gamified sleep intervention for veterans: an overview

A good night’s sleep is well known to be imperative for maintaining one’s overall wellness. Yet, about half of Canadian adults struggle with falling asleep or maintaining sleep. The impacts of insufficient sleep are wide-ranging, from physiological correlates such as diabetes to mental correlates such as depression. Effective treatments for sleep-related issues exist: for example, online interventions for insomnia have been found to be effective. As a medicine and a health psychology student at, respectively, Sherbrooke University and McGill University, we worked on the MissionVAV health promotion program during the COVID-19 pandemic, providing free gamified interventions for Canadian Veterans and their families. Over the course of several online interventions related to physical health, we observed that a large proportion of our participants were dissatisfied with their sleep. Consequently, we have developed an 8-week online sleep intervention to address this primordial element of primary prevention. The intervention aims to better our participants’ sleep through providing weekly readings on the following topics: age-related changes in sleep, proper sleep hygiene, varied relaxation techniques as well as the relationship between sleep and chronic pain, menopause, shift work, rumination, exercise and light. To promote healthy sleep hygiene habits, daily self-assessment questions are provided and are incentivized through points and storytelling. Furthermore, health coaches trained in sleep medicine follow participants throughout their journey to provide support and reinforcement. Ultimately, the intervention aims to shed light on the importance of sleep within preventative medicine, tackling it systematically in an engaging, gamified fashion.

Online health promotion program and individualized health coaching for veteran wellbeing

The pandemic has highlighted the need for accessible and effective health promotion as Canadians are isolated from their communities during social distancing measures. A web-based health promotion program in which participants also received individualized email-based health coaching from medical students has been available during the pandemic to empower veterans and their family members to engage in healthy lifestyle change. Health coaches’ email interactions with participants used techniques of motivational interviewing, including an empathetic style, statements of affirmation, and reflections. Open-ended questions were useful in gaining insight into the participant’s current lifestyle, including habits, challenges, and coping strategies. As services have transitioned online and individuals have become more isolated, the connection formed between online health coaches and individuals participating in the health promotion program became crucial in countering the mental and physical health repercussions of the pandemic. In a preliminary analysis, we show that web-based health promotion with health coaching, for Canadian Veterans and their families, leads to significant weight loss, increased activity and improvement in wellbeing metrics such as sleep and stress. The medical students acting as health coaches were able to gain a deeper understanding of the challenges involved in behaviour change, something that is seldom covered in detail in the medical school curricula. Medical students were also able to practice their motivational counseling skills surrounding lifestyle changes. Given the lack of available evidence for web-based health promotion that targets veterans and their families, these preliminary results appear promising, with longer-term follow-up planned for the next two years.

Reflections of Health Coaching Narratives

This narrative focuses on a health coach collaborating with a physical therapist and working with the emotional needs of physical therapy patients, but anyone looking to improve health can use the strategies presented. Integrative health coaching incorporates vision and values into a person's goal-setting process. Health coaches provide resources such as journal writing to assist the healing journeys of patients as well as strategies for healthy people who want to make wellness behavior changes.

A Qualitative Study of Characteristics of an Effective Health Coach: Personal, Professional, and Program Based

Health coaching continues to grow in popularity as an effective intervention to empower and engage patients and their caregivers. However, little is known about what characteristics contribute to the success of health coaches in implementing evidence-based interventions. This study examines the characteristics that contribute to effective health coaches. Semi-structured interviews were conducted with health coaches and an interdisciplinary research team of an ongoing study examining a virtual health coaching intervention. Interviewees identified three discrete themes of characteristics that contribute to the success of health coaches: personal (e.g. compassion), professional (e.g. transferability of soft skills) and program based (e.g. training regimen). We conclude that it is not just innate personality attributes that make a health coach effective in their role, but training and program design intended to support health coaches are also important in implementing interventions.

Self-Care Theory and Translation to Intervention

Self-care is defined as a process of maintaining health through health promoting practices and managing illness when it occurs. Self-care is integral in the management of chronic conditions, but even those without illness engage in some level of self-care daily. In our on-going study we promote self-care as a means to control the stress associated with caregiving. We acknowledge the burden of caregiving for a loved one experiencing a serious chronic illness. That responsibility is typically associated with significant stress for the caregiver. We use stress theory to address the caregivers’ appraisal of events and coping responses. Three experienced health coaches were hired to provide 10 sessions of coaching over a 6-month period to each of the caregivers randomized to the intervention group. The emphasis of the iCare4Me coaching sessions is to address primary and secondary appraisal and coping as a means to improve self-care and thereby decrease stress.

