Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback

Background: Non-communicable diseases (NCDs) are the leading causes of death globally and are associated with a limited set of common, modifiable health behaviours: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. General practice offers an ideal avenue for addressing such health behaviours on a population-wide basis. This paper describes the protocol of a multiple health behaviour change intervention designed for implementation in general practice and summarises the baseline characteristics of its participants

Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

Background: Diabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus

‘10 Small Steps’: A randomised controlled trial to improve health behaviours using computer-tailored advice in a general practice setting

Objective: Consensus exists regarding the urgent need to address non-communicable diseases by developing effective strategies to modify health risk behaviours such as insufficient physical activity, smoking, alcohol use and diet. Sir Geoffrey Rose first proposed that prevention can be better achieved by targeting whole populations rather than high risk individuals; however, the area of non-communicable diseases remains shaped by the high risk approach. Research is needed to develop and test health behaviour intervention models that have wide reach and are easy to incorporate into existing practice. The ‘10 Small Steps’ study, a randomised controlled trial, is based on the notion that it might be possible to create an effective system in primary care to help large numbers of people to adopt and maintain healthier lifestyle. Aims: The overarching question addressed in this doctoral thesis is: ‘Can a low intensity computer-tailored intervention be used to motivate large numbers of individuals to adopt and maintain a healthier lifestyle and diet?’ The set of studies reported in the thesis aimed to: (i) develop a reliable and valid self-report summary measure to assess and provide personalised feedback on current health behaviours in the general practice setting; (ii) develop and test an intervention designed to produce short-term ( at 3 months after baseline) improvement in ten health behaviours; and (iii) test if health improvements can be maintained over a longer term (at 12 months after baseline) and if an additional 3-month contact improves maintenance of health behaviour change over and above a single one-off intervention. Methods: The ‘10 Small Steps’ study took place in Brisbane, Australia between October 2006 and December 2009. A pilot study involving two general practices and 113 patients sought to establish the reliability and general utility of the study questionnaire. The main intervention trial recruited and randomised 4678 adult participants from 21 general practitioners. Participants were randomised to four groups: contact at baseline only (‘single intervention’ and corresponding control group) and contact at baseline and 3 months (‘dual intervention’ and corresponding control group). At each contact the participants received a computer-tailored feedback and one page information sheet according to their allocation to intervention or control groups. Current recommended guidelines for ten key health behaviours were used to develop the ‘Prudence Score’, a summary health score that assessed an individual’s health behaviours. Data were collected at 3 months from half of the participants (the dual group) to test the short term effectiveness of the intervention measured as increase in the percentage of participants adhering to the suggested guidelines and as increase in the mean Prudence Score. At 12 months invitations to participate in the follow-up were sent to all participants with the aim of testing the long term maintenance of behaviour change. Results: At baseline the response was 56.5% (4678 of 8343 invited participants) and the study sample was primarily female (68.7 %), married or living as married (68.8 %), with a diploma or university degree (56.6 %) and an average age of 47 years. The mean Prudence Score was 5.80 (95% CI 5.75-5.85). Only 5.1% of the study population followed five important health behaviours. At 3 months participant response was 76.2% (1711 of 2309). The intervention group showed significant increase (F = 13.3,

Evaluating impact of a multi-dimensional education programme on perceived performance of primary care professionals in diabetes care

AIM: The purpose of this study is to evaluate an educational programme, 'Diabetes Connect: Connecting Professions', which was developed to enhance communication across primary care networks, to support best practice in clinical interventions and progress multidisciplinary team work to benefit patients in diabetes care.METHODS: A total of 26 workshops were successfully delivered for 309 primary care professionals across the state of Queensland in Australia from November 2011. It consists of two separate, but complementary training elements: a series of online clinical education training modules and state-wide interprofessional learning workshops developed to enhance professional competencies. The evaluation design included completion of online surveys by the participants at two time points: first upon registering for the online modules or workshops; second, one week after attending a workshop. The survey included questions to evaluate the change in role performance measures.FINDINGS: Overall, significant increases in participants' current knowledge, perceived ability to adopt this knowledge at work and willingness to change professional behaviour in the short term were observed.CONCLUSION: The study suggests that for maximum benefit both, workshop and online training, should be combined and made available widely. Future programmes should use a randomised trial design to test the delivery model

The critical role of community-based micro-grants for disability aids and equipment: results from a needs analysis

