CClinicalTrials.gg
CompletedNCT03258138Updated Oct 14, 2022

Feasibility and Implementation of a Healthy Lifestyles Program

An interventional study of Health and wellness learning sessions and Brainstorming group sessions in Health Behavior, Quality of Life and Chronic Disease, sponsored by McMaster University. Completed at 1 site in Canada. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-10-14.

Sponsored by McMaster University · Not applicable, Interventional, and Health services research

Phase
Not applicable
Study type
Interventional
Enrollment
30
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Chronic conditions, such as obesity and diabetes, are increasing worldwide. Lifestyle changes (e.g., physical activity, healthy diet, sufficient sleep, managing stress, smoking cessation) are often recommended to prevent or manage these conditions, but changing habits is difficult. Mental health can play a role in the ability to seek out and follow through on the changes necessary to achieve or maintain a healthy lifestyle, yet this aspect is rarely addressed, and access to mental health services is often limited. Furthermore, individuals are influenced by factors at the individual, interpersonal, community and policy levels (e.g., lack of socialization, unsafe neighborhoods). These factors can act as barriers and need to be addressed in order for individuals to make sustainable lifestyle changes.

A new year-long person-centered healthy lifestyles program is proposed to address the "how to" gap in making lifestyle changes through a combination of individual and group sessions. The feasibility and implementation of this new program will be evaluated through a pilot study looking at the full healthy lifestyles program compared to a less intensive version of the program. The study's hypothesis is that the full program will be feasible, acceptable and more effective for helping participants move across stages of change and for meeting their goals than the less intensive program.

Read the detailed description

A pragmatic mixed methods design including a randomized controlled trial and qualitative components will be used for this pilot study. The randomized controlled trial will include a 1:1 allocation comparing a more intensive program (MIP - usual care plus healthy lifestyles program) with a less intensive program (LIP - usual care plus development of health goals).

The qualitative components include semi-structured interviews of participants (exit interviews at 12 months), MIP staff and participants' healthcare providers (at 6 months and 12 months). In addition, focus groups will be conducted with family members of MIP participants at 9 months. These elements will provide perspectives from multiple stakeholders for improving the healthy lifestyles program and on their roles in creating and maintaining healthy lifestyles.

The primary aim of this study is to assess the feasibility and implementation of the healthy lifestyles program. Impact on participant experiences and outcomes will also be measured. Findings from this study will help inform a larger randomized trial to further look at effectiveness of the program and to determine health system implications. A 2-year extension was approved in order to determine sustainability of findings.

02

Conditions studied

  • Health Behavior
  • Quality of Life
  • Chronic Disease
  • Health Promotion
  • Stress
  • Mental Health Wellness 1

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Keywords

  • Pragmatic
  • Pilot study
  • Mixed methods
  • Randomized controlled trial
  • Implementation research
  • Person-centered care
  • Multidisciplinary
  • Ecological approach
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion criteria for randomized controlled trial:

  • English-speaking
  • 18 years of age or older

Inclusion criteria for qualitative components (family focus groups):

  • English-speaking
  • 16 years of age or older
  • related to participants in randomized controlled trial

Inclusion criteria for qualitative components (program staff):

  • Provide services within the more intensive program

Inclusion criteria for qualitative components (healthcare providers):

  • Provide health care outside of the healthy lifestyles program for participants in randomized controlled trial

Exclusion Criteria:

  • NA
04

Study design

Phase
Not applicable
Primary purpose
Health services research
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
30 participants (actual)

Study arms

  • Experimental
    More Intensive Program (MIP)

    Participants will receive the more intensive program, which combines usual care with the full version of the healthy lifestyles program. Participants in this arm will meet weekly for group health and wellness learning sessions or brainstorming group sessions. In addition, they will meet monthly for individual sessions with a multidisciplinary health team, including a family physician, physical therapist and dietician to tailor their health goal development and action plans to their particular needs and situations. They will be asked to maintain physical activity and nutrition journals for a week each every three months.

