Background - Problem Statement and Pilot Work
Almost half of US adults have one or more lifestyle-related chronic diseases, including stroke, heart disease, and type 2 diabetes. Patients at risk for these diseases visit their primary care physician (PCP) roughly four times per year, while research suggests only frequent, personalized, and timely care helps patients adopt and maintain healthy behaviors. In light of this, we piloted MyLife, a 16-week digital health program that utilizes wearable activity trackers and mobile health coaching to improve health behaviors in patients at early risk for lifestyle-related chronic diseases.
Over the last year and a half, the MyLife program has been refined through the implementation of three PDSA cycles. Results were promising, and we chose to evaluate this method of patient behavior change through a larger randomized controlled trial (RCT). Thus, the MyLife team developed an RCT comparing two groups of patients: MyLife health coach plus Fitbit vs Fitbit alone.
Methods - transition to an RCT
Our pilot work utilized Microsoft SQL server, REDCap, Chorus, and Google Voice to track data, send surveys, and message patients, respectively. MyLife partnered with Way to Health which combined these functionalities into one reliable platform. Way to Health is an engagement platform developed by faculty at University of Pennsylvania, which supports SMS messaging, survey development and Fitbit data integration. IRB approval was obtained (IRB#: 18-000325) and our study was registered (ClinicalTrials.gov: NCT03529903) by June 2018.
Results - Recruitment and Training New Health Coaches
Health coaches were recruited via word-of-mouth and by sending batch emails to pre-health groups at UCLA. Fifteen incoming health coaches completed 6 online “homework” assignments and two in-person training sessions, about 10 hours of training in totalThe homework assignments featured practice in motivational interviewing and goal setting and in the in-person training sessions we focused on how to use Way to Health and further practiced motivational interviewing.
Results - Provider Outreach and Patient Recruitment Efforts
UCLA Health patients are referred to the study via their PCPs. To inform UCLA Health PCPs about our new study we identified clinic managers and lead physicians for 18 UCLA Health Ambulatory Care clinics which support a total of 120 PCPs. They were sent marketing emails and flyers to be given to patients and hung in clinics. Additionally, we created an order within Care Connect to facilitate patient referrals. We also created a website for patients and PCPs to visit to provide study details, key contact information, and a link to our patient screening and enrollment process.
Next Seps and Potential Impact
If effective, MyLife and other similar digital health coaching programs may represent a new service for primary care providers to provide to patients identified to be at early risk for lifestyle-related illness. Mobile health coaching provides a way for patients to engage in frequent discussions about their health goals, as opposed to having these discussions solely during their often infrequent visits to the doctor. By addressing and troubleshooting barriers throughout the week, health coaches and patients work together to create positive change in the patient's lifestyle, thus decreasing their risk for developing lifestyle-related chronic disease.
Another potential impact of this program is that it can provide a means for pre-medical students to gain communication skills and exposure to patient interviewing. Many premedical students take gap years between college and medical school. This program will allow pre-medical students to engage in motivational interviewing as well as discussions of goals and barriers with patients, skills necessary to excel in medical school and as a physician.