A randomized comparative effectiveness study of Healthy Directions 2—A multiple risk behavior intervention for primary care

Abstract

Objective To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting. Methods HD2 was a cluster randomized trial (conducted 3/09 – 11/11). Primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2,440). Study arms included: 1) usual care (UC); 2) HD2-- a patient self-guided intervention targeting 5 risk behaviors; or 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was proportion of participants with a lower multiple risk behavior score (MRB) by follow-up. Results At baseline, only 4% of participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of UC participants had improved MRB scores at 6 mo., vs. 39% and 43% in HD2 and HD2+CC respectively (p’s≤.001); results were similar at 18 mo. (p≤.05). The incremental cost of one risk factor reduction in MRB score was $319 in HD2 and $440 for HD2+CC. Conclusions Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.

Chronic Disease Diagnosis as a Teachable Moment for Health Behavior Changes Among Middle-Aged and Older Adults

“…MHBC focuses on promoting multiple health behaviors either simultaneously or sequentially within a limited time period to improve efficiency because health risk behaviors often cluster (Prochaska, Spring, & Nigg, 2008). Although many MHBC intervention studies conducted in the past met with limited success (Prochaska et al, 2008), more positive results have been reported in recent literature (Emmons et al, 2014; Green, Hayman, & Cooley, 2015). In a recent systematic review of MHBC interventions for cancer survivors, Green et al (2015) found that in-person interventions consistently produced changes in diet, exercise, and smoking, and interventions using phone or mail contact with longer durations also showed promising results.…”

Social Support for Changing Multiple Behaviors: Factors Associated With Seeking Support and the Impact of Offered Support

“…Healthy Directions 2 (HD2) study was a cluster-randomized controlled trial of a self-guided, multiple risk behavior (MRB) intervention conducted in two urban health centers (conducted from 3/2009–11/2011) in the Boston, Massachusetts, area that has been described elsewhere (Emmons et al, 2014; Greaney et al, 2014). Briefly, English-speaking patients 18+ years of age with scheduled well visits or chronic disease management appointments at the participating health centers were sent a study introduction letter prior to their scheduled appointments.…”

“…Each of the two intervention conditions led to greater improvements in MRB score than usual care, although there was no significant difference between the two intervention conditions. At 6 months, 28% of participants randomized to usual care had improvements in their MRB scores versus 39% of those randomized to the HD2 intervention materials and 43% of those randomized in the HD2 intervention materials plus coaching calls (Emmons et al, 2014).…”

Feasibility and acceptability of “healthy directions” a lifestyle intervention for adults with lung cancer

“…Algorithms developed by Emmons and colleagues from the previous Healthy Directions intervention were used to guide increases in physical activity over time. 16,31…”