Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial

Abstract

ObjectivesTo evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care.DesignA pragmatic two-arm cluster randomised controlled trial.SettingUrban general practices in lower socioeconomic areas in Sydney and Adelaide.ParticipantsWe aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control).InterventionA practice nurse-led preventive health check, a mobile application and telephone coaching.Primary and secondary outcome measuresPrimary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted.ResultsAt 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information; mean DiD 0.22; 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47); p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure.ConclusionsTargeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (http://www.ANZCTR.org.au/ACTRN12617001508369.aspx).Trial protocolThe protocol for this trial has been published (open access;https://bmjopen.bmj.com/content/8/6/e023239).

Technology‐delivered personalized nutrition intervention on dietary outcomes among adults with overweight and obesity: A systematic review, meta‐analysis, and meta‐regression

“…In this review, three types of fruit intake were reported, including servings/day in nine trials, 54,60,67,73,75,79,89,93,102 g/day in four trials, 56,65,94,101 and fruit intake scores in six trials, 62,77,87,97,99,103 involving 1283–4448 adults with overweight and obesity, as illustrated in Figure 5A–C. However, there were no significant differences ( p > 0.05) for the three types of fruit intake.…”

“…Our review found three types of vegetable intake such as servings/day, gram per day (g/day), vegetable intake scores in eight trials, 54,60,62,67,73,75,79,102 five trials, 56,65,93,94,101 and seven trials, 55,62,77,87,97,99,103 respectively, among 1365–2419 adults with overweight and obesity. Meta‐analyses showed that treatment intervention significantly ( t = 3.09, p = 0.012) improved vegetable intake (0.15 servings/day, 95% CI: 0.04, 0.26, PI 95% = 0.05, 0.25) with minimal effect ( g = 0.15) in Figure 4A.…”

“…Tables S4 and S5 reasonably show the lists of excluded full‐text articles and ongoing trials in various clinical trial registries. Eventually, a total of 46 RCTs in 52 articles 52–103 were included in published peer‐review journals ( n = 41) and unpublished theses or dissertations ( n = 5) 58,72,73,82,83,86 . There was substantial and perfect agreement ( κ = 0.83–0.88) between two independent reviewers on article selection, data extraction, risk of bias, and GRADE criteria.…”

“…The studies were conducted across 14 countries, and the distribution of RCTs is presented in Figure S2. The mean age ranged from 19.6 72 to 57.7 102 years old. Meanwhile, the sample sizes of the studies range from 17 71 to 3876 88 .…”

In it for the long haul: the complexities of managing overweight in family practice: qualitative thematic analysis from the Health eLiteracy for Prevention in General Practice (HeLP-GP) trial

“…In total 215 participants were recruited to the study (120 to the intervention group and 95 to the control group). The main outcomes of this study have been reported in Parker et al [ 17 ]. This nested study used qualitative interviews to elicit patient and provider perceptions and views regarding the receipt or delivery of weight management within the context of the HeLP-GP intervention.…”