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An Adjusted Preventive Program Against Lifestyle Related Diseases (TOFpilot2)

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ClinicalTrials.gov Identifier: NCT03913585
Recruitment Status : Recruiting
First Posted : April 12, 2019
Last Update Posted : April 16, 2019
Sponsor:
Collaborator:
University of Oslo
Information provided by (Responsible Party):
University of Southern Denmark

Brief Summary:

A large proportion of the Danish population leads an unhealthy lifestyle. The associated surge in lifestyle-related disease (LRD) represents a significant health and economic burden for the individual as well as society. However, the reactive nature of the Danish national health-care system, complicates a comprehensive and concerted preventive response to this issue. The TOF project aims to remedy this situation by 1) Using digital support systems to systematically identify citizens at risk of LRD and 2) Target the preventive services at citizens with the highest need. Specifically, the ultimate goal of TOF is to integrate the clinical and municipal preventive primary health-care system into a targeted preventive service that facilitates lifestyle change in the at-risk population, and thus reduces LRD at a population level. To this end, we have developed a complex intervention in close collaboration with central stakeholders (health professionals, citizens). The initial feasibility of the intervention has been tested in a pilot study comprising two municipalities, 47 GPs, and 8814 citizens. The intervention has subsequently been adjusted in collaboration with the end users, focusing both on recruitment activities and implementation activities in general practice. The upcoming step involves testing of the adjusted intervention (Pilot2), before large-scale implementation and efficacy evaluation.

The feasibility, acceptability, and short-term effect of the adjusted intervention will be tested in two municipalities using quantitative as well as qualitative research methods. The evaluation will focus on the reach of the intervention, the implementation and acceptability of the intervention in general practice and municipality, the use and assessment of the digital support system and the possible short-term effects on patient lifestyle and risk of disease. We expect 15 general practitioners and 4800 patients to participate.

The intervention comprises four main components:

  1. Participants will be screened for LRD-risk factors by survey
  2. Survey information is linked with participants' medical history in order to stratify participants into designated risk groups
  3. Depending on risk level, participants will be offered targeted interventions at the GP or municipality.
  4. Throughout the intervention, a digital support system providing personalized feedback and advice (health profile) to participants will be accessible to both participants and health professionals.

Condition or disease Intervention/treatment Phase
Lifestyle-Related Disorder Behavioral: Lifestyle intervention Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 4800 participants
Intervention Model: Single Group Assignment
Intervention Model Description: To test the acceptability, feasibility and short-term effect of a selective preventive program that systematically helps citizens evaluate individual risk of lifestyle related disease and, if needed, offers targeted and coordinated preventive services in the primary health care sector.
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Early Detection and Prevention of Lifestyle Related Diseases - Pilot2
Actual Study Start Date : October 22, 2018
Estimated Primary Completion Date : May 31, 2020
Estimated Study Completion Date : August 31, 2020

Arm Intervention/treatment
Experimental: Lifestyle intervention
The intervention group comprises ~4800 patients born 1959-1988, living in the municipalities of Haderslev or Middelfart, and affiliated to one of the participating GPs. No control group is included.
Behavioral: Lifestyle intervention
Upon inclusion and consent all patients receive a questionnaire to estimate risk of disease and risk behavior. Information about lifestyle is systematically registered and collated with existing Electronic Patient Record (EPR) data and the patients risk of developing a lifestyle-related disease is estimated based on validated algorithms for risk of type-2 diabetes, cardiovascular disease and COPD (Stratification). All patients receive digital feedback including a personal health profile and targeted advice. Patients at high risk of lifestyle-related disease(s) are offered targeted prevention activities at the GP including a health examination and if needed a health dialog. Patients with health risk behavior are offered behavior counselling in the municipality and community health services, if necessary. Patients diagnosed with a lifestyle related disease and patients with a healthy lifestyle are not offered any further services.
Other Name: TOF project




Primary Outcome Measures :
  1. Participation (Consent) [ Time Frame: From initial invitation (consent) (October 2018) to deadline for consent (6 weeks later) ]
    Participation (Consent) is defined as the proportion of citizens who following the initial invitation concents to take part in the study.

  2. Participation (Personal Health Profile) [ Time Frame: From invitation to receive a personal health profile (April 2019) to deadline for receiving the personal health profile (4 months later) ]
    Participation (Personal Health Profile) is defined as the proportion of consenting participants who receives a personale health profile.

  3. Participation (Targeted intervention in General practice or Municipality) [ Time Frame: From second invitation (April 2019) to deadline for receiving the targeted interventions (4 months later) ]
    Participation (Targeted intervention in General practice or Municipality) is defined as the proportion of participants (Personal Health Profile) who takes up the targeted intervention in general practice or municipality.


