Randomized Controlled Trial

. 2017 Sep 29;17(1):754.

doi: 10.1186/s12889-017-4797-3.

BETTER HEALTH: Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings

Lawrence Paszat¹, Rinku Sutradhar², Mary Ann O'Brien³, Aisha Lofters⁴, Andrew Pinto⁵, Peter Selby⁶, Nancy Baxter⁷, Peter D Donnelly⁸, Regina Elliott⁹, Richard H Glazier², Robert Kyle⁹, Donna Manca¹⁰, Mary-Anne Pietrusiak⁹, Linda Rabeneck¹¹, Nicolette Sopcak¹², Jill Tinmouth¹³, Becky Wall⁹, Eva Grunfeld³

Affiliations

¹ Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. lawrence.paszat@ices.on.ca.
² Institute for Clinical Evaluative Sciences, University of Toronto, St. Michael's Hospital, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
³ Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada.
⁴ University of Toronto, St Michael's Hospital Family Practice Unit, 30 Bond St, Toronto, ON, M5B1W8, Canada.
⁵ University of Toronto, 410 Sherbourne St, 4th Floor, Toronto, ON, M5, Canada.
⁶ University of Toronto, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1R8, Canada.
⁷ University of Toronto, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
⁸ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
⁹ Durham Region Health Department, 605 Rossland Road E, Whitby, ON, L1N6A3, Canada.
¹⁰ Department of Family Medicine, Grey Nuns Family Medicine Clinic, University of Alberta, 2927 - 66th St NW, Edmonton, AB, T6K4C1, Canada.
¹¹ Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5, Canada.
¹² Department of Family Medicine, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G2T4, Canada.
¹³ University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.

PMID: 28962558
PMCID: PMC5622533
DOI: 10.1186/s12889-017-4797-3

Randomized Controlled Trial

BETTER HEALTH: Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings

Lawrence Paszat et al. BMC Public Health. 2017.

. 2017 Sep 29;17(1):754.

doi: 10.1186/s12889-017-4797-3.

Authors

Affiliations

¹ Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. lawrence.paszat@ices.on.ca.
² Institute for Clinical Evaluative Sciences, University of Toronto, St. Michael's Hospital, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
³ Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada.
⁴ University of Toronto, St Michael's Hospital Family Practice Unit, 30 Bond St, Toronto, ON, M5B1W8, Canada.
⁵ University of Toronto, 410 Sherbourne St, 4th Floor, Toronto, ON, M5, Canada.
⁶ University of Toronto, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1R8, Canada.
⁷ University of Toronto, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
⁸ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
⁹ Durham Region Health Department, 605 Rossland Road E, Whitby, ON, L1N6A3, Canada.
¹⁰ Department of Family Medicine, Grey Nuns Family Medicine Clinic, University of Alberta, 2927 - 66th St NW, Edmonton, AB, T6K4C1, Canada.
¹¹ Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5, Canada.
¹² Department of Family Medicine, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G2T4, Canada.
¹³ University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.

PMID: 28962558
PMCID: PMC5622533
DOI: 10.1186/s12889-017-4797-3

Abstract

Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening (BETTER) cluster randomized trial in primary care settings demonstrated a 30% improvement in adherence to evidence-based Chronic Disease Prevention and Screening (CDPS) activities. CDPS activities included healthy activities, lifestyle modifications, and screening tests. We present a protocol for the adaptation of BETTER to a public health setting, and testing the adaptation in a cluster randomized trial (BETTER HEALTH: Durham) among low income neighbourhoods in Durham Region, Ontario (Canada).

Methods: The BETTER intervention consists of a personalized prevention visit between a participant and a prevention practitioner, which is focused on the participant's eligible CDPS activities, and uses Brief Action Planning, to empower the participant to set achievable short-term goals.

Better health: Durham aims to establish that the BETTER intervention can be adapted and proven effective among 40-64 year old residents of low income areas when provided in the community by public health nurses trained as prevention practitioners. Focus groups and key informant interviews among stakeholders and eligible residents of low income areas will inform the adaptation, along with feedback from the trial's Community Advisory Committee. We have created a sampling frame of 16 clusters composed of census dissemination areas in the lowest urban quintile of median household income, and will sample 10 clusters to be randomly allocated to immediate intervention or six month wait list control. Accounting for the clustered design effect, the trial will have 80% power to detect an absolute 30% difference in the primary outcome, a composite score of completed eligible CDPS actions six months after enrollment. The prevention practitioner will attempt to link participants without a primary care provider (PCP) to a local PCP. The implementation of BETTER HEALTH: Durham will be evaluated by focus groups and key informant interviews.

Discussion: The effectiveness of BETTER HEALTH: Durham will be tested for delivery in low income neighbourhoods by a public health department.

Trial registration: NCT03052959, registered February 10, 2017.

Keywords: Chronic disease; Cluster randomized trial; Deprivation; Prevention; Screening.

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Conflict of interest statement

Authors’ information

There is no other authors’ information.

Ethics approval and consent to participate

This work has been approved by the Research Ethics Board of Sunnybrook Health Sciences Centre, Toronto, Ontario Canada (approval number 222–2016). . Recruitment has not commenced. When recruitment commences, written informed consent will be sought from individual participants.

Consent for publication

This manuscript does not contain any material or data for which consent for publication is required.

Competing interests

All authors have received research funding for this trial from the Canadian Institutes for Health Research and the Canadian Cancer Society Research Institute. There are no other competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Consolidated Framework for Implementation Research adapted to BETTER HEALTH: Durham. Adapted from: Damschroder [25]

**Fig. 2**
Adapted Knowledge to Action Process for BETTER HEALTH: Durham. Adapted from Canadian Institues for Health Research [35]

See this image and copyright information in PMC

References

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1. Kiran T, Wilton AS, Moineddin R, Paszat L, Glazier RH. Effect of payment incentives on cancer screening in Ontario primary care. Ann Fam Med. 2014;12:317–323. doi: 10.1370/afm.1664. - DOI - PMC - PubMed
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1. Grunfeld E, Manca D, Moineddin R, Thorpe KE, Hoch JS, Campbell-Scherer D, Meaney C, Rogers J, Beca J, Krueger P, Mamdani M for the BETTER Trial Investigators Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial. BMC Fam Pract. 2013;14:175. doi: 10.1186/1471-2296-14-175. - DOI - PMC - PubMed

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BETTER HEALTH: Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings

Affiliations

BETTER HEALTH: Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings

Authors

Affiliations

Abstract

Conflict of interest statement

Authors’ information

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical