bridging health disparities through digital health coaching
DESCRIPTION
Bridging Health Disparities through Digital Health Coaching: Use and Outcome of the Online Losing Weight Coach in Individuals with Low, Middle and High Socio-economic PositionsTRANSCRIPT
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%
10%
20%
30%
40%
50%
28%
45%
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
Koning Boudewijnstichting (2010). Tackling Health inequalities in Belgium
higher education
6 years of secondary school
3 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
Koning Boudewijnstichting (2010). Tackling Health inequalities in Belgium
higher education
6 years of secondary school
3 years of secondary school
only primary school
0 5 10 15 20 25 30 35 40 45 50
2010Belgian woman, 25
SES as a fundamental cause of HI
Phelan, Link, & Tehranifar(2010). J of Health and Social Behavior
• 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
Phelan, Link, & Tehranifar(2010). J of Health and Social Behavior
• 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
Phelan, Link, & Tehranifar(2010). J of Health and Social Behavior
• 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%
65%
31%
4%
Online Weight Coach Users
weight of Online Weight Coach Users
higher education
secondary school
only primary school
0% 10% 20% 30% 40% 50%
34%
22%
13%
44%
44%
38%
22%
33%
49%
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
48.62
44.93
48.62
54.09
51.38
52.25
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
44.55
43.73
47.20
54.75
55.98
54.21
post pre
• increase in physical activity scores • M = 10.71, SD=35.07, F(1,2782)=63.83, p<.001
• no significant interaction effect with SES• F(2,2782)= 1.61, p=.20
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
45.91
42.93
39.75
53.66
50.32
45.59
post pre
• increase in calorie control scores • M = 7.68, SD=19.76, F(1,2782)=102.00, p<.001
• no significant interaction effect with SES• F(2,2782)= 0.66, p=.25
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
77.20
79.81
84.25
75.56
78.02
81.59
post pre
• weight loss• M = 1.73, SD=4.92, F(1,2782)=138.46, p<.001
• no significant interaction effect with SES• F(2,2782)= 2.22, p=.11
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