Secondary Outcome Measures :
  1. Change in patient health risk behaviour (lifestyle) from study commencement to 12 months follow up [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    Lifestyle is defined by smoking habits, alcohol intake, excercise habits and dietary habits, and health risk behaviour is defines by smoking tobacco on a daily basis, consuming more than 14/21 (male/female) standard units of alcohol per week, sustaining an unhealthy diet (diet score ≤4 on a 12-point score drawn from the Swedish National Guidelines on Disease Prevention), maintaining a BMI ≥ 35, and/or engaging in a generally sedentary lifestyle.

  2. Qualitative evaluation of the digital support system with focus on experienced usefulness [ Time Frame: Observations will be conducted during full working days at the municipal health centers and in general practice. Interviews will be of approximately 30 minutes duration. ]

    Participant observations about using the digital support system in GP clinics (1-2 days, 2-4 GP clinics), municipal health centers (1-2 days, 2 municipal health centers) and if possible at citizens homes.

    Interviews of general practice staff, municipal health professionals, and patients conducted during and after the observations.


  3. Qualitative process evaluation focusing on the intervention in general practice [ Time Frame: Observations will be conducted during the health checks (10 minutes) and the health dialogues (30 minutes). The subsequent interviews will be of up to 30 minutes duration. ]
    Ethnographic observational studies of 10 patients, stratified to receive a health check and dialogue with their GP/practice staff. The interaction between these patients and the relevant health professional will be observed, and both parties will further be asked to participate in semi-structured individual interviews.

  4. Qualitative process evaluation focusing on the intervention in the municipality [ Time Frame: The semistructured individual interviews will be of up to 30 minutes duration. The focus group interviews will be of up to 2 hours duration. ]

    Ten participants who receive health advice/assistance from their municipality will be asked to participate in semi-structured individual interviews.

    One or two focus groups with municipal health-care staff and leaders will be conducted in each participating municipality.


  5. Patients' perceptions of relational empathy following the health dialogue at the GP and municipality [ Time Frame: Immediately following each health dialogue ]
    Following each behavior counseling session in general practice and municipality the patients perception of the health professionals empathy is measured by The Consultation And Relational Empathy (CARE) measure (score range: 10-50)

  6. Patient reported self-efficacy before study commencement and at one year follow up [ Time Frame: At consent and 1 year follow up ]
    Participants self-efficacy will be assessed before study commencement and at one year follow up using the The General Self-Efficacy Scale (total score range: 10-40; The higher the score, the higher the level of self-efficacy)

  7. Patient reported mental well-being before study commencement, immediately after the study period and at one year follow up [ Time Frame: At consent, immediately after the study period and at 1 year follow up ]
    Participants mental well-being will be assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (total score range: 7-35; The higher the score, the higher the level of mental well-being)

  8. Participants social network before study commencement and at one year follow up [ Time Frame: At consent and 1 year follow up ]
    The extent and quality of the participants social network will be assessed using Lubbens Social Network Scale 6 (LSNS-6) (total scale range: 0-60; the higher the score, the stronger the social network)

  9. Perceived social network norms before study commencement and at one year follow up [ Time Frame: At consent and 1 year follow up ]
    The perception of participants with regard to the social networks norms on lifestyle will be assesed using a validated two-item measure from the Theory of Planned Behavior

  10. Osteoarthritis risk factors at study commencement and one year follow up [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    Prevalence of osteoarthritis (OA) risk factors will be assessed by questions on the presence of persistent knee and/or hip pain, previous knee/hip injury, previous knee/hip surgery, leisure time physical activity, and family history of OA

  11. Uptake of targeted intervention against osteoarthritis (GLA:D) [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    The number of participants taking up a targeted intervention against osteoarthritis (GLA:D) will be assessed from the GLA:D-register

  12. Change in proportion of patients at increased risk of diabetes from study commencement to 12 months follow up [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    Risk of diabetes is identified using the validated risk score: the Danish Diabetes Risk model. The Danish Diabetes Risk score is based on an algorithm that incorporates age, sex, BMI, known hypertension, leisure activity level, and family history of diabetes.

  13. Change in proportion of patients at increased risk of COPD from study commencement to 12 months follow up [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    Risk of COPD is identified using the validated risk score: the Chronic Obstructive Pulmonary Disease Population Screener (COPD-PS). The COPD-PS uses an algorithm accounting for age, lifetime use of cigarettes, and smoking-related symptoms to identify at-risk patients who may benefit from a spirometry to test for COPD.

  14. Change in proportion of patients at increased risk of CVD from study commencement to 12 months follow up [ Time Frame: From receipt of personal health profile (April 2019) to one year follow up ]
    Risk of CVD is identified using a modified Heartscore BMI score. The modified Heartscore BMI score accounts for age, sex, body mass index (BMI), and smoking status.

  15. Patients perception of the shared decision making proces during health consultations [ Time Frame: Immediately following each health dialogue ]
    Shared decision making is measured by the The 9-item Shared Decision Making Questionnaire (SDM-Q-9)

  16. Health professionals perception of the shared decision making proces during health consultations [ Time Frame: Immediately following each health dialogue ]
    Shared decision making is measured by the The 9-item Shared Decision Making Questionnaire (SDM-Q-doc)

  17. Patient reported meaning-making [ Time Frame: At consent and at one year follow up ]
    Questionnaire items sampled from the validated questionnaire SoMe (Sources of Meaning) and European Value Study (EVS).