    Behavioral: Health and wellness learning sessions · Behavioral: Brainstorming group sessions · Behavioral: Individual sessions with a multidisciplinary health team · Behavioral: Health goal development · Behavioral: Physical activity and nutrition journals

  • Experimental
    Less Intensive Program (LIP)

    Participants will receive the less intensive program, which combines usual care along with health goal development. Participants in this arm will meet at baseline to set health goals with the support of a research assistant trained in theories of health behaviour and goal setting. They will also meet every three months to measure progress in achieving their goals. They will be asked to maintain physical activity and nutrition journals for a week each every three months.

    Behavioral: Health goal development · Behavioral: Physical activity and nutrition journals

Interventions

  • BehavioralHealth and wellness learning sessions

    The health and wellness learning sessions provide a platform for concepts from a variety of health behaviour theories and CBT to be combined with evidence- and practice-based recommendations for healthy lifestyles. They provide the basis for participants' development of an individualized action plan. The sessions will last one hour and participants will receive them in a group setting, 18 times throughout the duration of the program. Specifically, the sessions will be delivered during weeks: 1-8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48.

  • BehavioralBrainstorming group sessions

    The brainstorming group sessions allow for facilitated discussions where individuals explore barriers and facilitators to achieving their goals and provide an interpersonal component to the program through the building of social interactions. Participants will also receive help in finding community programs to support healthy lifestyles. These sessions will last one hour and participants will receive them in a group setting, 30 times throughout the duration of the program. Specifically, these sessions will be delivered during weeks: 9-11, 13-15, 17-19, 21-23, 25-27, 29-31, 33-35, 37-39, 41-43, 45-47.

  • BehavioralIndividual sessions with a multidisciplinary health team

    Monthly individual sessions with a family physician trained in medical CBT, a dietician and a physical therapist help individuals tailor their action plans and recommendations to their particular circumstances and provide supports based on their needs. The initial session will last 3 hours and occur at baseline. The follow-up sessions will last 1 hour.

  • BehavioralHealth goal development

    Participants in both arms will develop health goals. Several components of these goals will be measured throughout the study, including the stage of change, self-efficacy and actual goal achievement. In the more intensive program arm, participants will develop health goals and learn about how to meet those goals through the group and individual sessions. In the less intensive program arm, participants will receive support in developing health goals from a research assistant trained in theories of health behaviour and in goal setting at baseline, 3 months, 6 months, 9 months and 12 months. The initial goal setting session will be provided within a time period of 2 hours, and the follow-up sessions will be provided within one hour time periods.

  • BehavioralPhysical activity and nutrition journals

    Participants in both arm will be asked to maintain a physical activity journal and a nutrition journal for a week each every three months. These journals help participants reflect on current behaviours and areas for change.

05

What researchers measure

Primary outcomes

  1. Retention rates

    Number of participants recruited and number of participants completing the program

    Time frame: Baseline to 12 months

Secondary outcomes

  1. Changes in health goals - Stage of change over time

    For each health goal, stage of change will be determined with a 7-point Likert scale. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  2. Changes in health goals - Self-efficacy over time

    For each health goal, self-efficacy will be determined with a 7-point Likert scale. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  3. Changes in health goals - Goal achievement over time

    For each health goal, goal achievement will be determined with a 7-point Likert scale. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  4. Changes in health-related quality of life on the SF-36

    Using a validated scale, health-related quality of life will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  5. Changes in health-related quality of life on the Health Utilities Index (HUI) 2/3

    Using a validated scale, health-related quality of life will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  6. Changes in the Patient Health Questionnaire (PHQ)

    Using a validated scale, five common mental health conditions (depression, anxiety, alcohol misuse, somatoform disorder and bulimia) will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  7. Changes in the Insomnia Severity Index (ISI)

    Using a validated scale, signs and symptoms of insomnia will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  8. Changes in the Perceived Stress Scale

    Using a validated scale, signs and symptoms of perceived stress will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  9. Changes in the DeJong Gierveld 6-item Loneliness Scale

    Using a validated scale, emotional and social loneliness will be measured over time. Comparisons will be made with baseline but also with other time points.

