What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial

Anjana E. Sharma; Rachel Willard-Grace; Danielle Hessler; Thomas Bodenheimer; David H. Thom

doi:10.1370/afm.1924

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Figure 1
CONSORT Diagram of study participants.
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Figure 2
Outcome measures at baseline, 12, and 24 months for patients in the health coaching arm of the 12-month randomized controlled trial.
HbA_1c = hemoglobin A_1c; LDL = low-density lipoprotein; SBP = systolic blood pressure

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Table 1

Baseline Participant Characteristics From Original RCT and Current 24 Month Follow-Up, Overall and by Study Arm

	All Participants at Baseline (n = 441)	All Participants in 12- and 24-Month Analysis (n = 290)	Usual Care Arm Participants in 12- and 24-Month Analysis (n = 133)	Health Coaching Arm Participants in 12- and 24-Month Analysis (n = 157)
Demographic Characteristics
Clinic site, % (No.)
Clinic site A	75.3 (332)	76.2 (221)	77.4 (103)	75.2 (118)
Clinic site B	24.7 (109)	23.8 (69)	22.6 (30)	24.8 (39)
Age, mean (SD), y	52.7 (11.1)	53.2 (10.8)	52.5 (11.5)	53.7 (10.2)
Female sex, % (No.)	55.3 (244)	56.6 (164)	62.4 (83)	51.6 (81)
Married or in long-term relationship, % (No.)	53.1 (234)	51.97 (150)	57.1 (76)	47.1 (74)
Born in United States, % (No.)	25.6 (113)	26.6 (77)	25.6 (34)	27.4 (43)
Years in United States, mean (SD)^a	18.2 (11.2)	18.6 (11.0)	17.4 (11.6)	19.6 (10.4)
Primary language, % (No.)
English	27.7 (122)	28.3 (82)	27.1 (36)	29.3 (46)
Spanish	68.7 (303)	69.0 (200)	70.7 (94)	67.5 (106)
Other	3.6 (16)	2.8 (8)	2.3 (3)	3.2 (5)
Race/Ethnicity, % (No.)
Asian/Pacific Islander	4.1 (18)	3.5 (10)	4.5 (6)	2.6 (4)
African American	19.0 (84)	20.0 (58)	19.6 (26)	20.4 (32)
Latino or Hispanic	70.1 (309)	69.7 (202)	71.4 (95)	68.2 (107)
White	2.5 (11)	2.8 (8)	3.0 (4)	2.6 (4/)
Other	4.3 (19)	4.1 (12)	3.0 (4)	6.4 (10)
Working status, % (No.)
Employed full time	18.6 (82)	18.3 (53)	17.3 (23)	19.1 (30)
Employed part time	25.6 (113)	27.9 (81)	29.6 (38)	27.4 (43)
Homemaker	13.8 (61)	13.5 (39)	16.5 (22)	10.8 (17)
Unemployed	16.1 (71)	14.5 (42)	16.5 (22)	12.7 (20)
Retired, Disabled, SSI, other	25.9 (114)	25.9 (75)	21.1 (28)	29.9 (47)
Education, % (No.)
<5th grade	22.7 (100)	23.1 (67)	26.3 (35)	20.4 (32)
6th to 8th grade	21.1 (93)	21.0 (61)	19.6 (26)	22.3 (35)
Some high school	13.4 (59)	13.1 (38)	12.0 (16)	14.0 (22)
High school graduate or GED	17.7 (78)	16.9 (49)	13.5 (18)	19.8 (31)
Some college	15.6 (69)	15.9 (46)	19.6 (26)	12.7 (20)
College graduate	9.5 (42)	10.0 (29)	9.0 (12)	10.8 (17)
Income, % (No.)
<$5,000	34.0 (150)	33.5 (97)	30.8 (41)	35.7 (56)
$5,000–$10,000	24.3 (107)	22.8 (66)	21.8 (29)	23.6 (37)
$10,000–$20,000	29.5 (130)	33.5 (97)	33.1 (44)	33.8 (53)
>$20,000	12.2 (54)	10.3 (30)	14.3 (19)	7.0 (11)
No. primary care visits in year before study, mean (SD)	5.4 (3.9)	5.2 (3.9)	5.2 (4.2)	5.3 (3.6)
Baseline Clinical Characteristics
BMI, mean (SD), kg/m2	31.6 (6.6)	31.7 (6.0)	31.7 (5.7)	31.8 (6.2)
HbA_1c, mean (SD), %^b	9.9 (1.5)	9.8 (1.5)	10.0 (1.5)	9.6 (1.4)
LDL, mean (SD), mg/dL^b	146.5 (34.9)	143.1 (32.2)	143.9 (32.5)	142.6 (32.3)
SBP, mean (SD), mm Hg^b	158.9 (15.1)	159.3 (15.4)	160.4 (16.6)	158.3 (14.2)
Uncontrolled at baseline, % (No.)
For 1 condition	72.6 (320)	74.5 (216)	75.9 (101)	73.3 (115)
For 2 conditions	23.6 (104)	22.1 (64)	21.1 (28)	22.9 (36)
For 3 conditions	3.9 (17)	3.5 (10)	3.0 (4)	3.8 (6)
For HbA_1c	35.8 (158)	35.5 (103)	33.1 (44)	37.6 (59)
For SBP	43.5 (192)	44.8 (130)	46.6 (62)	43.3 (68)
For LDL	51.9 (229)	48.6 (141)	47.4 (63)	49.7 (78)

HbA_1c = hemoglobin A_1c; LDL = low-density lipoprotein; SBP = systolic blood pressure; SSI = Supplemental Security Income
↵a For participants born outside the United States.
↵b Includes only patients eligible for the study on this measure (158 at baseline, and 103 at 24 months for HbA_1c; 192 at baseline and 130 at 24 months for SBP; 218 at baseline, and 141 at 24 months for LDL).
Note: We found no significant differences between health coaching and usual care groups at 24 months.

