The intervention was health coaching, as defined previously.82We describe the intervention according to the TIDieR (Template for Intervention Description and Replication) guidelines99inTable 11and show a schematic of the process inFigure 4. The intervention was based on three mechanisms: (1) health coaching, (2) social prescribing and (3) low-intensity support for low mood. Social prescribing is linking patients and resources in the wider community.100,101Low-intensity support for low mood includes the assessment of common mental health problems, simple lifestyle advice and behavioural techniques to manage mood, and appropriate risk protocols.102,103
TABLE 11 Description of the intervention
TIDieR category Description of PROTECTS
What Telephone health coaching: the core telephone and health coaching materials include telephone and associated patient tracking and management software, and scripts for lifestyle support around diet, exercise, smoking and alcohol
Social prescribing: advisors had access to local resources in Salford through the Ways to Well-being site Support for low mood: around three core areas (assessment of symptoms, advice and behavioural activation, risk assessment)
Who The intervention was delivered by a health advisor (Agenda for Change band 4 worker) with essential skills in working with information technology and communication, as well as experience of working with the general public, good time management and an ability to work flexibly and under time pressure. The health advisors were supported by specialist nurses and managers within the ICC, with additional advice around mental health and social prescribing from the academic team
How and where The health coaching was delivered via telephone from a central facility When and how
much
Proactive, monthly calls of around 20 minutes were made for a period of 6 months, with the option for additional calls to deal with complex patients or issues of risk
Tailoring Health coaching staff were trained to customise the pace and detail of the call to the social context of the individual patient. Provision of support for low mood and access to community resources was provided when appropriate
Modifications There were no major changes to the delivery of the intervention through the study
How well The fidelity of the intervention was assessed by qualitative work with patients and staff and ensured by ongoing clinical supervision
Level Description
1 Patients do not feel in charge of their own health and care, with low confidence in their ability to manage health and few problem-solving skills or coping skills
2 May lack basic knowledge about their long term-condition(s) and have low confidence in their ability to manage health, with limited knowledge about appropriate treatments and self-management behaviours. Patients expect their health and social care professionals to be in charge in terms of making decisions
3 Patients have basic facts relating to their long term-condition(s) and appropriate treatments. Patients will have some experience and success in making changes to self-management behaviour, as well as some confidence in handling limited aspects of their health
4 Patients have made most of the necessary behaviour changes, although they may face difficulty in maintaining behaviours over time or during times of stress
Training and supervision
The intervention was delivered by a health advisor (Agenda for Change band 4) who was already
delivering health coaching to patients with diabetes mellitus or pre-diabetes mellitus. Training focused on the additional skills needed when dealing with a wider range of long-term conditions and dealing with low mood. A session on long-term conditions was run by a GP from the CLASSIC team, to help prepare for potential queries. Advisors were encouraged to refer people to the NHS Choices website.
Advisors were trained in detecting and working with participants with low mood over a 2-day training session with further updates over time. They were given the opportunity to role play low mood assessments and delivering interventions.They also received a comprehensive manual to aid them in delivery of the low mood component.
The advisors received clinical supervision (initially fortnightly, then monthly from applicant KL) by group for 1 hour. They had an opportunity to discuss challenging calls and risk issues. They were supported in making decisions about how to progress the intervention for each patient who identified as having low mood and in delivering structured low mood intervention such as behavioural activation. The advisors had contact details for the supervisors for immediate concerns.
Outcomes
The PROTECTS trial was a cmRCT,20for which a large population cohort is recruited and followed systematically over time. Participants were followed up as detailed inChapter 7. Outcomes used in the PROTECTS trial were prespecified in an analytic plan (seeAppendix 1,Tables 52–61).
Introduction/welcome/background Assessment of low mood No low mood/ anxiety Low mood/ anxiety
The areas of focus for the patient: Exercise
General scripts: • Key lifestyle messages Scripts:
• Smoking Scripts:
• Meal planning • Weight
• Food types (dairy, fats, etc.)
Scripts: • Physical activity • Barriers to activity Websites: • Way to Well-being • PLANS Scripts: • Alcohol Alcohol Social activity Smoking Diet Mental health component manual Brief patient- centred assessment Goal-setting and action- planning Brief psychological interventions: • Behavioural activation • Cognitive restructuring • Problem-solving Goal-setting and action- planning
FIGURE 4 Schematic of health coaching process. PLANS, Patient-Led Assessment for Network Support.
modification of an existing service, for which the likely risks are minimal, a Data Monitoring Committee was not used.104