    Time frame: Baseline, 3 months, 6 months, 9 months and 12 months, 18 months, 24 months, 30 months, 36 months

  10. Changes in blood pressure

    Both systolic and diastolic blood pressure will be measured

    Time frame: Baseline and 12 months, 24 months, 36 months

  11. Changes in weight

    Weight will be measured in kilograms

    Time frame: Baseline and 12 months, 24 months, 36 months

  12. Changes in body mass index (BMI)

    Weight and height will be combined to report BMI in kg/m\^2

    Time frame: Baseline and 12 months, 24 months, 36 months

  13. Changes in waist circumference

    Measured around waist with a tape measure in inches

    Time frame: Baseline and 12 months, 24 months, 36 months

  14. Changes in waist:hip ratio

    Measured around waist and hips with a tape measure in inches

    Time frame: Baseline and 12 months, 24 months, 36 months

06

Study locations

1 site
  • McMaster University
    Hamilton, Ontario L8S 4K1, Canada
07

References and documents

Publications

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  • Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X. The influence of obesity on primary total hip arthroplasty outcomes: A meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res. 2015 May;101(3):289-96. doi: 10.1016/j.otsr.2015.01.011. Epub 2015 Mar 25. PubMed 25817907 ↗
  • Gibbons CJ, Fournier JC, Stirman SW, DeRubeis RJ, Crits-Christoph P, Beck AT. The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. J Affect Disord. 2010 Sep;125(1-3):169-76. doi: 10.1016/j.jad.2009.12.030. Epub 2010 Jan 18. PubMed 20080305 ↗
  • Porto PR, Oliveira L, Mari J, Volchan E, Figueira I, Ventura P. Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders. J Neuropsychiatry Clin Neurosci. 2009 Spring;21(2):114-25. doi: 10.1176/jnp.2009.21.2.114. PubMed 19622682 ↗
  • Chesson AL Jr, Anderson WM, Littner M, Davila D, Hartse K, Johnson S, Wise M, Rafecas J. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 1999 Dec 15;22(8):1128-33. doi: 10.1093/sleep/22.8.1128. PubMed 10617175 ↗
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  • Sherman MD, Miller LW, Keuler M, Trump L, Mandrich M. Managing Behavioral Health Issues in Primary Care: Six Five-Minute Tools. Fam Pract Manag. 2017 Mar/Apr;24(2):30-35. No abstract available. PubMed 28291312 ↗
  • Dubord G. Part 1. Goalification. Can Fam Physician. 2010 Dec;56(12):1312. No abstract available. PubMed 21375060 ↗
  • Dubord G. Part 2. Scalification. Can Fam Physician. 2011 Jan;57(1):54. No abstract available. PubMed 21322287 ↗
  • Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983 Jun;51(3):390-5. doi: 10.1037//0022-006x.51.3.390. No abstract available. PubMed 6863699 ↗
  • Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci. 2011;13(2):217-24. doi: 10.31887/DCNS.2011.13.2/npatsopoulos. PubMed 21842619 ↗
  • Thabane L, Kaczorowski J, Dolovich L, Chambers LW, Mbuagbaw L; CHAP Investigators. Reducing the confusion and controversies around pragmatic trials: using the Cardiovascular Health Awareness Program (CHAP) trial as an illustrative example. Trials. 2015 Sep 2;16:387. doi: 10.1186/s13063-015-0919-3. PubMed 26329614 ↗
  • Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56. doi: 10.1111/1475-6773.12117. Epub 2013 Oct 23. PubMed 24279835 ↗
  • Anderson TJ, Gregoire J, Pearson GJ, Barry AR, Couture P, Dawes M, Francis GA, Genest J Jr, Grover S, Gupta M, Hegele RA, Lau DC, Leiter LA, Lonn E, Mancini GB, McPherson R, Ngui D, Poirier P, Sievenpiper JL, Stone JA, Thanassoulis G, Ward R. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016 Nov;32(11):1263-1282. doi: 10.1016/j.cjca.2016.07.510. Epub 2016 Jul 25. PubMed 27712954 ↗