Purpose: To investigate the role of philanthropic micro-grants (maximum of $10 000) in the provision of aids and equipment for adults (aged 18-65 years of age) with complex disabilities and examine key trends in aids and equipment requests. Method: This study examined, through quantitative and qualitative analysis, aids and equipment requests (n = 371 individual applications as represented by 136 service organisations in three Australian states) received by a not-for-profit (NFP) organisation across five consecutive years of an innovative micro-grants scheme. Results: Findings highlight that living situation (living with family or living independently) significantly influences the nature of requests for respite, aids, equipment and home modifications. Specifically, people with complex disabilities living with their families require greater combined service provision (higher equipment need, respite support, home modifications) than those living independently (equipment need only). Type of disability did not influence request type. Qualitative data further indicated the "last resort" nature of respite requests, particularly for younger applicants (under 45 years of age) indicating critical unmet needs in the community. Conclusions: Results demonstrate the vital role of NFP organisations and philanthropic funds in supporting daily lifestyle aids and equipment (including respite) that might otherwise not be funded for people with complex disabilities. Although preliminary in its scope and prior to implementation of a National Disability Insurance Scheme (NDIS) in Australia, findings suggest both opportunity and risk to the uptake of community-based micro-grant funding: opportunity for users through the provision of essential aids and lifestyle supports, and risk through over-subscription and devolving of responsibility for critical support resources from public sector.Implications for RehabilitationThe aids and equipment needs of adults under the age of 65 appear to have been underestimated, poorly defined and under-serviced.Service users need more assistance for their carers (i.e. equipment to facilitate safe lifting, urgent breaks from care routines) as well as aids, equipment and modifications to help them to live a more normal life (e.g. going to the beach).Living situation (i.e. independently or with family) significantly influences the nature and extent of aids and equipment requested. Supporting adults up to the age of 65 to live more independently would positively influence carers and family, while at the same time providing opportunities for more targeted personal care supports.Philanthropic and not-for-profit schemes are helping to address these needs through micro-grant schemes for purchases under$10 000, but sustainability is questioned.The introduction of Australia's National Disability Insurance Scheme (NDIS) presents an opportunity to consider the lifestyle needs of service users and carers, and determine who is best placed to address them

Randomized controlled trial of a computer-tailored multiple health behaviour intervention in general practice: 12-month follow-up results

Background: Effective strategies to address risk factors of non-communicable diseases are required to curtail the expanding costs of health care. This trial tested the effectiveness over one year of a minimal intervention targeting multiple health behaviours (diet, physical activity, alcohol and smoking) in a general practice setting, through the provision of personalised, computer-tailored feedback.Methods: Patients who had attended a general practice in the previous 6 months were recruited from 21 general practitioners in Brisbane, Australia. Baseline data were collected using self-reports on adherence to ten health behaviours and summarised into a health score from 0 to 10. This randomised controlled trial used a 2×2 factorial design, with one arm randomising subjects to the intervention or control group. The other arm was either feedback at baseline (single contact) or an additional assessment with feedback at 3 months (dual contact). As such, 4 study groups created were, to which participants were randomised blindly: A. Intervention with single contact; B. Intervention with dual contact; C. Control with single contact and D. Control with dual contact. All participants were assessed again at 12 months.Results: Of the 4676 participants randomised, 3065 completed questionnaires at 12 months. Both single and dual contact groups improved their 10 item health scores (+0.31 and +0.49 respectively) relative to control group outcomes (+0.02; p < 0.01). Improvement in adherence to guidelines for fish intake, type of milk consumed, vegetable and fruit intake, and alcohol intake were observed in single and dual contact intervention groups (p < 0.01). Both intervention groups showed greater improvement than controls for individual health behaviours, apart from red meat intake, smoking behaviour, physical activity and body weight. Interestingly, there was an improvement in reported non-smoking rates in both intervention and control groups (3% single contact; 4.5% dual contact).Conclusions: Small but meaningful long-term changes in health behaviours can be achieved with a low-intensity intervention, which may reduce health care costs if implemented on a large scale. Further research is needed to better understand the mechanism by which maintenance of behaviour change can be achieved.Trial Registration: The Australian New Zealand Clinical Trials Registry: ACTRN12611001213932

Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice : a randomised controlled trial

Background: The adoption and maintenance of healthy behaviours is essential in the primary prevention of chronic non-communicable diseases. This study evaluated the effectiveness of a minimal intervention on multiple lifestyle factors such as diet, physical activity, smoking and alcohol, delivered through general practice, using computer-tailored feedback