A digitally enhanced home-based physical activity intervention for high-risk middle school youth during COVID-19

COVID-19 significantly impacted physical activity among high-risk youth. Camp from Home, a digitally enhanced home-based intervention, was developed to address physical activity disparities among middle school youth during COVID-19. Camp from Home enrolled 62 youth in 54 families from five schools in Philadelphia during the summer of 2020. The 6-week intervention comprised of (1) three home deliveries of “activity kits” including exercise equipment and activity booklets, (2) asynchronous sport and exercise videos posted to a private YouTube channel, and (3) supportive text-messages from health coaches. YouTube analytics and self-report surveys completed by parents and youth at baseline and at the end of programming were used to assess engagement, acceptability, and preliminary efficacy. Youth participants were 12.4 (1.2) years, 38.7% female and 90.3% Black/African American. At follow-up, 41 parents (75.9%) and 34 youth (54.8%) completed measures. Youth self-reported increases in self-efficacy (ΔM(sd) = 0.4(1.0), p = .03) and physical activity (ΔM(sd) = 4.2(7.9), p = .004), despite suboptimal engagement in digital program components. Overall, participants highly rated the program. Activity kits and text-messages from health coaches were rated as most helpful. Most parents (95.1%) and youth (83.8%) expressed interested in participating again in the future. A 6-week digitally enhanced, home-based physical activity intervention was acceptable and feasible among parents and youth during the summer of 2020, with youth reporting improvements in self-efficacy and physical activity. Summer programs are critical for reducing disparities in physical activity and hold potential for addressing key barriers for high-risk youth even outside the context of COVID-19.

Using self-determination theory to understand and improve recruitment for the Coaching for Healthy Ageing (CHAnGE) trial

Background Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. Methods We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory—autonomy, competence and relatedness—was used to explore if and how this theory fit with and helped to explain our data. Results Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention’s demonstrated potential to support self-determination needs could be conveyed more effectively. Conclusions Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.

Characterizing Autonomy Supportiveness in Diabetes Peer Health Coaches

BackgroundPrior studies have shown that peer health coaching improves outcomes among adults with chronic conditions such as diabetes. These studies have also suggested that higher ratings of their peer coach’s autonomy supportiveness, i.e., the degree to which a coach supports participant choice, is associated with improved outcomes. The types of actual behaviors and interactions that participants in these coaching relationships perceive as being more or less autonomy supportive are important to define. This investigation aims to more concretely characterize the ways in which participants perceive autonomy support and how important these perceptions are to their satisfaction with their peer coaches.MethodsThis article is a qualitative investigation of the US Department of Veterans Affairs–Technology Enhanced Coaching (VA-TEC) study, a parallel randomized controlled trial with diabetes patients with poor glycemic control at the Detroit VA Medical Center. Intervention arm participants work for 6 months with peer coaches who are also VA patients who now have good glycemic control. Researchers conducted semi-structured interviews with veterans who had recently completed their 6 months of coaching. Responses to Health Care Climate Questionnaire (HCCQ) items in the trial’s 6-month survey were used to identify veterans for interviews who rated their coaches either especially high or low in terms of autonomy supportiveness. Interview responses were then analyzed in order to elucidate veterans’ perceptions of autonomy support in their coaching relationships.ResultsSemi-structured interviews were conducted with 17 of the veterans who completed the VA-TEC program. Veterans who rated their coaches higher on HCCQ items tended to emphasize the positivity and non-judgmental nature of their coaches. They also described coaches who offered them choices and non-directive suggestions in identifying health behavior goals. Veterans who gave their coaches lower HCCQ ratings described coaches who tended to be less personally engaged and less focused on addressing veterans’ specific concerns about diabetes. Some veterans who rated their coaches lower on autonomy-supportiveness felt their coaches underestimated their existing knowledge of diabetes and were overly directive in providing advice. Overall, participants’ HCCQ ratings correlated well with expressed satisfaction with their coach in interviews. ConclusionsVA-TEC participant feedback outlines meaningful ways in which coaches can support autonomy. These include, among others, eliciting participants’ personal goals, remaining positive and non-judgmental, providing suggestions for behavior changes without being overly directive, and maintaining a balance between discussing diabetes and the types of personal conversations that are crucial to building trust. The effective behaviors described in this investigation can be used to train future coaches and other lay health workers.

Process evaluation of a medical assistant health coaching intervention for type 2 diabetes in diverse primary care settings

Team-based models that use medical assistants (MAs) to provide self-management support for adults with type 2 diabetes (T2D) have not been pragmatically tested in diverse samples. This cluster-randomized controlled trial compares MA health coaching with usual care in adults with T2D and poor clinical control (“MAC Trial”). The purpose was to conduct a multi-method process evaluation of the MAC Trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Reach was assessed by calculating the proportion of enrolled participants out of the eligible pool and examining representativeness of those enrolled. Key informant interviews documented adoption by MA Health Coaches. We examined implementation from the research and patient perspectives by evaluating protocol adherence and the Patient Perceptions of Chronic Illness Care (PACIC-SF) measure, respectively. Findings indicate that the MAC Trial was efficient and effective in reaching patients who were representative of the target population. The acceptance rate among those approached for health coaching was high (87%). Both MA Health Coaches reported high satisfaction with the program and high levels of confidence in their role. The intervention was well-implemented, as evidenced by the protocol adherence rate of 79%; however, statistically significant changes in PACIC-SF scores were not observed. Overall, if found to be effective in improving clinical and patient-reported outcomes, the MAC model holds potential for wider-scale implementation given its successful adoption and implementation and demonstrated ability to reach patients with poorly controlled T2D who are at-risk for diabetes complications in diverse primary care settings.