Health Coaching and Genetic Risk Testing in Primary Care: Randomized Controlled Trial

• Published in: Health psychology 2022-10, Vol.41 (10), p.719-732
• Main Authors: Wolever, Ruth Q., Yang, Qing, Maldonado, Carlos J., Armitage, Nicole H., Musty, Michael D., Kraus, William E., Chang, Jianhong, Ginsburg, Geoffrey S., Vorderstrasse, Allison A.
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Cardiovascular diseases; Clinical trials; Coaching; Coronary artery disease; Counseling; Female; Genetic susceptibility; Genetics; Genomics; Human; Linear analysis; Major Depression; Male; Mental depression; Perceived control; Physical Activity; Primary care; Primary Health Care; Risk assessment; Type 2 diabetes mellitus; Weight loss
• ISSN: 0278-6133; 1930-7810
• DOI: 10.1037/hea0001183

Objective: Accessible interventions are needed to prevent coronary heart disease (CHD) and Type 2 diabetes (T2D). This prospective, randomized, controlled trial evaluated remote health coaching (HC), genetic risk testing (GRT), or both added to standardized risk assessment (SRA) in at-risk military primary care patients. Method: Using a 2 × 2 factorial longitudinal design, 200 Air Force at-risk participants provided primary outcomes at baseline, 3-, 6- (HC endpoint), and 12-months. Secondary measures were taken less often. Per protocol analyses used linear models and logistic regression; intent-to-treat (ITT) analyses used mixed models. Results: Compared with those not receiving HC, the HC group was 3.6 times more likely to report moderate to intense physical activity at 6-months (p = .0009), and 2.9 times more likely to report such at 12-months (p = .0065). ITT longitudinal model did not reach significance (p = .0885). The HC group reported lower emotional representations of illness at 6-weeks and lower depression at 6 months. There were no other significant findings. HC and GRT interacted; higher T2D risk participants receiving HC were 4.7 times more likely to report higher stage of change for exercise at 6-months, and lost 2.2 kg more by 12-months. Lower T2D risk participants receiving HC perceived greater control over CHD risk at 6-weeks, and averaged lower 6-month depression. Conclusions: Remote HC after SRA increased physical activity, which was sustained 6-months later. Incorporating GRT into SRA warrants further exploration regarding the potential to leverage HC for weight loss in elevated T2D risk participants, and for depression in lower T2D risk participants.