The Effects of Snack Control Education and Telephone Coaching on Self-Management, Social Support, Self-Efficacy, and Blood Glucose in Diabetes Patients

Dietary therapy for diabetes is the most basic way to manage blood glucose. Currently, the nutritional intake rate of diabetic patients in Korea is beyond the recommended rate of the Korean Diabetes Association, showing large amounts of carbohydrates in foods consumed as snacks with an additional focus on sugar. Thus, it is necessary to support healthy dietary habits through snack control. This study is a random assignment experimental study with a total of 56 participants; 28 participants were in the control group, while the remaining 28 patients had type 2 diabetes and had visited Kyung Hee University Hospital. The experimental group with snack control education and telephone coaching exhibited a higher self-management score (t = –9.494, P < 0.001), perceived social support score (t = 7.201, P < 0.001), and self-efficacy score (t = 7.185, P < 0.001) than the control group. Additionally, the experimental group showed lower levels of glycosylated hemoglobin and average blood glucose compared to the control group (t = –4.820, P < 0.001). Thus, snack control education and telephone coaching are effective in improving diabetes self-management behavior, perceived social support, self-efficacy, and reducing glycosylated hemoglobin and average blood glucose. These results confirm the usefulness of snack education materials, and I suggest snack control education as a means of arbitration to improve the self-care of diabetics.

Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10–13 years: study protocol for a randomised controlled trial

IntroductionChildhood anxiety is common, causes significant functional impairment and may lead to psychosocial problems by adulthood. Although cognitive behavioural therapy (CBT) is effective for treating anxiety, its availability is limited by the lack of trained CBT therapists and easily accessible local services. To address the challenges in both recognition and treatment, this study combines systematic anxiety screening in the general population with a randomised controlled trial (RCT) on internet-assisted CBT (ICBT) with telephone coaching. Child, family and intervention-related factors are studied as possible predictors or moderators, together with the COVID-19 pandemic.Methods and analysisThe study is an open two-parallel group RCT, stratified by sex, that compares ICBT with telephone coaching to an education control. Children aged 10–13 are screened at yearly school healthcare check-ups using five items from the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire. The families of children who screen positive for anxiety are contacted to assess the family’s eligibility for the RCT. The inclusion criteria include scoring at least 22 points in the 41-item SCARED Questionnaire. The primary outcome is the SCARED child and parent reports. The secondary outcomes include the impact of anxiety, quality of life, comorbidity, peer relationships, perceptions of school, parental well-being and service use. Additional measures include demographics and life events, anxiety disorder diagnoses, as well as therapeutic partnerships, the use of the programme and general satisfaction among the intervention group.Ethics and disseminationThe study has been approved by the research ethics board of the Hospital District of South West Finland and local authorities. Participation is voluntary and based on informed consent. The anonymity of the participants will be protected and the results will be published in a scientific journal and disseminated to healthcare professionals and the general public.Trial registration numberClinicalTrials.gov NCT03310489, pre-results, initially released on 30 September 2017.

Organisational Factors Associated With Readiness to Implement a Preventive Intervention for Overweight and Obese Patients in Australian General Practice: a Mixed Methods Exploration From the HELP GP Trial.

Background: Australian rates of obesity are increasing. General practice has a definite role to play in addressing obesity and preventing further chronic disease but relatively few encounters focus primarily on weight management. The HeLP GP trial assisted overweight and obese patients to make positive lifestyle changes to diet and physical activity and increase the capacity of practice nurses to deliver comprehensive weight management. The nurse led intervention comprised a health check and access to a lifestyle app and/or telephone coaching. Within this paper we describe the experience of implementing this intervention through the lens of organisational readiness with specific emphasis on the role of the practice nurse. Methods: Routinely collected research data, quantitative practice surveys, and qualitative field notes from research officers and facilitators were mapped against a recognised organisational readiness framework. Motivation to implement, general capacity and intervention-specific capacity were assessed. Results: The level of organisational readiness within the participating practices was observed to vary considerably, particularly the domain of intervention specific capacity. The level of practice nurse turnover negatively impacted the implementation of the intervention, affecting half of the intervention practices. Within this study we observed a general lack of practice-based support for the practice nurse regarding intervention delivery and varying levels of interest, skill, and confidence in delivering the program to patients. Nurses struggled to complete the health checks and subsequently to conduct timely follow up appointments. Risk assessment and referral to telephone coaching were generally not problematic, although we noted lower confidence with the setup of the lifestyle app and with instructing patients to use it.Conclusions: Using an organisational readiness checklist is valuable for determining specific capacity issues prior to commencing research but should also assess the capacity of those individuals responsible for the intervention. We found a lack of general ‘readiness’ inherent in the practice nurse role. If they are to fulfil their potential in supporting patients to reduce risk and adopt healthier life choices, our study indicates that more could be done to improve their workforce positioning and remuneration, which may, in turn, improve continuity of care, retention, and individual motivation.Trial registration:The HeLP GP trial is registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR - ACTRN12617001508369). The trial was registered 26/10/2017 http://www.ANZCTR.org.au/ACTRN12617001508369.aspx

