUSIONS The development of an innovative, technology-enabled model will provide necessary support for individuals living with T2D and mental health challenges. This TECC program will determine the feasibility of TECC for patients with T2D and mental health issues. TRIAL REGISTRATION ClinicalTrials.gov NCT04607915; https://clinicaltrials.gov/ct2/show/NCT04607915. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39724.
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Affiliation(s)
| | - Diana Sherifali
- Addictions Research Program, Clinical Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Osnat C Melamed
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret Hahn
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean Hill
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Vector Institute for Artificial Intelligence, Toronto, ON, Canada.,Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada.,École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Serhal
- Department of Virtual Mental Health, Outreach and Project ECHO, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Leah Tackaberry-Giddens
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Carly Whitmore
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Frank Tang
- Diabetes Action Canada, Toronto, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada.,Office of Social Accountability and Community Engagement, McGill University, Montreal, QC, Canada.,The Association of Faculties of Medicine of Canada, Ottawa, ON, Canada.,Conseil Pour La Protection Des Malades, Montreal, QC, Canada.,Montreal Children's Hospital, Montreal, ON, Canada
| | | | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Bariatric Surgery Program, University Health Network, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Addictions Research Program, Clinical Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Almulhim AN, Hartley H, Norman P, Caton SJ, Doğru OC, Goyder E. Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis. BMC Public Health 2023; 23:95. [PMID: 36639632 PMCID: PMC9837922 DOI: 10.1186/s12889-022-14874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Given the high rates globally of Type 2 Diabetes Mellitus (T2DM), there is a clear need to target health behaviours through person-centred interventions. Health coaching is one strategy that has been widely recognised as a tool to foster positive behaviour change. However, it has been used inconsistently and has produced mixed results. This systematic review sought to explore the use of behaviour change techniques (BCTs) in health coaching interventions and identify which BCTs are linked with increased effectiveness in relation to HbA1C reductions. METHODS In line with the PICO framework, the review focused on people with T2DM, who received health coaching and were compared with a usual care or active control group on HbA1c levels. Studies were systematically identified through different databases including Medline, Web of science, and PsycINFO searches for relevant randomised controlled trials (RCTs) in papers published between January 1950 and April 2022. The Cochrane collaboration tool was used to evaluate the quality of the studies. Included papers were screened on the reported use of BCTs based on the BCT taxonomy. The effect sizes obtained in included interventions were assessed by using Cohen's d and meta-analysis was used to estimate sample-weighted average effect sizes (Hedges' g). RESULTS Twenty RCTs with a total sample size of 3222 were identified. Random effects meta-analysis estimated a small-sized statistically significant effect of health coaching interventions on HbA1c reduction (g+ = 0.29, 95% CI: 0.18 to 0.40). A clinically significant HbA1c decrease of ≥5 mmol/mol was seen in eight studies. Twenty-three unique BCTs were identified in the reported interventions, with a mean of 4.5 (SD = 2.4) BCTs used in each study. Of these, Goal setting (behaviour) and Problem solving were the most frequently identified BCTs. The number of BCTs used was not related to intervention effectiveness. In addition, there was little evidence to link the use of specific BCTs to larger reductions in HbA1c across the studies included in the review; instead, the use of Credible source and Social reward in interventions were associated with smaller reductions in HbA1c. CONCLUSION A relatively small number of BCTs have been used in RCTs of health coaching interventions for T2DM. Inadequate, imprecise descriptions of interventions and the lack of theory were the main limitations of the studies included in this review. Moreover, other possible BCTs directly related to the theoretical underpinnings of health coaching were absent. It is recommended that key BCTs are identified at an early stage of intervention development, although further research is needed to examine the most effective BCTs to use in health coaching interventions. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228567 .
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Affiliation(s)
- Abdullah N Almulhim
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, 13316, Saudi Arabia.
| | - Hannah Hartley
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Cathedral Court, The University of Sheffield, Vicar Ln, Sheffield, S1 2LT, UK
| | - Samantha J Caton
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Onur Cem Doğru
- Department of Psychology, Afyon Kocatepe University, Gazlıgöl St, 03200, Afyonkarahisar, Turkey
| | - Elizabeth Goyder
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 146] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Racey M, Jovkovic M, Alliston P, Sherifali D. Applying the RE-AIM implementation framework to evaluate diabetes health coaching in individuals with type 2 diabetes: A systematic review and secondary analysis. Front Endocrinol (Lausanne) 2022; 13:1069436. [PMID: 36583001 PMCID: PMC9792599 DOI: 10.3389/fendo.2022.1069436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes health coaching continues to emerge as an effective intervention to support diabetes self-management. While previous systematic reviews have focused on the effectiveness of diabetes health coaching programs in adults with type 2 diabetes (T2DM), limited literature is available on its implementation. This review examines what aspects of diabetes health coaching interventions for adults living with type 2 diabetes have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to optimize implementation. Methods We examined the included studies from our recently completed systematic review, which searched 6 databases for randomized controlled trials (RCTs) of health coaching interventions delivered by a health professional for adults with T2DM. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework. Results 9 diabetes health coaching RCTs were included in this review. 12 criteria were reported by all the included studies and 21 criteria were not reported by any of the studies. The included studies all reported on more than 20 RE-AIM criteria, ranging from 21 to 27. While Reach was the best reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authors. Conclusions Due to the paucity of reporting of the RE-AIM components for diabetes health coaching, limited implementation and clinical practice implications can be drawn. The lack of detail regarding implementation approaches to diabetes health coaching greatly limits the interpretation and comparisons across studies to best inform the application of this intervention to support diabetes self-management. Systematic review registration PROSPERO identifier, CRD42022347478.
