Abstract
Background: Computer-tailored communications have been proposed as an easily accessible, cost-effective method to improve population health behaviours; however, evidence of these outcomes in “real world” practice settings is required to inform policy decisions.
The 5+YourWay® Coach is an online service that delivers personally tailored communications designed to motivate and enable adults to eat more fruit and vegetables. This thesis reports the first part of a 2.5-year translation research study evaluating the population public health impact and cost-effectiveness of the 5+YourWay® Coach service in routine general practice, using the RE-AIM Framework. The RE-AIM Framework assesses interventions on five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance.
Objective: This research project aims to evaluate Setting Adoption in Otago general practices, and to report preliminary evaluations of Staff Adoption, Reach and Implementation five weeks after service launch.
Methods: Twelve large Otago general practices, with above average primary health organisation performance indicators, were offered use of the 5+YourWay® Coach service for one year. Prior to launch, a needs analysis was conducted with participating practices, and a “Practice Toolkit” was developed and distributed to assist with service implementation. At five weeks, the proportion of participating (referring) general practitioners and practice nurses (Staff Adoption) and the proportion of participating patients (accessing the website) of those offered referral (Reach) were reported. Structured telephone interviews were carried out with four practice managers and three non-participating registered patients to identify factors that facilitated and inhibited staff referrals and patient access to the service. The 5+YourWay® computer system and service “help desk” monitored the consistency of service delivery (Implementation). The operating costs of setting up and delivering the service in general practices were recorded, and a 12-month projection of ongoing service delivery costs was estimated.
Results: Six practices, comprising a total of 14,958 patients aged 25-65 years, agreed to adopt the service for one year, resulting in a 50% Setting Adoption rate. All three practices based in higher deprivation neighbourhoods declined use of the service. At five weeks, Staff Adoption was 7% with four of 61 eligible staff registering at least one patient with the service. Staff-reported referral barriers included time constraints and forgetting. Preliminary Reach was 6%; at five weeks, one patient had accessed the website out of 18 patients offered a referral. The 5+YourWay® computer system delivered the coaching session and almost all correspondence error free, resulting in an Implementation rate of 98%. The projected annual service delivery cost, assuming 1,500 referred patients, was NZ$4,399.
Conclusion: The 5+YourWay® Coach had good uptake in general practices located outside higher deprivation neighbourhoods, allowing almost 15,000 potentially eligible patients the opportunity to be referred to this free service. At five weeks, it was too early to evaluate Staff Adoption, Reach, and Implementation outcomes; however, it appears strategies are needed to improve Staff Adoption and referral offers (and the methods used to collect this information). This research suggests the 5+YourWay® Coach has the potential to be cost-effective, if sufficient patient numbers are registered with the service; although the services impact on inequalities needs to be assessed.