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

294 Participants Needed

Trial Summary

What is the purpose of this trial?

The VetASSIST study is a randomized clinical trial testing whether receiving virtual health coaching from Veteran peers improves the physical and mental health-related quality of life of Veterans with multiple chronic health conditions and complex healthcare needs. VetASSIST will test the efficacy of an intervention that matches Veteran patients with multimorbidty with Veteran health coaches who will provide education, resources, guidance and support to help them manage their physical and mental health over the course of a year.

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 data supports the effectiveness of the treatment Virtual Health Coaching for Multiple Chronic Conditions?

Research shows that peer health coaching, a component of virtual health coaching, is effective in helping people manage chronic conditions like diabetes and hypertension (high blood pressure). Peer support, especially among veterans, is a cost-effective way to encourage healthy behavior changes and improve health outcomes. ^{1 2 3 4 5}

Is virtual health coaching safe for people with multiple chronic conditions?

The research on virtual health coaching, including peer support and coaching for various conditions like diabetes and cardiovascular disease, suggests it is generally safe for humans. These programs are designed to help people manage their health better and do not involve any physical interventions that could cause harm. ^{1 2 3 4 6}

How is the Virtual Health Coaching treatment different from other treatments for multiple chronic conditions?

Virtual Health Coaching is unique because it uses peer support and coaching through virtual means, making it more accessible and adaptable, especially during situations like the COVID pandemic. This approach combines the strengths of peer support and coaching to enhance self-management and behavior change, which is particularly beneficial for individuals with multiple chronic conditions. ^{2 3 4 7 8}

Research Team

Kristen E. Gray, PhD MS BS

Principal Investigator

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

Katherine D Hoerster, PhD MPH BA

Principal Investigator

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

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States 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. [2019]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease. [2023]

3. England pubmed.ncbi.nlm.nih.gov

An Innovation to Expand the Reach of Peer Support: A Feasibility and Acceptability Study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Peer coaching to improve diabetes self-management: which patients benefit most? [2022]

5. England 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. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

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

7. Canada 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. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Current trends in health coaching for chronic conditions: A systematic review and meta-analysis of randomized controlled trials. [2023]