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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12
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Mustapa A, Justine M, Manaf H. Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: A scoping review. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:22-32. [PMID: 36606173 PMCID: PMC9809450 DOI: 10.51866/rv.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Patient education is an integral component of diabetes mellitus care. The emergence of different methods and characteristics of patient education has led to varying outcomes of quality of life (QoL). Herein, we systematically searched for published studies reporting patient education and its methods and characteristics for improving the QoL of patients with type 2 diabetes mellitus (T2DM). METHOD In this scoping review, eligible studies from six databases (PubMed, Scopus, Cochrane Library, Springer Link, Science Direct and Google Scholar) were identified. The keywords used in the search strategies were as follows: health education, health promotion, patient education, diabetes care, QoL, diabetes mellitus and type 2 diabetes mellitus. Two reviewers independently screened all references and full-text articles retrieved to identify articles eligible for inclusion. RESULTS A total of 203 articles were identified in the initial search. Of them, 166 were excluded after screening the titles and abstracts. Further full-text screening led to the subsequent removal of 22 articles, leaving 15 articles eligible for data extraction. CONCLUSION There is a broad array of methods of patient education for improving the QoL of patients with T2DM. Self-management education with supplementary supervision and monitoring effectively improves QoL. Future studies must emphasise the application of holistic education covering psychological distress, diet plan, and physical health.
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Affiliation(s)
- Amirah Mustapa
- MSc, Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan Campus, Kuantan, Pahang, Malaysia
| | - Maria Justine
- PhD, Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Selangor, Malaysia
| | - Haidzir Manaf
- PhD, Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Selangor, Malaysia.
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Lee AYL, Wong AKC, Hung TTM, Yan J, Yang S. Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40364. [PMID: 36322107 PMCID: PMC9669889 DOI: 10.2196/40364] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode. OBJECTIVE This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases. METHODS A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots. RESULTS A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate. CONCLUSIONS This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases. TRIAL REGISTRATION International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.
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Affiliation(s)
- Athena Yin Lam Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Tommy Tsz Man Hung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Yan
- Zhejiang Hospital, Zhejiang, China
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Di S, Petch J, Gerstein HC, Zhu R, Sherifali D. Optimizing Health Coaching for Patients With Type 2 Diabetes Using Machine Learning: Model Development and Validation Study. JMIR Form Res 2022; 6:e37838. [PMID: 36099006 PMCID: PMC9516374 DOI: 10.2196/37838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health coaching is an emerging intervention that has been shown to improve clinical and patient-relevant outcomes for type 2 diabetes. Advances in artificial intelligence may provide an avenue for developing a more personalized, adaptive, and cost-effective approach to diabetes health coaching. OBJECTIVE We aim to apply Q-learning, a widely used reinforcement learning algorithm, to a diabetes health-coaching data set to develop a model for recommending an optimal coaching intervention at each decision point that is tailored to a patient's accumulated history. METHODS In this pilot study, we fit a two-stage reinforcement learning model on 177 patients from the intervention arm of a community-based randomized controlled trial conducted in Canada. The policy produced by the reinforcement learning model can recommend a coaching intervention at each decision point that is tailored to a patient's accumulated history and is expected to maximize the composite clinical outcome of hemoglobin A1c reduction and quality of life improvement (normalized to [ 0, 1 ], with a higher score being better). Our data, models, and source code are publicly available. RESULTS Among the 177 patients, the coaching intervention recommended by our policy mirrored the observed diabetes health coach's interventions in 17.5% (n=31) of the patients in stage 1 and 14.1% (n=25) of the patients in stage 2. Where there was agreement in both stages, the average cumulative composite outcome (0.839, 95% CI 0.460-1.220) was better than those for whom the optimal policy agreed with the diabetes health coach in only one stage (0.791, 95% CI 0.747-0.836) or differed in both stages (0.755, 95% CI 0.728-0.781). Additionally, the average cumulative composite outcome predicted for the policy's recommendations was significantly better than that of the observed diabetes health coach's recommendations (tn-1=10.040; P<.001). CONCLUSIONS Applying reinforcement learning to diabetes health coaching could allow for both the automation of health coaching and an improvement in health outcomes produced by this type of intervention.
