During the pandemic, online health coaching from medical students helped veterans and Canadians improve their physical and mental health.
By Steven Grover
In 1995, the McGill Comprehensive Health Improvement Program (CHIP) was launched in Montreal. Over the first decade, it rapidly evolved to provide both primary and secondary disease prevention services for individuals with cardiometabolic health problems (cardiovascular disease, diabetes, pre-diabetes, obesity, cancer, etc.) and mental health issues that can often be prevented or managed with the adoption of lifestyle habits including regular exercise, healthy eating, and stress management.
CHIP quickly became a clinical laboratory for research studies focusing on engaging individuals to make healthy lifestyle changes by supporting education, self-efficacy, ongoing monitoring, and regular feedback. Over the past 15 years, digital health tools and web-based health promotion have grown to play an increasingly important role.
From day one, engaging participants in “shared decision making” proved to be an essential part of our mission. Our research group had previously developed and validated a computerized risk assessment to estimate a patient’s “Cardiovascular Age.” Discussing the risk assessment between patients and their physicians were subsequently shown to improve the management of dyslipidemia and hypertension. In 2017, the “Cardiovascular Age” calculator was replaced with a validated “Cardiometabolic Age” assessment that could help individuals evaluate the potential benefits of weight loss, regular exercise, and adherence to prescribed medication to reduce the lifelong complications associated with both cardiovascular disease and diabetes. We are now completing a new, validated “Healthy Brain Age” calculator to estimate the lifelong risk of developing Alzheimer’s disease and vascular dementia. We hope to demonstrate that this new assessment will further engage individuals at increased risk to make healthy lifestyle changes. Dementia is a particularly interesting target for shared decision-making given that many individuals, as they become middle aged, appreciate that their cognitive function is slowing down with the increasing years.
One of the important early lessons was recognizing the significant inertia that surrounds human behaviour and the importance of teachable moments to motivate individuals to make changes. Beyond the onset of new medical problems, several life events were identified that could provide this starting point, including: the birth of a new child, adult children leaving home, or the evolving care of an elderly parent. In 2020, the impact of the COVID-19 pandemic joined this list.
Now that the pandemic is coming to an end, there is growing interest in regaining one’s pre-pandemic health, or improving one’s health to mitigate the impact of the next public health challenge. Digital health solutions have never been more important in reaching out to Canadians on a broad scale at minimal cost. The challenge is now proving that digital health programs, can actually engage individuals “in the real world” and demonstrate measurable health benefits.
Effective online platforms
During the pandemic, we have been providing six to 10-week programs using two online platforms for veterans and their families (www.missionvav.com) and other Canadians interested in building resiliency through exercise, healthy eating, social connectivity and stress management (www.nvigorus.com). Weight reduction has also proven important given the nationwide impact of unwanted “pandemic pounds.”
Recently the first “ZEN Mission” was completed focusing on improving mental health. Family Fitness Missions have encouraged Canadians to reach out to their children, parents and grandparents who were particularly susceptible to the social isolation during the pandemic.
Upon arriving on the landing page, all participants are invited to register on the platform in English or French. After providing informed consent, each participant provides sociodemographic data, and medical history details. Depending on the focus of the upcoming challenge, brief online assessments evaluate their health at baseline. Validated assessments may include the following: cardiometabolic health, healthy eating habits, weight history, stress, mood, sleep quality, exercise habits, alcohol consumption, etc. Participants are then introduced to the specific features of that month’s program and begin daily tracking of newly acquired lifestyle habits.
Evidence-based, educational modules are available following each assessment that underscore the effectiveness of behaviour change to reduce specific symptoms, improve health, and quality of life. Modules include quizzes and a health library to provide more information for those who are interested.
Gamification and social connectivity
To support behaviour change, participants are encouraged to form a team with at least one other friend or family member to enhance peer support. Gamification techniques are used to engage participants with daily points assigned for completing assessments, reading the short educational module, tracking, communicating with other participants, checking the leader board, and reading daily healthy tips. Each participant tracks their steps, or the time spent in specific physical activities which are then translated into step equivalents. Apps are available for digital devices and smartphone step tracking to sync with the platform. Ongoing data analysis and regular updates are provided to participants. At the end of each challenge, participants are asked to reassess their mental and physical health metrics so that they can appreciate the benefits of changing habits.
Early in the pandemic we were fortunate to identify a cohort of McGill Medical students looking for additional clinical experience given reduced hospital services. Health coaches were provided with an online dashboard to track the performance of each participant on a daily basis. This information is used to customize each weekly email to ensure that feedback is timely and personalized. The positive impact was immediate. Significantly fewer drop-outs in the first two weeks and higher completion rates during the program.
Results to date
Prior to the pandemic, we demonstrated that in the workplace, on military bases, and among hospital employees, participation in these online programs resulted in measurable benefits including reductions in blood pressure, weight, and improvements in mental health metrics including sleep, fatigue, stress, and symptoms of depression.
As of July, 2021, the missionvav and nvigorus programs have been used by over 3,000 participants including Canadian veterans and their families, employees of the Federal Government, and interested Canadian families across the country.
Dr. Steven Grover is a professor in the Department of Medicine at McGill University.