Healthy Choices: The effect of co-designed community programs on healthy lifestyle choices for people with chronic conditions.

The Program has 4 components and runs as a three-month module (minimum 6 weeks) which can be repeated as necessary for longer term goals. Where goals are simple and further referrals/support are not indicated, the program can be conducted in 6 weeks (on request) and will therefore not employ all components listed. The principles of self-management will form the basis of the first two components and these will be reiterated throughout the service pathway where participants: • gain knowledge of their condition • follow a management plan, based on identified wellbeing goals, as agreed with health team • actively share in decision-making with the health team • monitor and manage signs and symptoms of their condition • manage the impact of the condition on their physical, emotional and social life • adopt lifestyles that promote health • have confidence, access and ability to use support services. 1. Education Package and sessions – specific to the individual’s chronic disease/s We will use a comprehensive education package (paper-based and online) detailing the implications of the targeted chronic disease/s and potential risk management strategies – for group presentations and for individual reference. This includes descriptions of any necessary medical monitoring of health factors as well as lifestyle changes and is consistent with current national guidelines for the prevention and management of chronic disease. The resources were initially constructed with the support of postgraduate Design students at UniSA and staff trained in Chronic Disease Self-Management (Flinders Program). These sessions will be offered individually or in groups using the online and paper-based resources, supported by the student/s and their supervisor. From our pilot work, they usually need to occur over 1-3 hour long sessions – this will be tailored. Specific delivery: a) the frequency of sessions will be once per week b) the mode and location/setting where the intervention takes place will initially be face-to-face at the clinic, and then negotiated subsequently to continue at the clinic or face-to-face at participant's home, or via a TeleHealth platform. The location and mode will be recorded for each session. c) the number of sessions delivered will be decided between the student, participant and supervisor based on expressed need for coaching and monitoring. This will be recorded with reasons. d) University of South Australia health students will deliver the sessions under supervision. 2. Individual Health Coaching 2.1 Motivational interview with identification of strategies to promote and support identified behaviour change – focus on health behaviours. The initial session will identify needs and establish future assistance/requirements using motivational interviewing processes. This will allow participants to use the LS7 metrics to identify which aspects of their lifestyle they wish to address, or which particular health targets they are having difficulty achieving. For example, one participant may have high cholesterol levels and wish to have assistance to adapt their diet to Mediterranean guidelines, while another may struggle to control their diabetes and have a desire to undergo regular exercise to improve their blood sugar levels. Participants will be offered a tool kit of tailored supports for behaviour change to help them achieve their health and lifestyle goals by monitoring and reminding them about those goals in decision-making situations. Specific examples of behaviour change techniques can take the form of: shaping and cues (pre-designed shopping lists that have more room for vegetables and fruits than for snacks); antecedents (stickers on the food containers attracting attention to healthier food groups); outcome expectancies (a key ring which reminds participants of the benefits of walking when possible instead of taking the car). 2.2. Ongoing health coaching with new/reviewed strategies, liaison and Health Diary The health coaches will follow-up the adherence to the identified strategies above via coaching check-ups. This will be the opportunity to re-evaluate participants’ scores and provide valuable feedback for behaviour change. This process will also be facilitated by the use of a personal Health Diary – an individually held portfolio of information and recording sheets for the participant to keep a monthly record of advice, goals, monitoring activities (e.g. diet habits, levels of physical activity, BP results from the GP, health service utilisation and so forth). The check-ups will occur with decreasing regularity – commencing with weekly - and reducing by negotiation, perhaps interspersed with telephone/on-line check-ups. There will also be ongoing liaison with the treating GP for medical checks (check veracity of self-reports) and to encourage use of the Health Diary as a tool of communication between the participant, students/staff and the GP or other health providers. All health and diary resources have been developed specifically for the study and have been piloted. Specific delivery: a) the approximate duration of each session will be 1 hour, b) the duration of time between the initial session and subsequent ongoing health coaching sessions is anticipated to be weekly and will continue as negotiated. c) University students will deliver the coaching under supervision. d) The expected frequency of GP medical checks is at minimum on entry to the study, at 3 months, 6 months and 12 months. e) The telephone/online check-ups will occur as for the education sessions - minimum of weekly but as negotiated and recorded by the student/supervisor and individual participant. 3. Individual and group sessions with targeted disciplines - referral and attendance will be recorded but will be bespoke to each individual participant. In this aspect of the service the participant and their health coach will have identified and coordinated more specific sessions as required. All activities will be goal-based and monitored. For example: 3.1 Dietitian/nutrition consultations – to establish dietary intake and goals/modifications. This could expand from individual consultations with UniSA Nutrition students and supervisors (or Academic and community-based Dietitians if required) to include pop-up cooking classes or support in shopping choices and budgets. All plans will be based on evidence and personal preference and could span specific dietary targets (reducing salt) or individualised diet plans through to dietary patterns such as the Mediterranean diet or Intermittent Energy Restriction. 3.2 Physical activity – this may require investigation of local opportunities, personal preference, barriers and accessibility. Participants can be referred to existing local programs such as cardiac rehabilitation, gyms or walking groups or specific programs and groups can be established by UniSA Exercise Physiology students as pop-ups in the Program. Again evidence-based plans could range from specific targeted exercise programs (e.g. high intensity) through to lifestyle activities like gardening or walking the dog. 3.3 Liaison with the relevant General Practitioner (GP) and Pharmacy for the routine medical monitoring of identified risk factors including: scheduled BP, cholesterol, other blood-work, diabetic control, management of co-morbidities. 3.4 Miscellaneous consultations – for example referring to sleep counselling; smoking cessation (community programs); stress management; pain management; hydrotherapy; other UniSA clinics – physiotherapy, podiatry, occupational therapy, psychology, social work. 4. Health Buddy The participant will be encouraged to identify a ‘health buddy’ to attend sessions with them and to support them in their identified goals and strategies. This method has been trialled successfully in Scandinavian countries and serves two purposes – a friendly peer supporter to be there between formal coaching sessions and snowballing knowledge about health and wellbeing to the broader community. These components run concurrently and in some cases in parallel if reinforcement or reiteration is needed. The individualisation will be ongoing as each session builds on the previous in a co-design approach. All sessions will be monitored by a supervisor in real time, all session times/mode and location will be logged and adherence recorded (via attendance software). Fidelity checks will be run by videoing at least one session per participant (ethics approval obtained) and the advisory group will evaluate these videos for accuracy regarding motivational interviewing, participation and engagement.