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Affiliation(s)
- Shuang Di
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ruoqing Zhu
- Department of Statistics, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Diana Sherifali
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Racey M, Jovkovic M, Alliston P, Ali MU, Sherifali D. Diabetes health coach in individuals with type 2 diabetes: A systematic review and meta analysis of quadruple aim outcomes. Front Endocrinol (Lausanne) 2022; 13:1069401. [PMID: 36589795 PMCID: PMC9800616 DOI: 10.3389/fendo.2022.1069401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As diabetes self-management necessitates life-long learning, behaviour change, support, and monitoring, health coaching is a promising intervention to assist individuals in more than just meeting glycemic goals and glycated hemoglobin (A1C) targets. Currently, studies of health coaching for type 2 diabetes (T2DM) are limited due to their emphasis on glycemic control. The goal of this systematic review and meta-analysis is to determine the effects of health coaching on adults with T2DM based on quadruple aim outcomes and to assess the implementation of these interventions. METHODS We searched 6 databases for randomized controlled trials of health coaching interventions delivered by a health professional for adults with T2DM. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies. RESULTS Nine studies were included in this review. Our meta-analysis showed a significant reduction of A1C [0.24 (95% CI, -0.38 to -0.09)] after exposure to diabetes health coaching, and small to trivial significant benefits for BMI, waist circumference, body weight, and depression/distress immediately post intervention based on moderate certainty of evidence. However, long term benefit of these clinical outcomes were not maintained at follow-up timepoints. There was a small significant benefit for systolic blood pressure which was maintained after the completion of health coaching exposure at follow-up, but there was no statistically significant benefit in other secondary outcomes such as diastolic blood pressure and lipid profile measures (e.g. triglycerides). Very few studies reported on other quadruple aim measures such as patient-reported outcomes, cost of care, and healthcare provider experience. CONCLUSIONS Our systematic review and meta-analysis shows that health coaching interventions can have short term impact beyond glucose control on cardiometabolic and mental health outcomes. Future studies should try to examine quadruple aim outcomes to better assess the benefit and impact of these interventions at longer time points and following termination of the coaching program. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero, identifier (CRD42022347478).
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, ON, Canada
| | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, ON, Canada
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Team; and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, ON, Canada
- *Correspondence: Diana Sherifali,
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16
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O'Reilly DJ, Blackhouse G, Bowen JM, Brozic A, Agema P, Punthakee Z, McInnes N, Gerstein HC, Sherifali D. Economic Analysis of a Diabetes Health Coaching Intervention for Adults Living With Type 2 Diabetes: A Single-Centre Evaluation From a Community-Based Randomized Controlled Trial. Can J Diabetes 2021; 46:165-170. [PMID: 35115250 DOI: 10.1016/j.jcjd.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A recent randomized controlled trial demonstrated that a community-based, telephone-delivered diabetes health coaching intervention was effective for improving diabetes management. Our aim in this study was to determine whether this intervention is also cost-effective. METHODS An economic evaluation, in the form of a cost-utility analysis (CUA), was used to assess the cost-effectiveness of the coaching intervention from a public payer's perspective. All direct medical costs, as well as intervention implementation, were included. The outcome measure for the CUA was quality-adjusted life-year (QALY). Uncertainty of cost-effectiveness results was estimated using nonparametric bootstraps of patient-level costs and QALYs in the coaching and control arms. A cost-effectiveness acceptability curve was used to express this uncertainty as the probability that diabetes health coaching is cost-effective across a range of values of willingness-to-pay thresholds for a QALY. RESULTS The results show that subjects in the coaching arm incurred higher overall costs (in Canadian dollars) than subjects in the control arm ($1,581 vs $1,086, respectively) and incurred 0.02 more QALYs. The incremental cost-effectiveness ratio of the diabetes health coaching intervention compared with usual care was found to be $35,129 per QALY, with probabilities of 67% and 82% that diabetes health coaching would be cost-effective at a willingness-to-pay threshold of $50,000 per QALY and $100,000 per QALY, respectively. CONCLUSION A community-based, telephone-delivered diabetes health coaching intervention is cost-effective.
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Affiliation(s)
- Daria J O'Reilly
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Pharmacy Consulting, Health Benefits Management, TELUS Health, Toronto, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James M Bowen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network Research Institute, Toronto, Ontario, Canada
| | - Anka Brozic
- Kitchener Downtown Community Health Centre, Kitchener, Ontario, Canada
| | - Pieter Agema
- Langs Community Health Centre, Cambridge, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Natalia McInnes
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Nursing, Faculty of Health Sciences. McMaster University, Hamilton, Ontario, Canada.
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