title: A Coaching by Telephone Intervention for Veterans and Care Team Engagement (ACTIVATE): A study protocol for a Hybrid Type I effectiveness-implementation randomized controlled trial.
abstract: A large proportion of deaths and many illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. Health risk assessments (HRAs) are widely available online but have not been consistently used in healthcare systems to activate patients to participate in prevention programs aimed at improving lifestyle behaviors.
  
  
  
  The goal of this study is to test whether adding telephone-based coaching to use of a comprehensive HRA increases at-risk patients' activation and enrollment into a prevention program compared to HRA use alone.
  
  
  
  Participants were randomized to either complete an HRA alone or in conjunction with a telephone coaching intervention. To be eligible Veterans had to have at least one modifiable risk factor (current smoker, overweight/obese, or physically inactive). The primary outcome is enrollment and participation in a prevention program by 6months. Secondary outcomes include change in a Patient Activation Measure and Framingham Risk Score.
  
  
  
  This study is the first to test a web-based health risk assessment coupled with a health coaching intervention within a large healthcare system. Results from this study will help the Veterans Health Administration (VHA) implement its national plan to include comprehensive health risk assessments as a tool to engage Veterans in prevention. The results will also inform health systems outside VHA who seek to implement Medicare's advisement that health risk assessment become a mandatory component of care under the Affordable Care Act.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA. Electronic address: eugene.oddone@va.gov.
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gierisch
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Maren
authors.initials: M
authors.lastname: Olsen
authors.affiliation: VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Sanders
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Sparks
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Turner
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: May
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: McCant
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Curry
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: White-Clark
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Juntilla
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D000071252:Mentoring / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy*; D012107:Research Design; D018570:Risk Assessment; D057185:Sedentary Behavior; D012907:Smoking / Q000628:therapy*; D012959:Socioeconomic Factors; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Health coaching; Health risk assessment; Prevention program