title: Health coaching and genomics-potential avenues to elicit behavior change in those at risk for chronic disease: protocol for personalized medicine effectiveness study in air force primary care.
abstract: BACKGROUND
  Type 2 diabetes (T2D) and coronary heart disease (CHD) are prevalent chronic diseases from which military personnel are not exempt. While many genetic markers for these diseases have been identified, the clinical utility of genetic risk testing for multifactorial diseases such as these has not been established. The need for a behavioral intervention such as health coaching following a risk counseling intervention for T2D or CHD also has not been explored. Here we present the rationale, design, and protocol for evaluating the clinical utility of genetic risk testing and health coaching for active duty US Air Force (AF) retirees and beneficiaries.
  Determine the direct and interactive effects of health coaching and providing genetic risk information when added to standard risk counseling for CHD and T2D on health behaviors and clinical risk markers.
  
  
  METHODS
  Four-group (2 X 2 factorial) randomized controlled trial.
  
  
  METHODS
  Two AF primary care clinical settings on the west coast of the United States.
  
  
  METHODS
  Adult AF primary care patients.
  
  
  METHODS
  All participants will have a risk counseling visit with a clinic provider to discuss personal risk factors for T2D and CHD. Half of the participants (two groups) will also learn of their genetic risk testing results for T2D and CHD in this risk counseling session. Participants randomized to the two groups receiving health coaching will then receive telephonic health coaching over 6 months.
  
  
  METHODS
  Behavioral measures (self-reported dietary intake, physical activity, smoking cessation, medication adherence); clinical outcomes (AF composite fitness scores, weight, waist circumference, blood pressure, fasting glucose, lipids, T2D/CHD risk scores) and psychosocial measures (self-efficacy, worry, perceived risk) will be collected at baseline and 6 weeks, and 3, 6, and 12 months.
  
  
  CONCLUSIONS
  This study tests novel strategies deployed within existing AF primary care to increase adherence to evidence-based diet, physical activity, smoking cessation, and medication recommendations for CHD and T2D risk reduction through methods of patient engagement and self-management support.
authors.affiliation: Duke University School of Nursing, United States.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Vorderstrasse
authors.affiliation: Institute for Genome Sciences & Policy, United States.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Ginsburg
authors.affiliation: Division of Cardiology, Duke Schools of Medicine and Nursing, United States.
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.affiliation: David Grant USAF Medical Center, Travis Air Force Base, California, United States.
authors.forename: Maj Carlos J
authors.initials: MC
authors.lastname: Maldonado
authors.affiliation: Duke Integrative Medicine, Department of Psychiatry & Behavioral Science, Duke School of Medicine, Center for Personalized Medicine, Duke University Health System, United States.
authors.forename: Ruth Q
authors.initials: RQ
authors.lastname: Wolever
keywords: Health coaching; behavior change; chronic disease; coronary heart disease; diabetes; genomics