Virtual Health Coaching for Multiple Chronic Conditions

(VetASSIST Trial)

Overseen By Jennifer L Williams

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Dementia, Renal disease, Substance use, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 20

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether virtual health coaching from fellow Veterans can enhance both physical and mental health for Veterans managing multiple ongoing health issues. Participants in the intervention group will engage in 20 virtual sessions over a year with trained Veteran peers who provide guidance, support, and resources. Veterans with at least three chronic health conditions and recent emergency care needs might be a good fit.

As an unphased trial, this study offers Veterans a unique opportunity to contribute to innovative health solutions while receiving personalized support.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, since the trial involves health coaching and not medication changes, it's likely you can continue your current medications.

What prior data suggests that this virtual health coaching intervention is safe?

Research shows that peer health coaching is generally safe and well-received. Studies have found that it helps people manage chronic conditions like diabetes and heart problems without causing major issues. Participants in past research reported better quality of life and mental health, with no significant unwanted side effects. This suggests that peer health coaching is likely safe for most people. However, as with any treatment, individual experiences can vary. Always discuss any concerns with a healthcare provider. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the peer health coach intervention because it introduces a novel approach to managing multiple chronic conditions by leveraging the power of peer support and virtual interaction. Unlike traditional treatments that often rely on medication or in-person visits, this intervention uses trained Veteran peers to provide health education, assist with setting goals, and enhance social support—all delivered via 20 virtual visits over a year. This method not only offers convenience and flexibility for participants but also harnesses the motivational benefits of peer interaction, potentially leading to improved health outcomes and increased access to care resources.

What evidence suggests that virtual health coaching is effective for improving the quality of life in Veterans with multiple chronic conditions?

Research has shown that peer health coaching, which participants in this trial may receive, can help manage long-term conditions like diabetes and high blood pressure. Studies have found that patients with multiple heart disease risks experienced better health with peer support. Specifically, Veterans who participated in peer coaching reported improved self-care and felt more socially supported. Online health coaching, including peer coaching, has also improved the quality of life for those with multiple ongoing health issues. Overall, these findings suggest that peer health coaching could be a promising way to help Veterans manage their health more effectively. ^{3 4 6 7 8}

Who Is on the Research Team?

Katherine D Hoerster, PhD MPH BA

Principal Investigator

VA Puget Sound Health Care System Seattle Division, Seattle, WA

Kristen E. Gray, PhD MS BS

Principal Investigator

VA Puget Sound Health Care System Seattle Division, Seattle, WA

Are You a Good Fit for This Trial?

This trial is for Veterans with multiple chronic conditions who have had a primary care visit at VA Puget Sound in the last year. They must be managing three or more chronic illnesses across different body systems, take many medications, or have been to the emergency department recently. Participants need reliable internet access, an email address, and a device compatible with VA video conferencing. Those with severe hearing loss, dementia, non-English fluency, no phone access, or certain other health conditions are excluded.

Inclusion Criteria

Inclusion criteria assessed via the phone screen includes frailty, treatment burden, and willingness to use an Internet-connected device with a web camera compatible with the VA video conferencing platform

Veteran VA Puget Sound patient with >=1 primary care visit within last year

I can receive emails or text messages.

Exclusion Criteria

No phone access and/or missing phone number

Diagnosis of psychotic disorder in last year

Score of >8 (severe risk) on self-reported AUDIT-C questions on eligibility screen

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive virtual health coaching from Veteran peers to improve physical and mental health-related quality of life over 12 months

12 months

20 virtual visits

Follow-up

Participants are monitored for changes in health-related quality of life and other outcomes

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Peer health coach intervention

Trial Overview

The VetASSIST study is examining if virtual coaching by Veteran peers can improve life quality for Veterans with multimorbidity over one year. It involves education and support from coaches who are also Veterans to help manage both physical and mental health.

How Is the Trial Designed?

Group I: Peer health coach intervention Experimental Treatment 1 Intervention

Participants will receive 20 virtual visits with a trained Veteran peer health coach over 12 months. Coaches will provide participants with brief health education, assist with goal setting and problem solving, enhance social support, and link participants to VA and community resources.