Efficacy of telehealth acceptance and commitment therapy for weight loss: a pilot randomized clinical trial

Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n = 53) with standard behavioral therapy (SBT; n = 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15–20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reported weight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N = 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N = 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N = 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reported weight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N = 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.

A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: −13.38 (±14.98); 95%-CI: (−17.68; −9.07); noTC: −11.09 (±14.15); 95%-CI: (−15.11; −7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: −1.58; 95%-CI: (−7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants’ resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

Home-Based Exercise Program With Telephone Coaching: A Feasibility Study

Exercise is crucial to maintain mobility, reduce falls and delay functional decline in older adults, but effective implementation strategies are lacking. Self-directed home-based exercise therapy is recommended by clinicians to overcome barriers such as cost, travel and availability. However, non-adherence is a major challenge due to lack of motivation, real time feedback or social support. To overcome these barriers, we conducted a feasibility study to evaluate a home-based exercise program with telephone coaching to improve mobility in frail older adults. Four non-demented, frail community-dwelling older adults were taught one of two exercise routines at our research center. The first involved complex exercises with internal and external cueing techniques that have been associated with neuroplasticity in previous studies (N=3). The second was a lesser cognitively demanding control program that included aerobic, balance and strengthening exercises (N=1). One week later, the participants were asked to repeat the exercises in their own home. The research assistant coached the patient over the telephone. A board-certified physiatrist was present during the home session to monitor adherence and fidelity to the protocol as well as address safety. The study produced qualitative findings regarding recruitment strategies, exercise feasibility, and other logistical issues relating to participant understanding, safety, and monitoring. Based on direct observation of participants at home, safety assessment protocols, instructions, and exercises were all refined. Building on this data, we plan to design a clinical trial to evaluate the impact of complex exercises designed to promote neuroplasticity and reduce cognitive and motoric decline in older adults.

Peer support program (P-SUP) to strengthen self-management in patients with chronic conditions

Background Chronic care programmes (CCPs) ensure a standardised, evidence based and structured patient care. In Germany, CCPs are successful in improving quality of care and making care more patient-centred. Regarding self-management support, however, the programs only feature patient education and shared decisions on treatment goals. Peer support has proven to be a successful component in outpatient care to enhance self-management. The aim of this study is to support patients with type 2 diabetes and coronary artery disease in conducting successful self-management through a multimodal program. Methods This randomized controlled trial (RCT) is set up for 27 months and will include a study population of approximately 1800 patients, beginning in summer 2020. The primary outcome (PO) is the reduction of hospital admissions. In addition to the PO, secondary outcomes include motivational and knowledge-based aspects. Furthermore, health-competitive and health-economic data will be collected. The formative evaluation will review the processes for implementation. The central element of the intervention will be peer support groups, in which the group will participate in physical activities and educational lectures on nutrition, exercise or disease related knowledge. Additionally, a specially designed online platform, personalized feedback for patients on medical outcomes from their family doctors, and regular telephone coaching to increase intrinsic motivation and activation will be provided. Results In addition to the primary outcome (reduction of hospital admissions), increased motivation levels, improved quality of life and increased health literacy are expected. Conclusions This project, funded by the Federal Joint Committee (establishment of statutory health insurance funds and medical providers in Germany), can serve as a blueprint for future implementations of public health approaches and accessible care models for patients with chronic conditions. Key messages Peer support as a successful method to enhance self-management in patients with type 2 diabetes and coronary artery disease. A multimodal program, consisting of peer support groups, an online platform, personalized medical feedback and telephone coaching, aiming to improve quality of life in patients with chronic conditions.