Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
J Gen Intern Med. 2019 Apr;34(4):552-558. doi: 10.1007/s11606-019-04861-7. Epub 2019 Feb 12.
Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.
To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).
Secondary analysis of a randomized controlled trial.
Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly.
A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy.
The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04).
We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.
NCT01828567.
健康辅导是一种有效的行为改变策略。对于健康辅导对低健康素养患者是否有不同的影响，尚未进行充分研究。
确定电话辅导干预是否会导致低健康素养（具体为阅读素养和计算素养）患者与高健康素养患者相比，在预防计划的参与度和患者激活方面有类似的改善。
随机对照试验的二次分析。
417 名至少有一个可改变风险因素的退伍军人：当前吸烟者、BMI≥30 或每周中度体力活动<150 分钟。
在基线时使用单一的健康素养评估和主观计算量表进行评估。使用逻辑回归和一般线性纵向模型来检验干预措施与对照组相比，在低健康素养与高健康素养患者中，对预防计划的参与度和患者激活措施（PAM）评分变化的差异影响。
与常规护理相比，辅导干预措施无论基线健康素养如何，都能提高预防计划的参与度并改善 PAM 评分。对于计算能力较低的患者（干预组与对照组差异为 0.31，95%置信区间为 0.18，0.45），辅导干预措施对预防计划参与的影响大于计算能力较高的患者（0.13，95%置信区间为-0.01，0.27）；低与高的差异效应在临床上是显著的，但在统计学上不显著（0.18，95%置信区间为-0.01，0.38；p=0.07）。在计算能力较高的患者中，与对照组相比，干预组在 6 个月时 PAM 有更大的改善（改善的平均差异为 4.8；95%置信区间为 1.7，7.9；p=0.003）。这导致了低与高计算能力之间的临床和统计学上显著的差异干预效果（-4.6；95%置信区间为-9.1，-0.15；p=0.04）。
我们建议，当健康风险信息的解释是干预措施的一部分时，健康辅导可能特别有益于计算能力较低的人群的行为改变策略。
临床试验.gov 标识符：NCT01828567。
