Abstract
Background: Computer-tailored communications, particularly those delivered via the Internet, may be a cost-effective strategy to improve population health; however, “real- world” implementation research is necessary to establish their public health impact.
The 5+YourWay® Coach is an online behavioural intervention, designed to increase adult fruit and vegetable intakes using computer-tailored communications. This study is part of a 2.4-year implementation research project, evaluating the population public health impact of the 5+YourWay® Coach service in selected Otago general practices, using RE-AIM. Preliminary evaluations after five weeks of service delivery highlighted the need to improve Staff Adoption and patient registrations.
Objective: The present study aims to implement strategies to increase Staff Adoption and patient registrations, and to conduct interim analyses of Staff Adoption, Patient Reach, and Effectiveness at six months.
Methods: Personalised quarterly progress reports were sent to the six participating practices, providing feedback on patient registrations and offering target-based incentives. A single site visit was conducted with three available practices, to discuss their progress and strategies to increase service offers. Staff completed a questionnaire, which acted as a behavioural intervention to encourage them to offer the service to their patients, in addition to quantifying service offers and declines and understanding factors influencing their participation (Staff Adoption). The 5+YourWay® computer system documented participating patient characteristics including website access, session completions and feedback, fruit and vegetable intakes and stage of change (Patient Reach and Effectiveness). Structured telephone interviews were carried out with patients who did not access an initial (n=7) or follow-up session (n=6), to document their characteristics and explore factors influencing their participation (Patient Reach).
Results: At six months, twelve staff members had registered at least one patient with the service, producing a Staff Adoption rate of 20%. GP and practice nurses were equally likely to participate, although nurses registered more patients; two experienced nurses were responsible for more than 60% of total registrations at six months. “Time,” and “forgetting” were cited by responding staff (n=21) as the main barriers to offering the service to patients. Patient Reach was 14%; 18 patients accessed the service out of an estimated 132 patients offered the service during the first six months. Participating patients were more likely to be in pre-action stages of change (n=12) and have no or basic secondary school qualifications (n=11). Eight patients completed at least two online sessions by 14 May 2014. By the start of their second session, a greater proportion of patients met the fruit goal (n=6), while maintaining the vegetable goal (n=7). Five patients increased their baseline fruit intake by 1.0-2.0 servings per day and progressed one to three stages of change, and five patients increased their baseline vegetable intake by 0.8-2.0 servings per day, of which three patients progressed one to three stages of change.
Conclusion: Despite low Staff Adoption and Patient Reach at six months, the 5+YourWay® Coach appears to be a well-received and effective service for those patients it reaches, which includes groups that are difficult to engage. Further efforts are required to increase Staff Adoption and service offer and acceptance rates, in order to improve Patient Reach and evaluate Effectiveness in future analyses.