Pro-Change Population Health Solution

NCT ID: NCT02755636

Last Updated: 2016-06-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

780 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-05-31

Study Completion Date

2017-07-31

Brief Summary

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Patients with co-occurring health risk behaviors suffer greater morbidity, disability, and premature death. The Pro-Change Population Health Solution (PCPHS) is a suite of mobile tools designed to assist patients and primary care providers (PCPs) in applying evidence-based principles of health behavior change to reduce four cancer risk behaviors-cigarette smoking, risky drinking, noncompliance with national guidelines for physical activity, and overweight and obesity-and depression among at-risk patients. The intervention is based on the Transtheoretical Model of Behavior Change (TTM, the "stage model") and includes computer-tailored interventions and text messages for patients and a clinical dashboard for providers. The efficacy of the intervention will be assessed in a cluster-randomized trial involving 780 patients recruited from 12 federally qualified health centers randomly assigned to intervention or usual care.

Detailed Description

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A cluster-randomized design will be used to assess the efficacy of the PCPHS intervention for multiple behavior change for cancer prevention by comparing 6- and 12-month outcomes among 780 primary care patients recruited by 12 federally qualified health clinics randomly assigned to intervention or usual care. A Multiattribute Utility Measurement Approach will be used to ensure that clinics assigned to the two conditions are approximately equivalent on clinic size, patient demographics, and cancer risk behaviors (e.g., rates of smoking, overweight, and obesity). The most similar clinics will be paired, and one clinic within each pair will be assigned to intervention, and the other to usual care.

Patients with an upcoming appointment and who meet study inclusion criteria will be invited to participate in the study, which will begin with an online baseline survey. In addition, patients in the intervention group will complete an online health risk intervention (HRI) that assesses and intervenes on the four cancer risk behaviors targeted in the intervention-cigarette smoking, risky drinking, noncompliance with national guidelines for physical activity, and overweight and obesity-as well depression. It will also assess whether participants have received cancer screenings recommended by age and gender.

After the HRI session, intervention participants will have access to the TTM CTIs targeting their risk factors during the next six months. Patients assigned to the usual care condition will receive care as usual.

Providers at the six clinics assigned to intervention will receive training on the TTM and the clinical dashboard. They will have access to the dashboard via the patient electronic medical record (EMR) during the intervention period, and will be expected to use the dashboard to deliver the one-on-one component of the TTM intervention. The clinical dashboard will:

1. Report whether the participant has received recommended cancer screenings;
2. Summarize data on targeted behavioral risks for cancer;
3. Summarize data on level of depression;
4. For each cancer risk behavior, show stage of change for meeting recommended guidelines; if at least mild depression show stage of change for using healthy strategies to manage depression; and
5. For each cancer risk behavior and depression management, provide stage-matched scripts providers can use to help participants progress to the next stage of change or to prevent relapse to an earlier stage.

Intervention group providers will deliver the dashboard-guided session at the patient's next clinic visit. The dashboard will be updated as the participant completes CTI sessions post-visit. Study participants who return to the clinic for any reason during the intervention period will be flagged, and the provider will use the dashboard to review progress and deliver updated stage-matched guidance.

All study participants will receive an online survey to assess outcomes at 6 and 12 months follow-up. Participants who don't complete the online survey within two weeks will be contacted by a survey research company to complete the survey by phone.

Conditions

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Risk Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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PCPHC intervention

PCPHC intervention during 6-month intervention period plus study assessments at baseline, 6, and 12 months

Group Type EXPERIMENTAL

PCPHC

Intervention Type BEHAVIORAL

Mobile-delivered health risk intervention (HRI), computer-tailored interventions (CTIs), text messages; provider-delivered one-on-one session guided by clinical dashboard

Usual care

Intervention Type OTHER

Primary care as usual

Usual care

Usual primary care plus study assessments at baseline, 6, and 12 months

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type OTHER

Primary care as usual

Interventions

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PCPHC

Mobile-delivered health risk intervention (HRI), computer-tailored interventions (CTIs), text messages; provider-delivered one-on-one session guided by clinical dashboard

Intervention Type BEHAVIORAL

Usual care

Primary care as usual

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Has at least one of the following behavioral risk factors for cancer:

