Bridging Health Disparities through Digital Health Coaching

transcript

Bridging Health Inequalitiesthrough

Digital Health Coaching Use and Outcome of

the Online Losing Weight Coach in Individuals with Low, Middle and High Socioeconomic

Positions.

Dr. Claudia PutDr. Leentje VervoortInès Gaston-Echeverria

SES-related health inequalities• socio-economic related differences in

mortality• cancers, cardiovascular diseases• mediated by higher prevalence of health risk

behaviors• e.g. unhealthy diets, insufficient physical

activity or excercise, smoking, …

Phelan, Link, & Tehranifar(2010). J of Health and Social Behavior

health risk behaviors

• higher prevalence in individuals with lower SES• e.g., smoking

Stichting tegen Kanker, 2010

highest SES lowest SES0%

22%27%

men women

health inequalities (HI)

• mortality• life expectancy• how old will you get, given your gender and age?

• expected years of healthy living• how many years will you remain healthy, given your gender and age?

• health disparities are still increasing

Koning Boudewijnstichting (2010). Tackling Health inequalities in Belgium

life expectancy

higher education

6 years of secondary school

only primary school

70 71 72 73 74 75 76 77 78 79 80 81

10 years ago nowadaysBelgian man, 25

expected years of healthy living

higher education

only primary school

0 5 10 15 20 25 30 35 40 45 50

2010Belgian woman, 25

SES as a fundamental cause of HI

• influence on various diseases, e.g. cancer, CVD• through multiple risk behaviors, e.g., smoking,

unhealthy diet, …• different access to ‘resources’ that can be used to

avoid risks or treat problems• ‘healthy choices’ eg food• treatment, therapy, intervention• knowledge, money, social support, …

reducing SES-related HI

• health inequalities based on SES can be reduced by instituting health interventions that automatically benefit individuals irrespective of their own resources

• affordable interventions• easy-to-acces interventions• easy-to-use interventions• time-efficient interventions

Digital health coaching

• affordable interventions

• easy-to-acces interventions• high internet use in Belgium: 76%, but with SES-differences

• no-low formal education: 65%• medium formal education: 86%• high formal education: 98%

• ‘health-related issues’ are very popular on the internet

Digital health coaching

• easy-to-use• daily e-mailtips right into your mailbox• clearly structured webpages, easy to navigate• completely automated

• time-efficient• at home, no need to go out or plan• accessible 24/7• at your own pace

The Online Losing Weight Coach

• free of charge, provided by a large Belgian health insurance company (CM)

• online since january 2009

• 65.792 users

• completely automated, online interactive app

• based on cognitive & behavioral techniques

• goal is behavioral change

Start = questionnaire (eating behavior, physical activity, calory control, weight, motivation, self-efficacy)

Tailored individual feedback

Social comparison, in terms of motivation and behavior

start of the coaching proces

- Access to 3 programs- user chooses which one to start with, other remain accessible

Per program acces to:• advice• strategies• Interactive tools: tests, feedback tools, … • Library

Example: program for balanced eating

Simple, attractive interactive tools

Diary and graphical overviewsRegistration & evolution of behavior and applied techniques- Only the essence- Simple A tailored personal monthly report

Daily e-mailtips

• built up of a proces• triggers & engages• Controllable

Only live-element: ask the expert + forum

The Online Losing Weight Coach

• n = 2785• 83% women, 17% man• age: M = 45, SD = 12• weight: M = 78.29 kg, SD = 14.05

• underweight: 0.1%• normal weight: 29.7%• overweight: 43.5%• obesitas: 26.1%

• pre- and post assessment health behavior questionnaire

SES of Online Weight Coach Users

higher education

secondary school

only primary school

0% 10% 20% 30% 40% 50% 60% 70% 80%

Online Weight Coach Users

weight of Online Weight Coach Users

higher education

secondary school

only primary school

0% 10% 20% 30% 40% 50%

obese overweight normal weight

behavioral changes

• behavior • related to food pattern, physical activity, calorie control• measured on a scale from 0 to 100

• higher score = more healthy behavior

behavioral changes: balanced eating

higher education

secondary school

only primary school

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00

post pre

• increase in eating behavior scores • M = 5.85, SD=18.00, F(1,2782)=106.03, p<.001

• no significant interaction effect with SES• F(2,2782)= 1.38, p=.25

0behavioral changes: physical activity

higher education

secondary school

only primary school

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00

post pre

• increase in physical activity scores • M = 10.71, SD=35.07, F(1,2782)=63.83, p<.001

0behavioral changes: calorie control

higher education

secondary school

only primary school

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00

post pre

• increase in calorie control scores • M = 7.68, SD=19.76, F(1,2782)=102.00, p<.001

weight loss

higher education

secondary school

only primary school

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00

post pre

• weight loss• M = 1.73, SD=4.92, F(1,2782)=138.46, p<.001

conclusion

• effect of online intervention: irrespective of SES• potential for reducing SES-related HI

• but: lower participation level in lower SES need for adequate communication• Message: focus barriers, prejudices• Channel: workplace, unemployment agencies

Thank you for your attention

Contact: claudia@brandnewday.eu

www.brandnewday.eu

Bridging Health Disparities through Digital Health Coaching

Health & Medicine