  • Padwal RS, Pajewski NM, Allison DB, Sharma AM. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ. 2011 Oct 4;183(14):E1059-66. doi: 10.1503/cmaj.110387. Epub 2011 Aug 15. PubMed 21844111 ↗
  • Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160-4. doi: 10.1136/bmj.305.6846.160. PubMed 1285753 ↗
  • Marshall D, Pericak D, Grootendorst P, Gooch K, Faris P, Frank C, Bellamy N, Torrance G, Feeny D. Validation of a prediction model to estimate health utilities index Mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the hip. Value Health. 2008 May-Jun;11(3):470-7. doi: 10.1111/j.1524-4733.2007.00258.x. PubMed 18489670 ↗
  • Kohrt BA, Luitel NP, Acharya P, Jordans MJ. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry. 2016 Mar 8;16:58. doi: 10.1186/s12888-016-0768-y. PubMed 26951403 ↗
  • Seo JG, Park SP. Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain. 2015;16:97. doi: 10.1186/s10194-015-0583-8. Epub 2015 Nov 23. PubMed 26596588 ↗
  • Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004 Dec;42(12):1194-201. doi: 10.1097/00005650-200412000-00006. PubMed 15550799 ↗
  • Lynch DJ, McGrady A, Alvarez E, Forman J. Recent life changes and medical utilization in an academic family practice. J Nerv Ment Dis. 2005 Sep;193(9):633-5. doi: 10.1097/01.nmd.0000177778.27069.77. PubMed 16131948 ↗
  • Reis RS, Hino AA, Anez CR. Perceived stress scale: reliability and validity study in Brazil. J Health Psychol. 2010 Jan;15(1):107-14. doi: 10.1177/1359105309346343. PubMed 20064889 ↗
  • Leung DY, Lam TH, Chan SS. Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health. 2010 Aug 25;10:513. doi: 10.1186/1471-2458-10-513. PubMed 20735860 ↗
  • Grygiel P, Humenny G, Rebisz S. Using the De Jong Gierveld Loneliness Scale With Early Adolescents: Factor Structure, Reliability, Stability, and External Validity. Assessment. 2019 Mar;26(2):151-165. doi: 10.1177/1073191116682298. Epub 2016 Dec 8. PubMed 27932403 ↗
  • Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream: are researchers prepared? Circulation. 2009 May 19;119(19):2633-42. doi: 10.1161/CIRCULATIONAHA.107.729863. PubMed 19451365 ↗
  • Anderson JB. Unraveling health disparities: examining the dimensions of hypertension and diabetes through community engagement. J Health Care Poor Underserved. 2005 Nov;16(4 Suppl A):91-117. doi: 10.1353/hpu.2005.0121. PubMed 16327099 ↗
  • Alvarez E, Qutob M, Mbuagbaw L, Lavis J, Lokker C, Walli-Attaei M, Samaan Z, Sutton A, Singh J, Feeny D, Fortuna J. Feasibility and implementation of a healthy lifestyles program in a community setting in Ontario, Canada: protocol for a pragmatic mixed methods pilot study. BMJ Open. 2019 Oct 16;9(10):e031298. doi: 10.1136/bmjopen-2019-031298. PubMed 31619429 ↗

Study documents

  • Protocol and statistical analysis plan · Dec 11, 2017
  • Informed consent form · Oct 21, 2017
  • Informed consent form · Oct 21, 2017
  • Informed consent form · Oct 21, 2017
  • Informed consent form · Oct 21, 2017

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03258138
Lead sponsor
McMaster University
Responsible party
Elizabeth Alvarez (Assistant Professor, McMaster University) — Principal investigator
First posted
Aug 23, 2017
Start date
Feb 15, 2018
Primary completion
Oct 30, 2019
Completion
Sep 22, 2021
Last update
Oct 14, 2022

Study contacts

Elizabeth Alvarez, MD, MPH, PhD
principal investigator · McMaster University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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