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Table 2

Changes in Outcomes for Health Coaching Arm at 12 and 24 Months

Outcome	12 months	24 months	Difference, 12–24 months	P value
Composite 1, Patients meeting at least 1 goal (n = 157), % (No.)	47.1 (74)	45.9 (72)	−1.2	.80
Composite 2, Patients meeting all goals (n = 157), % (No.)	35.7 (56)	33 (53)	−1.9	.66
HbA_1c at goal (n = 58), % (No.)	53.4 (31)	36.2 (21)	−17.2	.03
LDL at goal (n = 70), % (No)	42.9 (30)	47.1 (33)	4.3	.58
SBP at goal (n = 68), % (No.)	25.0 (17)	32.4 (22)	7.4	.20
HbA1c, (mean (SD), %	8.3 (1.8)	8.9 (2.1)	0.6	.02
LDL, (mean (SD), mg/dL	111.6 (35.9)	115.2 (45.7)	3.6	.51
SBP, (mean (SD), mm Hg	148.4 (16.0)	145.6 (16.1)	−2.8	.16

HbA_1c = hemoglobin A_1c; LDL = low-density lipoprotein; SBP = systolic blood pressure.
Note: The proportions of participants reaching composite and condition-specific goals were evaluated using McNemar’s χ² test for (paired) dichotomous outcomes and paired t-tests for continuous outcomes.

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Table 3

Subgroup Analysis of Usual Care Arm, Comparing Those Who Received Post-RCT Coaching vs Those Not Coached

Outcome	Usual Care Arm Participants Coached Post-RCT^a			Usual Care Arm Participants Not Coached Post-RCT

	Baseline	12 months	24 months	Baseline	12 months	24 months
Composite 1, meeting 1 goal, % (No.)	0	10.4 (5) n = 48	33.3 (16) n = 48	0	45.9 (39) n = 85	48.2 (41) n = 85
Composite 2, meeting all goals, % (No.)	0	4.2 (2) n = 48	25.0 (12) n = 48	0	35.3 (30) n = 85	37.7 (32) n = 85
HbA_1c at goal, % (No.)	0	4.0 (1) n = 25	24.0 (6) n = 25	0	55.6 (10) n = 18	44.4 (8) n = 18
LDL at goal, % (No.)	0	14.3 (3) n = 21	38.1 (8) n = 21	0	43.2 (16) n = 37	56.8 (21) n = 37
SBP at goal, % (No.)	0	6.3 (1) n = 16	18.8 (3) n = 16	0	37.0 (17) n = 46	32.6 (15) n = 46
HbA_1c, mean (SD), %	10.2 (1.3) n = 25	10.2 (1.8) n = 25	9.7 (1.8) n = 25	9.6 (1.5) n = 18	8.3 (1.6) n = 18	8.9 (2.1) n = 18
LDL, mean (SD), mg/dL	136.7 (35.2) n = 21	130.7 (37.2) n = 21	116.0 (37.1) n = 21	149.8 (30.1) n = 37	119.3 (34.3) n = 37	103.0 (34.8) n = 37
SBP, mean (SD), mm Hg	162.8 (14.5) n = 16	158.8 (15.9) n = 16	154.3 (25.8) n = 16	159.6 (17.3) n = 46	146.3 (17.8) n = 46	148.8 (20.2) n = 46

HbA_1c = hemoglobin A1c; LDL = low-density lipoprotein; RCT = randomized controlled trial; SBP = systolic blood pressure.
↵a Includes only patients in usual care arm who were out of goal range at 12 months, were offered coaching and accepted, and had clinical measures available at 12 and 24 months.

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Supplemental Tables

Supplemental Table 1. Baseline Characteristics of RCT Health Coaching Patients.; Supplemental Table 2. Baseline Characteristics of RCT Usual Care Patients; Supplemental Table 3. Baseline Characteristics of Patients, RCT Health Coaching Arm Patients and Usual Care Subgroups; Supplemental Table 4. Baseline Characteristics Of Patients Without Both 12 Month and 24 Month Clinical Data

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Supplemental data: Tables - PDF file
The Article in Brief

What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial

Anjana E. Sharma , and colleagues

Background Most health coaching research focuses on effects during the period of active intervention. As a result, little is known about whether positive effects persist after health coaching has ended. This study follows up on a 12-month randomized controlled trial of a health coaching intervention for patients with poorly controlled diabetes, hypertension, and/or high cholesterol.

What This Study Found In the initial study, the health coaching intervention significantly improved achievement of clinical goals (systolic blood pressure, LDL cholesterol and hemoglobin A1c) at 12 months. In this follow-up, up to one year after health coaching patients in the study's intervention arm experienced only minimal declines in clinical goals, with the exception of hemoglobin A1c. Specifically, the proportion of patients in the coaching arm of the trial who achieved at least one clinical goal at 12 months dropped only slightly from 47 percent at 12 months to 46 percent at 24 months. Similarly, almost the same proportion achieved the secondary outcome of meeting all clinical goals for which they were eligible on study entry at 12 months (36 percent) and 24 months (34 percent).

Implications

These findings suggest that most improved clinical effects are maintained up to one year after receiving health coaching.