1. Cigarette smoker
2. Exceeds recommended limits for alcohol intake
3. Does not meet national guidelines for physical activity
4. Overweight or obese

Exclusion Criteria

1. Currently pregnant
2. Currently undergoing cancer treatment
3. Serious medical condition that could prevent participation in the study for a full year
4. History of mania, schizophrenia, or other psychoses
5. Admitted to an inpatient mental health facility within the previous 2 years
6. Currently enrolled in the In It to Quit Study at the Community Health Center, Inc.
7. Unable to read English or Spanish
8. Unable to receive text messages

Note: Risky drinkers who screen positive for alcohol dependence will not be eligible for the intervention's risky drinking program, which focuses on limiting drinking to national guidelines. Treatment and control participants who screen positive for alcohol dependence and who are not engaging in any of the other targeted cancer risk behaviors will screen out of the study.
Minimum Eligible Age

21 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Community Health Center, Inc.

INDUSTRY

Sponsor Role collaborator

Pro-Change Behavior Systems

OTHER

Sponsor Role lead

Responsible Party

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Deborah Levesque

Chief Science Officer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Deborah A Levesque, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Pro-Change Behavior Systems

Locations

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Connecticut Health Center, Inc.

Middletown, Connecticut, United States

Site Status RECRUITING

Pro-Change Behavior Systems, Inc.

South Kingstown, Rhode Island, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Deborah A Levesque, Ph.D

Role: CONTACT

401-360-2975

Deborah Van Marter, M.P.H.

Role: CONTACT

401-360-2981

Facility Contacts

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Daren Anderson, MD

Role: primary

860-347-6971

Bridget Teevan, MPH

Role: backup

860-416-3088

Deborah A Levesque, Ph.D.

Role: primary

401-360-2975

Deborah Van Marter, M.P.H.

Role: backup

401-360-2981

References

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Agency for Healthcare Policy and Research. CAHPS 2.0 survey and reporting kit. Rockville, MD: Agency for Healthcare Policy and Research; 1999.

Reference Type BACKGROUND

Cantril H. The pattern of human concerns. New Brunswick, NJ: Rutgers University Press; 1965.

Reference Type BACKGROUND

Centers for Disease Control and Prevention. Measuring Healthy Days: Population Assessment of Health-Related Quality of Life. Atlanta, GA; 2000.

Reference Type BACKGROUND

Duke CC, Lynch WD, Smith B, Winstanley J. Validity of a New Patient Engagement Measure: The Altarum Consumer Engagement (ACE) Measure. Patient. 2015 Dec;8(6):559-68. doi: 10.1007/s40271-015-0131-2.

Reference Type BACKGROUND
PMID: 26097010 (View on PubMed)

Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985 Sep;10(3):141-6.

Reference Type BACKGROUND
PMID: 4053261 (View on PubMed)

Graham JW, Flay BR, Johnson CA, Hansen WB, Collins LM. Group comparability: A multiattribute utility measurement approach to the use of random assignment with small numbers of aggregated units. Evaluation Review 1984;8(2):247-60.

Reference Type BACKGROUND

Hargraves JL, Hays RD, Cleary PD. Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. Health Serv Res. 2003 Dec;38(6 Pt 1):1509-27. doi: 10.1111/j.1475-6773.2003.00190.x.

Reference Type BACKGROUND
PMID: 14727785 (View on PubMed)

Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009 Apr;114(1-3):163-73. doi: 10.1016/j.jad.2008.06.026. Epub 2008 Aug 27.

Reference Type BACKGROUND
PMID: 18752852 (View on PubMed)

Prochaska JO, Redding C, Evers K. The Transtheoretical model and stages of change. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research and Practice. 4 ed. San Francisco, CA: Jossey-Bass; 2008. p. 97-122.

Reference Type BACKGROUND

Prochaska J, Prochaska J, Prochaska J. Building a science for multiple-risk behavior change. In: Riekert KA, Ockene JK, Pbert L, editors. The handbook of health behavior change. 4 ed. New York: Springer; 2014. p. 245-67.

Reference Type BACKGROUND

Other Identifiers

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HHSN261201500015C

Identifier Type: -

Identifier Source: org_study_id

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