Group II: Control group/no intervention Active Control 1 Intervention

Participants will continue to receive their regular, usual primary care.

Peer health coach intervention is already approved in United States for the following indications:

Approved in United States as Peer Health Coach Intervention for:

• Improving quality of life among veterans with multimorbidity
• Managing physical and mental health conditions

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A virtual training program for peer coaches with rheumatoid arthritis was successfully implemented during the COVID-19 pandemic, demonstrating feasibility and acceptability among participants.

The training, which focused on listening, discussing, practicing, and certifying, resulted in high satisfaction and confidence among the coaches, highlighting the potential for virtual formats to enhance recruitment and diversity in peer coaching interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease. Brown, M., Páez, YD., Jabri, A., et al.[2023]

Peer health coaching significantly lowers hemoglobin A1c (A1c) levels in patients with diabetes who have low self-management and medication adherence, indicating its effectiveness in high-risk groups.

In contrast, patients with high self-management and adherence showed similar improvements in A1c regardless of whether they received coaching or usual care, suggesting that coaching is particularly beneficial for those struggling with diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer coaching to improve diabetes self-management: which patients benefit most? Moskowitz, D., Thom, DH., Hessler, D., et al.[2022]

The My Health, My Life, My Way study is a 6-month randomized controlled trial involving 200 individuals with chronic conditions and physical disabilities, designed to assess the feasibility and preliminary efficacy of a web-based self-management program that combines health coaching and telehealth technology.

The study aims to determine the most effective combination of scheduled coaching calls and gamified rewards to enhance participation in self-management, potentially leading to a scalable solution for managing chronic conditions in people with disabilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

My Health, My Life, My Way-An Inclusive Web-Based Self-management Program for People With Disabilities Living With Chronic Conditions: Protocol for a Multiphase Optimization Strategy Study. Evans, E., Zengul, A., Knight, A., et al.[2023]

A 12-week study tested a new hybrid model of peer support for veterans, combining mutual peer support with on-demand peer coaching, which was found to be acceptable and feasible for promoting heart-healthy behaviors.

Participants engaged well with the program, maintaining regular communication and reporting positive experiences, indicating that this model could effectively support behavior change in veterans with cardiovascular disease risk factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Innovation to Expand the Reach of Peer Support: A Feasibility and Acceptability Study. Goldstein, KM., Voils, CI., Bastian, LA., et al.[2022]

This study will evaluate the effectiveness of peer coaching in improving diabetes outcomes among 400 low-income patients with poorly controlled diabetes over a 6-month period, focusing on changes in HbA1c levels as the primary outcome.

Peer coaches, who are trained patients with diabetes, may enhance self-management skills and clinical outcomes, potentially providing a cost-effective solution to improve diabetes care in resource-limited settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial. Ghorob, A., Vivas, MM., De Vore, D., et al.[2022]

This systematic review aims to evaluate the effectiveness of health coaching (HC) interventions for adults with chronic conditions, synthesizing studies published in the last four years to assess patient improvement and coaching characteristics.

If health coaching is found to be effective, it could lead to broader public health applications and integration into current management strategies for chronic diseases, potentially improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Current trends in health coaching for chronic conditions: A systematic review and meta-analysis of randomized controlled trials. Yang, J., Bauer, BA., Lindeen, SA., et al.[2023]

Participants in a diabetes self-management coaching program who became coaches reported that their own experiences with peer coaching significantly influenced their decision to take on the coaching role.

The study highlights that these coaches emphasized commitment to their partners and shared personal challenges to foster motivation and a sense of connection, suggesting that their unique insights enhance the effectiveness of peer support in managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experiences of Participants Who Then Become Coaches in a Peer Coach Diabetes Self-Management Program: Lessons for Future Programs. Saint, K., Heisler, M.[2023]

This study aims to evaluate a peer support intervention for improving hypertension control among 400 Veterans with poorly managed hypertension and additional cardiovascular risks, using a home-based approach with peer health coaches.

The trial will assess the effectiveness of this intervention by measuring changes in systolic blood pressure and cardiovascular disease risk, potentially providing valuable insights for community-based prevention programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks. Nelson, K., Fennell, T., Gray, KE., et al.[2019]

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