Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare

Background: People with low health literacy communicate less well with health care providers, miss opportunities for prevention and experience adverse health outcomes.
Aim/Objectives: To evaluate the effectiveness of a practice nurse supported mHealth and telehealth intervention in general
practice in changing health literacy, diet and physical activity. 
Methods: Patients aged 40–70 years with a BMI ≥ 28 were enrolled in a two-arm pragmatic practice-level cluster randomised trial in low socioeconomic areas in Sydney and Adelaide. Intervention group patients were invited to a practice
nurse health check visit, offered the use of a lifestyle app (my snapp) and referred for telephone coaching. Primary outcomes included patient reported health literacy (Domains 8 and 9 of the
Health Literacy Questionnaire (HLQ)), diet (serves of fruit and vegetables) and physical activity (moderate and vigorous) at baseline and 6 months and assessed using difference-in-differences analysis (DiD) (comparing average change). 
Findings: 22 practices and 214 patients were recruited (117 in intervention and 97 in control practices). At six months in the intervention group HLQ8 Ability to find good health information increased compared to the control group (DiD 1.46, 95% CI
0.10-2.82; P = 0.035), but HLQ9 Understanding health information well enough to know what to do did not. There was a significant improvement in diet score (DiD 0.78 (0.10–1.47; P = 0.026) but not in physical activity. 
Implications: There was evidence of impact on health literacy and health behaviours limited by ‘ceiling effects’ in baseline HLQ scores. Prevention in general practice is challenging even with a comprehensive mHealth app and telephone coaching.