BETTER HEALTH : Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings
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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.
Paszat , L , Sutradhar , R , O'Brien , M A , Lofters , A , Pinto , A , Selby , P , Baxter , N , Donnelly , P D , Elliott , R , Glazier , R H , Kyle , R , Manca , D , Pietrusiak , M-A , Rabeneck , L , Sopcak , N , Tinmouth , J , Wall , B & Grunfeld , E 2017 , ' BETTER HEALTH : Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings ' , BMC Public Health , vol. 17 , 754 . https://doi.org/10.1186/s12889-017-4797-3
BMC Public Health
Copyright © The Author(s). 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
DescriptionFunding: Funded as a grant proposal entitled ‘Advancing Cancer Prevention Among Deprived Neighbourhoods’ by the Canadian Cancer Society Research Institute grant #704042 and by the Canadian Institutes for Health Research Institute of Cancer grant OCP #145450.
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