BETTER HEALTH: Durham
Condition: Cancer and Chronic Disease Prevention
MeSH terms: Chronic Disease
Study type: Interventional

Summary: 
      The BETTER intervention consists of supportive meetings between a specially trained
      prevention practitioner nurse and individuals aged 40-64 years to review recommended chronic
      disease prevention and screening activities (CDPS). The prevention practitioner nurse will
      assist participants to identify goals for accomplishing CDPS activities in the next 6 months.
      Promotion, recruitment of participants and delivery of the BETTER intervention will be
      adapted to meet the needs of the residents through the use of participatory research methods
      and community engagement strategies. The study population consists of individuals aged 40-64
      years living in 10 designated areas or "clusters" within Durham Region in Oshawa and Whitby.

      Objectives:

        1. Help people in the designated areas identify personal goals related to chronic disease
           prevention and screening activities.

        2. Evaluate whether the prevention practitioner was effective in helping people achieve
           their goals and explore whether this type of intervention could work in other settings.

        3. Share what the investigators learn with government and other public health units in
           Ontario and across Canada.

      Some clusters will receive the BETTER intervention right away and other clusters will be in a
      wait-list control group to receive the intervention 6 months later. Our main outcome is the
      change in a score that considers the number of preventive health items a person has achieved
      during the 6 months. The investigators will also be doing in-depth interviews and focus
      groups with health care providers, community organizations and people who live in the
      designated areas to understand whether the primary practitioner was effective.
    

Detailed description: 
      Research has shown that many Ontarians do not participate in all the chronic disease
      prevention and screening activities that could keep them healthy. Previous studies have found
      that a prevention practitioner, a nurse who works with health care providers and their
      practices, can be effective at improving the uptake of chronic disease prevention and
      screening activities.

      The goal of this study is to adapt the BETTER intervention from a health care setting with
      family practice teams to a community-based strategy in designated areas in Durham Region. The
      BETTER intervention consists of supportive meetings between a specially trained prevention
      practitioner nurse and individuals aged 40-64 years to review recommended chronic disease
      prevention and screening activities (CDPS). The prevention practitioner nurse will assist
      participants to identify goals for accomplishing CDPS activities in the next 6 months.
      Promotion, recruitment of participants and delivery of the BETTER intervention will be
      adapted to meet the needs of the residents through the use of participatory research methods
      and community engagement strategies.

      Previous work by the researchers identified census dissemination areas in Ontario with: (1)
      the lowest quintile of median household income, (2) low cancer screening rates, and 3) poor
      access to primary care services. The study population consists of individuals aged 40-64
      years living in 10 designated areas or "clusters" within Durham Region in Oshawa and Whitby.
      The investigators will be working closely with local community agencies and primary care
      providers to identify people who may benefit from this study.

      Objectives:

        1. Help people in the designated areas identify personal goals related to chronic disease
           prevention and screening activities.

        2. Evaluate whether the prevention practitioner was effective in helping people achieve
           their goals and explore whether this type of intervention could work in other settings.

        3. Share what the investigators learn with government and other public health units in
           Ontario and across Canada.

      Some clusters will receive the BETTER intervention right away and other clusters will be in a
      wait-list control group to receive the intervention 6 months later. The investigators will
      compare the two groups. The study will involve about 120 residents in 10 designated areas.
      Our main outcome is the change in a score that considers the number of preventive health
      items a person has achieved during the 6 months. The investigators will also be doing
      in-depth interviews and focus groups with health care providers, community organizations and
      people who live in the designated areas to understand whether the primary practitioner was
      effective.
    

Intervention name(s): Immediate Intervention; Wait List Intervention
Intervention type(s): Behavioral; Other
Intervention description(s): The 'BETTER' prevention practitioner intervention involves assessment of a person's current participation, or lack of participation, among domains of evidence-based chronic disease prevention and surveillance (CDPS) actions. The assessment is followed several days later by a supportive meeting with a prevention practitioner nurse, using principles of shared decision making and health coaching, to establish goals for accomplishing CDPS activities of the individual's choice during the subsequent six months to develop personal goals and targets for participating in CDPS actions during the following six months. In BETTER HEALTH: DURHAM, the prevention practitioner nurse will be a public health nurse from the Durham Region Health Department.; The control arm will receive the prevention practitioner intervention 6 months after the intervention arm. Their outcomes will not be assessed in the study.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention