Effects of program enrollment in a digital multiple health behavior change intervention on clinical outcomes

Abstract

Abstract Background: Multiple health behavior change interventions (MHBCIs) are successful for changing maladaptive behaviors related to individual chronic conditions (CC), but less is known about MHBCIs in the context of managing multiple CC. This study examined effects of enrollment on clinical outcomes in multiple remote monitoring programs, including diabetes (DM), hypertension (HTN), and weight loss (WL).  Methods: Participants were adults enrolled in at least one of three programs for DM, HTN, and WL with an optional mental health (MH) component; identified as “at-risk” at baseline ((A1c ≥7%, HTN ≥130/80, or BMI≥30 kg/m2); with ≥ 1 month of data available over a 12-month evaluation period. Outcomes consisted of mean blood glucose (BG), systolic blood pressure (SBP), and percent WL. Data were aggregated to the month level and mixed-effects models tested the effects of multiple program enrollment and the supplemental effect of MH enrollment on outcomes. All models controlled for demographics, time on program, baseline disease status, and engagement. 2,818 adults (55% female) were included, with mean age of 53 years (SD=10.0).   Results: A significant interaction was shown between time on program and multiple program enrollment for DM (B=-0.48, SE=0.29) and HTN (B=-0.42, SE=0.12) (z=-3.57, z=-3.89; ps<0.001, respectively). Each program enrollment in addition to DM was associated with a 5.8 mg/dL reduction in BG, and each program enrollment in addition to HTN was associated with a 4.8 mmHg reduction in SBP. Significant interactions were found for time on program and MH enrollment for DM (B=-1.25, SE=0.29), HTN (B=-0.81, SE=0.19), and WL (B=-0.15, SE=0.03) (z=-4.36, z=-4.25, and z=-5.27; ps<0.001, respectively). Additional enrollment in MH was associated with a reduction of 15 mg/dL in blood glucose, of 9.6 mmHg in SBP, and 1.8% WL.  Conclusions: Findings support the success of MHBCIs in management of CC and emphasize the supplemental effect a MH program has on improving outcomes.