  18. Patient reported spiritual wellbeing [ Time Frame: At consent and at one year follow up ]
    Questionnaire items from the validated questionnaire SoMe (Sources of Meaning) and European Value Study (EVS).

  19. Patient reported religious belief and practices [ Time Frame: At consent and at one year follow up ]
    Questionnaire items sampled from the validated questionnaire SoMe (Sources of Meaning) and European Value Study (EVS).



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Ages Eligible for Study:   29 Years to 59 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • GP affiliation: Patients affiliated to one of the participating GPs
  • Year of birth: 1959-1988
  • Place of recidence: Municipalities of Haderslev or Middelfart

Exclusion Criteria:

  • Patients invited to participate in TOFpilot1
  • No access to digital mail (e-Boks)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03913585


Contacts
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Contact: Trine Thilsing, DVM, PhD, Associate professor +45 65507195 ext +4565507195 tthilsing@health.sdu.dk
Contact: Jens Søndergaard, MD, PhD, professor, head of research unit +45 65503691 ext +4565507195 jsoendergaard@health.sdu.dk

Locations
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Denmark
National Institute of Public Health, University of Southern Denmark Not yet recruiting
Copenhagen, Denmark, 1353
Contact: Marie Broholm-Jørgensen, MPH, PhD, Postdoc    +45 65507819    mbro@si-folkesundhed.dk   
Contact: Tine Tjørnhøj-Thomsen, PhD, Professor    +45 65507811    titt@si-folkesundhed.dk   
Sub-Investigator: Marie Broholm-Jørgensen, MPH, PhD, Postdoc         
Principal Investigator: Tine Tjørnhøj-Thomsen, PhD, Professor         
Research Unit of General Practice, Dept. of Public Health, University of Southern Denmark Recruiting
Odense, Denmark, 5000
Contact: Trine Thilsing, DVM, PhD, Associate professor    +45 65507195 ext +4565507195    tthilsing@health.sdu.dk   
Contact: Jens Søndergaard, MD, PhD, professor, head of research unit    +45 65503691 ext +4565503691    jsoendergaard@health.sdu.dk   
Principal Investigator: Jens Søndergaard, MD, PhD, professor, head of research unit         
Sub-Investigator: Trine Thilsing, DVM, PhD, Associate professor         
Sub-Investigator: Lars Bruun Larsen, MPH, PhD         
Sub-Investigator: Niels Christian Hvidt, PhD, Professor         
Sub-Investigator: Anders Sønderlund, Social Psychologist, PhD, Postdoc         
Sub-Investigator: Nanna Herning Svensson, MPH         
Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark Not yet recruiting
Odense, Denmark, 5230
Contact: Ewa Roos, PT, PhD, Professor, Head of Research Unit    +45 65504331    eroos@health.sdu.dk   
Contact: Jonas Bloch Thorlund, MSc, PhD, Associate Professor    +45 65503894    jthorlund@health.sdu.dk   
Principal Investigator: Ewa Roos, PT, PhD, Professor, Head of Research Unit         
Sub-Investigator: Jonas Bloch Thorlund, MSc, PhD, Associate Professor         
Department of People and Technology, Roskilde University Recruiting
Roskilde, Denmark, 4000
Contact: Troels Mønsted, PhD    +45 28440734    monsted@ruc.dk   
Principal Investigator: Troels Mønsted, PhD         
Sponsors and Collaborators
University of Southern Denmark
University of Oslo
Investigators
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Principal Investigator: Trine Thilsing, DVM, PhD, Associate professor Research Unit of General Practice, Dept. of Public Health, University of Southern Denmark, DK-5000 Odense C, Denmark
Study Director: Jens Søndergaard, MD, PhD, professor, head of research unit Research Unit of General Practice, Dept. of Public Health, University of Southern Denmark, DK-5000 Odense C, Denmark

Publications:
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Responsible Party: University of Southern Denmark
ClinicalTrials.gov Identifier: NCT03913585     History of Changes
Other Study ID Numbers: TOFpilot2
18/32742 ( Registry Identifier: Research & Innovation Organisation, University of Southern Denmark )
ID: 125508 ( Other Grant/Funding Number: Trygfonden )
18/5270 ( Other Grant/Funding Number: The Committee of Quality and Education in General Practice, The Region of Southern Denmark )
11/13244 ( Other Grant/Funding Number: Region of Southern Denmark )
First Posted: April 12, 2019    Key Record Dates
Last Update Posted: April 16, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University of Southern Denmark:
Tailored lifestyle intervention
Selective prevention
Primary care
Web based health risk assessment
Patient-centered health information system

Additional relevant MeSH terms:
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Mental Disorders