title: A randomized comparative effectiveness study of Healthy Directions 2--a multiple risk behavior intervention for primary care.
abstract: OBJECTIVE
  To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting.
  
  
  METHODS
  HD2 was a cluster randomized trial (conducted 3/09-11/11). The primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2440). Study arms included: 1) usual care (UC); 2) HD2--a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up.
  
  
  RESULTS
  At baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6 months, vs. 39% and 43% in HD2 and HD2+CC, respectively (ps≤.001); results were similar at 18 months (p≤.05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and $450 for HD2+CC.
  
  
  CONCLUSIONS
  Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.
authors.affiliation: Kaiser Foundation Research Institute, 1800 Harrison Avenue, Oakland, CA 94612, USA. Electronic address: Karen.m.emmons@kp.org.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.affiliation: University of Massachusetts Amherst, Amherst, MA, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.affiliation: University of Rhode Island, Kingston, RI, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Greaney
authors.affiliation: Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Duke University, Department of Psychology and Neuroscience, Box 90086, 417 Chapel Drive, Durham NC 27708-0086.
authors.forename: Gary G
authors.initials: GG
authors.lastname: Bennett
authors.affiliation: University of Guelph, Guelph, Ontario, Canada.
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Sprunck-Harrild
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Viswanath
mesh_terms: D001900:Boston; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000379:methods; D004032:Diet; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000517:prevention & control; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods; D016540:Smoking Cessation / Q000379:methods; D017216:Telemedicine / Q000379:methods
keywords: Cancer prevention; Multimorbidities; Physical activity; Primary care intervention; Red meat; Smoking cessation