Cindy is a mother and partner. A primary caregiver who works part-time to support her family. She has also recently been diagnosed with diabetes.
Immediately following her diagnosis, Cindy had access to educators who explained all the things she needed to know and do to manage her diabetes. But what would she do when she went home and back to the reality of juggling all of the aspects of her daily life?
That’s where the Telephone Self-Management Health Coach Program comes in. This program supports people living with chronic conditions to become better self managers with Peer Health Coaches who connect with participants once a week for a half-hour conversation over the course of six months. Coaches support participants to identify and problem-solve barriers to being healthy and choose goals and actions they want to take to manage their health. For people like Cindy, this helps them keep motivated to initiate and maintain healthy behaviours.
The pilot initiative
Funded by the Lawson Foundation, the program pilot took place between 2014 and 2017 and involved people with type 2 diabetes receiving care at 11 centres in the Fraser Health Region of British Columbia. During treatment, diabetes educators spoke with clients about the option of having a weekly telephone call from a Health Coach. 115 people signed up.
In addition to their participation in the coaching program, participants completed outcome questionnaires at the start and then again at six and twelve months. Analysis of these questionnaires found statistically significant improvements on eight measures including A1C level, patient activation and self-efficacy, and depression. It also revealed that program effectiveness was not influenced by peoples’ age, gender, number of chronic conditions, or education level.
With participant input, minor program changes were made, namely to implement the program across the entire province, make it accessible to persons with any type(s) of chronic conditions, and reduce the program duration from six to three months. In 2017, the program received ongoing funding support for provincial implementation from the BC Ministry of Health, and more than 1,400 participants have been paired with a Self-Management Health Coach.
Taking it to scale
With growing awareness of the program, a number of service providers expressed interest in providing the program in their own service areas. As the Telephone Self-Management Health Coach Program was non-proprietary, the BC team refined the training and resource materials (i.e., training manual and participant scenarios) and made them available to interested organizations in Canada. As well, coach training sessions and additional support has been provided to teams in five provinces.
With a proven approach and growing interest, What would it take to scale up and get more people to participate?
Leveraging social and traditional media to boost participation
The University of Victoria received a grant of $85,000 from the Lawson Foundation to develop a social marketing campaign to recruit participants. The campaign involved: radio, TV, Instagram, Facebook, Twitter, and existing communication mechanisms used by health professionals, disease specific NGOs, professional associations, older-adult oriented associations, and provincial informational resources. It used key messages that would resonate with seniors – providing motivation and identifying how participation in this program could benefit people with a chronic condition in living a healthier life.
The campaign involved several venues including print, radio, Facebook and Instagram, and media videos and interviews, with posts and stories describing the Self-Management Health Coach Program and explaining why and how people could enrol.
Results and lessons learned from the campaign
Facebook and Instagram produced immediate results with more than 150 people signalling their interest after the first week. Feature newspaper and magazine articles were next, followed by videos. Increases in people registering for the program continued to rise until March and a total number of recruits was 528 – a significant number as in the previous year the Health Coach Program involved only 400 Coach / Participant pairings.
The campaign proved to be successful in recruiting participants but it also provided a learning opportunity for using social media strategies in the future:
Limiting the scope. The campaign was successful in attracting a large number of people who then registered for the program. This placed an additional work demand on program staff in that staff needed to interview each candidate to ensure their understanding and commitment to participate. This situation created several problems, namely: some participants needed to wait several weeks before they could be paired with a coach; and some candidates changed their mind and decided not to take the program once they learned of the required waiting time. With future social media campaigns to recruit participants, only a few strategies will be used at any one time to target potential participants living in different regions of the province.
Multiple use of the marketing products throughout the year. In this campaign it became apparent that using the same products repeatedly throughout the year would be both economical and persuasive. The products have been developed and therefore the cost of developing newer and more innovative products does not appear to be justified. Secondly, it may take several exposures to evoke a behaviour such as registering for a program. The social media campaign has produced an array of strategies which will be used repeatedly during the next few years.
The past four years has demonstrated that a pragmatic, low-cost telephone peer coaching intervention for people with type 2 diabetes or other chronic conditions works. Participants are better able to self-manage their care, improve health outcomes and reduce the demands on already stretched systems of care, and often are able to help others with their chronic conditions as well. Six months after completing the program, Cindy feels that she has become a better problem solver, has learned a number of techniques to actually get started doing things that she knows she should do like daily walking, cooking healthier meals and having better communication with her family and work colleagues. In fact, she’s even interested in taking the training and becoming a coach to assist someone else.
That is an undeniable measure of success.
About the Author
Patrick McGowan, PhD, is a Professor at the School of Public Health at the University of Victoria. His research focusses on self-management for persons experiencing chronic health conditions and takes place at the community, provincial, national, and international levels. He is based in Delta, BC, where he directs the Institute on Aging & Lifelong Health Ladner Office.
The Lawson Foundation Guest Blog Series
The Lawson Foundation is pleased to share updates from our grantees through this guest blog series. It provides an opportunity for our grantees to share stories from the field, lessons learned, as well as put forward thought provoking policy ideas.