Noah Wayne*, School of Kinesiology and Health Science, Toronto, Canada Joseph Cafazzo*, Centre for Global eHealth Innovation, University Health Network, Toronto, Canada Paul Ritvo*, School of Kinesiology and Health Science, Toronto, Canada Track: Research Presentation Topic: e-Coaching Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2013-09-25

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Background: Multiple data sources indicate economically disadvantaged populations have higher risks for chronic disease complications, with Type 2 Diabetes a primary concern. Because adoptions of healthier lifestyle behaviors can reduce Diabetes risks and complications, and associated healthcare expenditures, the challenge for healthcare practitioners is to effectively assist patients in adopting and longitudinally adhering to disease-preventive behaviors. Smartphone interventions can supply needed cohesion for patients impeded in contacts with primary care due to night and evening shiftwork, travel difficulties and reticence when communicating with physicians.
Methods: This trial was a single-arm pilot that tested a smartphone application developed with investigator-assistance (as domain experts). Smartphone-connected, health coaches applied health behaviour change methods (motivational interviewing, cognitive behavioral therapy) receiving real time self-report on exercise, diet and glucose self-monitoring through the smartphone app. N = 20 participants from a wide range of ethnic and socioeconomic groups were recruited from a Community Health Centre in Toronto, Canada and most had no prior experience using smartphones. E-health coaching supported adherence to glucose self-monitoring, modified food intake (through photo-journaling of meals), increased exercise and stress management. Study participants aided in software development, providing continuous user feedback that was applied in software modifications.
Results: Of N = 20 subjects recruited, N = 13 subjects completed the 6 month trial. N = 4 had baseline HbA1c levels>7.0% which were reduced by a mean of 0.68%. N = 2 had mean HbA1c levels at 6.4% which were reduced by 0.45%. N = 7 subjects had no HbA1c change or minor elevations.
Discussion: This project was a unique effort to combine development of smartphone software and an e-health coaching protocol uniquely addressing economically disadvantaged Type 2 diabetic patients. The project demonstrated the feasibility of electronic coaching for disadvantaged, ethnic minorities who can benefit from increased coherence and support with diabetes management. With lessons learned from the single-arm trial, a randomized controlled trial is now underway, intervening with N=120 participants using an improved version of the health coach software.