Efficacy of Health Coaching and an Electronic Health Management Program: Randomized Controlled Trial

BACKGROUND

For chronic disease management, self-management strategies are essential to achieve sustained improvement.

OBJECTIVE

Our study evaluated the efficacy of health coaching and a self-management strategy-based electronic program on self-management strategies for patients with osteoporosis, chronic respiratory disease, or arthritis.

DESIGN

Three-arm randomized controlled trial, pilot study PARTICIPANTS: Fifty-four participants INTERVENTIONS: The first intervention group (n = 53) received a self-management strategy-based electronic program and 12 weeks of health coaching (20 sessions). The second intervention group received the information and communications technology (ICT) program; the control group received usual care and an educational booklet about self-management of chronic diseases.

MAIN MEASURES

The primary outcome was the difference in the change of the mean of self-management strategy scores. Secondary outcomes included depression (PHQ-9), physical activity (Godin Leisure Exercise Questionnaire), and health habit maintenance (transtheoretical model) after 12 weeks in the program.

KEY RESULTS

The combination of health coaching and ICT was superior to control group (change 18.5 vs. - 2.6, adjusted difference = 24.5, p < 0.001); however, the ICT alone group was not superior to the control group (change 8.0 vs. - 2.6, adjusted difference = 8.0, p = 0.156). As a result of evaluating the change in the percentage of people with positive stage changes in the transtheoretical model of health habits, regular exercise (p = 0.008), a balanced diet (p = 0.005), helping others (p = 0.001), and living with loved ones (p = 0.038) showed significant differences. There was no significant difference in the changes in percentage of patients with depressive symptoms in comparison with control group; however, there was in comparison with control group among groups (p = 0.033). Compared to the control group, the proportion of patients who achieved an exercise amount of 12.5 MET or higher was significantly higher (p = 0.028) in the health coaching and ICT group.

CONCLUSIONS

The combination of ICT + health coaching led to improvement in self-management as well as in increasing exercise, and several healthy behaviors.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03294057.

Effect of Changes in Patient's Self-management Strategies on Clinical Outcomes: Evidence from a Cohort Study of Patients with Diabetes, Hypertension, and Hyperlipidemia

BACKGROUND

Self-management has become the dominant care model for chronic disease management. This study aimed to investigate the effect of changes in self-management strategies on the clinical outcomes of chronic diseases.

METHODS

Two hundred ninety-seven patients with one or more chronic disease (diabetes, dyslipidemia, or hypertension) were registered and followed in this prospective cohort study. We compared differences in the changes in clinical outcomes from baseline to 6 months according to the improvement of self-management strategies by analysis of covariance.

RESULTS

Diabetic patients with improved self-management strategies showed a significantly greater change in HbA1c levels compared to patients without improvement of self-management strategies (group difference in HbA1c = 0.51%). In hypertensive patients, systolic and diastolic blood pressure (BP) showed a significant decline in the patients with improved self-management strategies (group difference in systolic BP = 6.2 mmHg and in diastolic BP = 5.5 mmHg). Clinical outcomes improved significantly when self-management strategies improved in people with a poor self-management strategy at baseline.

CONCLUSIONS

This study suggests that improvements in self-management strategies are associated with an improvement in clinical outcomes among patients with chronic diseases, especially for those with an initially poor self-management strategy.

Self-management strategies and comorbidities in chronic disease patients: associations with quality of life and depression

Self-management strategies are essential for improving prognosis in chronic illnesses. This study aimed to investigate the association between comorbidity and self-management strategies. A total of 700 patients with one or more chronic diseases including diabetes, dyslipidemia, hypertension, osteoporosis, chronic lung disease, chronic kidney disease and arthritis were enrolled. A questionnaire including the Smart Management Strategy for Health Assessment Tool Short Form (SAT), the Short Form-12, the McGill Quality of Life questionnaire, and the Patient Health Questionnaire-9 was administered to participants. The trend of each SAT according to number of comorbidities was evaluated, and the difference in quality of life and depression according to self-management strategies was examined in the model classified by the number of diseases. Self-management strategy scores tended to decrease as the number of comorbidities increased from one to four (p-value: 0.001 to 0.008). Regardless of the number of comorbidities, the MQOL score was higher in the good self-management strategy group (p: <0.001 to 0.016). The prevalence of mild depression was higher in patients with low self-management strategy, but the differences were not significant. Based on these findings, self-management strategies should be evaluated multidimensionally, and patients should be encouraged to develop effective self-management strategies to manage multiple chronic diseases.

The Satisfaction with Life Scale and the Subjective Well-Being Inventory in the General Korean Population: Psychometric Properties and Normative Data

This study aims to evaluate the psychometric properties of the Satisfaction with Life Scale (SWLS) and the Subjective Well-Being Inventory (SWBI) in a nationally representative sample in Korea. A total of 1200 people completed the semi-structured, self-reported questionnaire, which included five items from the SWLS and 14 items from the SWBI. All items and the total score of both the SWLS and the SWBI showed high internal consistency (with Cronbach’s alphas of 0.886 and 0.946, respectively). The item-total correlation values for both measures were in the ranges of 0.71–0.75 and 0.65–0.80, respectively. There were positive correlations between the SWLS and SWBI (r = 0.59, p = 0.01). The SWLS, SWBI and global well-being (GWB) scores were positively correlated with the McGill Quality of Life subscales (p = 0.01) but negatively correlated with the Patient Health Questionnaire-9 (p = 0.01). Participants under 50 years old (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.00–1.69) and those in rural areas (aOR = 1.63, 95% CI = 1.28–2.07) had higher scores on the SWLS than other participant groups. Participants who were under 50 years old (aOR = 1.47, 95% CI = 1.12–1.92), were male (aOR = 1.33, 95% CI = 1.04–1.71), were married (aOR = 1.51, 95% CI = 1.13–2.01), lived in rural areas (aOR = 2.30, 95% CI = 1.35–3.91), or had higher incomes (aOR = 1.30, 95% CI = 1.02–1.65) showed higher SWBI scores. This study showed that the SLWS and SWBI have good psychometric properties and could be applicable to Korea.