Sarah S Nouri1, Laura J Damschroder2, Maren K Olsen3,4,5, Jennifer M Gierisch2,4, Angela Fagerlin6,7, Linda L Sanders3,4, Felicia McCant4, Eugene Z Oddone3,4. 1. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA. sarah.nouri@ucsf.edu. 2. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. 3. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA. 4. Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA. 5. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA. 6. Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT, USA. 7. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
Abstract
BACKGROUND:Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04). CONCLUSIONS: We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS. GOV IDENTIFIER: NCT01828567.
RCT Entities:
BACKGROUND: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04). CONCLUSIONS: We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS. GOV IDENTIFIER: NCT01828567.
Entities:
Keywords:
health literacy; health numeracy; health risk assessment; telephone coaching
Authors: Eugene Z Oddone; Jennifer M Gierisch; Linda L Sanders; Angela Fagerlin; Jordan Sparks; Felicia McCant; Carrie May; Maren K Olsen; Laura J Damschroder Journal: J Gen Intern Med Date: 2018-05-07 Impact factor: 5.128
Authors: Hayden B Bosworth; Maren K Olsen; Tara Dudley; Melinda Orr; Mary K Goldstein; Santanu K Datta; Felicia McCant; Pam Gentry; David L Simel; Eugene Z Oddone Journal: Am Heart J Date: 2009-01-10 Impact factor: 4.749
Authors: Mara A Schonberg; Mary Beth Hamel; Roger B Davis; Maria Karamourtopoulos; Adlin Pinheiro; Michelle C Hayes; Christina C Wee; Christine Kistler Journal: MDM Policy Pract Date: 2022-01-21