Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial

Abstract

IntroductionAdults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese.Methods and analysisA two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40–70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme.Ethics and disseminationThe study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval.Trial Registration numberACTRN12617001508369; Pre-results.

What should governments be doing to prevent diabetes throughout the life course?

“…This also includes the certification and payment of digital (prevention) services by public institutions and insurance companies. Accordingly, more evidence is needed on the optimal use of technology for patients with low health or eHealth literacy [104].…”

How is health literacy addressed in primary care? Strategies that general practitioners use to support patients

“…A GP (also known as a primary care physician or family doctor) plays a key role in coordinating patient care and providing advice and education on health care. Their work spans prevention and health promotion, and are well placed to influence chronic disease prevention and management outcomes through the delivery of lifestyle modification interventions [8]. GP registrars (also known as GPs in training or trainee specialists) are medical doctors enrolled in a speciality 'general practice' training program.…”

World Heart Federation Roadmap for Heart Failure

“…Decentralized heart failure centers established linked to a centralized care unit across South India to improve access for patients: this intervention has yet to be published but was shared with WHF during the survey process. HeLP-GP (Health eLiteracy for prevention in General Practice) intervention from Australia [75]: this study investigates the impact and outputs of a mobile health application for adults with lower levels of health literacy in the primary care setting.…”