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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca DM, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1496. [PMID: 34344340 PMCID: PMC8329623 DOI: 10.1186/s12889-021-11452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial. METHODS We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40-64 years residing in the neighbourhoods. Public health nurses trained as "prevention practitioners" held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline. RESULTS Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22-1.84]). CONCLUSION Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage. TRIAL REGISTRATION NCT03052959 , registered February 10, 2017.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D M Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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