The research

Open Health is backed by years of academic research, for example, a major systematic review of the literature to identify the specific behaviour change techniques and associated psychological frameworks utilised by successful health programs, whether face-to-face or online.  Another earlier review identified the key characteristics of effective internet-based health interventions.

We have also investigated models of health and wellbeing, lifestyle change programs around the world (whether face to face or online), trends in education towards online and social learning, social networking systems, and persuasive engagement techniques (eg: gamification) being used most effectively by the internet giants.

Below is a brief abstract from the original research proposal, explaining the rationale for, and significance of, the research.

Rationale

Chronic disease now accounts for over 70% of the global burden of illness in adults aged 30 years and over[1].

chronic conditions and risk factors comparison chartMost chronic conditions share common behavioural determinants and risk factors, including poor diet or nutrition, lack of physical activity, smoking, alcohol overconsumption, obesity, stress (including psychosocial), hypertension, dyslipidaemia, and hyperglycaemia in Diabetes. Conditions which may have lifestyle-related causes include cardiovascular diseases, stroke, Type 2 Diabetes, metabolic syndrome, lung diseases, kidney disease, asthma, arthritis, osteoporosis, dementia and some cancers[2].

It is estimated that 85% of the Australian population visits a General Practitioner (GP) at least once a year[3] with an average of five visits per person per year[4]. It is also recognised that most GP presentations are now underpinned by a lifestyle-related health condition and that primary care is an important intervention point for improving the health of a population[5]. Therefore, it is important to ensure that GPs are appropriately resourced to intervene and assist patients with multiple health behaviour change.

The modifiability of risk factors through physical activity and/or diet is well known. Research also suggests a multi-factorial ‘whole person’ approach may be more effective, with the addition of stress management and psychosocial factors[6,7]. Such programs would normally take place face-to-face in a small group setting. However, in-person interventions may be resource intensive, inaccessible to the wider community and unable to scale to meet demand.

Internet-based interventions have also been shown to be effective, specifically in achieving improvements in glycated haemoglobin (HbA1c), triglycerides, cholesterol, blood pressure, cardiovascular outcomes and quality of life[8,9]. Again, multi-factorial interventions may be more effective than those with only one or two lifestyle components[10,11].

In 2015, 86% of Australian households had access to the internet[12] and personal internet connectivity is now commonplace, therefore lifestyle change programs that are not only web-based, but smartphone and tablet friendly with sms messaging and email feedback have the potential to reach the majority of the population.

There is a clear and pressing need for an internet-based health behaviour change program that not only addresses multiple risk factors and behavioural determinants, but can be usefully disseminated by GPs and other healthcare professionals, in addition to use as a preventative and self-management tool by the general public.

Significance

This research directly addresses Australia’s National Health Priority Areas. It also addresses a number of priorities of the NHMRC, specifically a Key Priority Action of the Strategic Plan 2013-2015, “Improving care of patients with multiple and complex chronic disease[13].”

It also reflects priorities of the ANPHA Research Strategy 2013-2018[14] and the Agency’s 2010 mandate to target the lifestyle risk factors of chronic disease, specifically, “Interventions…to support behavioural changes in the social contexts of everyday lives[15].”

This initiative will make a significant contribution to the health and well-being of Australians and New Zealanders by addressing a gap in the healthcare system, providing practitioners and their patients with an accessible, scalable, cost-effective and sustainable resource to support health behaviour change intervention with the potential for long-term follow up.

References:
1. Strong et al. Preventing chronic diseases: how many lives can we save? Lancet 2005;366:1578–82.
2. Australian Institute of Health and Welfare, Canberra, Australia’s Health 2010. pp 61-125.
3. Catholic Health Australia and Newspoll Market Research, 2007. Medical treatment study, Catholic Health Australia, Canberra.
4. Medicare Australia, MBS Statistical data for 2007-08.
5. Neuwelt P, et al. Putting population health into practice through primary health care. N Z Med J. 2009 Feb 27;122(1290):98-104.
6. Ornish D, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23):2001-7.
7. Lorig KR, et al. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),1217-1223, 2001
8. Dalton, J.E., Web-based care for adults with type 2 diabetes. Can J Diet Pract Res, 2008. 69(4): p. 185-91.
9. Kuhl, E.A, et al. Internet-based behavioral change and psychosocial care for patients with cardiovascular disease: a review of cardiac disease-specific applications. Heart Lung, 2006. 35(6): p. 374-82.
10. Aalbers T, et al. Characteristics of effective Internet-mediated interventions to change lifestyle in people aged 50 and older: a systematic review. Ageing Res Rev. 2011 Sep;10(4):487-97.
11. Webb TL, et al. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010 Feb 17;12(1):e4.
12. Australian Bureau of Statistics. 8146.0 – Household Use of Information Technology, Australia, 2014-15
13. National Health and Medical Research Council. NHMRC Strategic Plan 2013–2015.
14. Australian National Preventive Health Agency. National Preventive Health Research Strategy (2013-2018).
15. Commonwealth of Australia Explanatory Memoranda. Australian National Preventive Health Agency Bill 2010.