Objective: To examine the effectiveness of a general health promotion intervention based on self-determination theory in proactively helping emergency department (ED) attendees to adopt healthy lifestyles.
Hypothesis to be tested: A general health promotion intervention based on self-determination theory will be effective in helping people adopt healthy lifestyles.
Design and subjects: The investigators will conduct a randomised controlled trial involving 1,172 ED attendees from five major acute care hospitals in Hong Kong.
Instruments: A behavioural risk factor questionnaire will be used to identify participants' health risk behaviours and document their blood pressure and body mass index. The EuroQoL 5-Dimension 5-level will be used to assess participants' quality of life.
Interventions: Participants in the intervention group will receive a brief health warning and advice on health-risk behaviours. In addition, participants will be asked about their priority in engaging in healthy lifestyles. Moreover, participants will receive WhatsApp/WeChat messages during the first 6 months as a reminder to adhere to their desired healthy lifestyle and a link to a 1-minute video relevant to their selected healthy lifestyle. Participants in the control group will receive brief advice on adopting healthy lifestyles through regular text messages.
Main outcome measures: The number of healthy lifestyles adopted at 6 months. Data analysis and expected results: SPSS for Windows will be used for quantitative data analysis. A significantly higher proportion of participants in the intervention group will adopt healthy lifestyles and exhibit better quality of life than those in the control group at 6 and 12 months.
being aged ≥18 years old Chinese
being triaged as semi-urgent (level 4) or non-urgent (level 5) and discharged home on the same day after receiving medical attention
having at least one health risk behaviour (tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity)
owning a smartphone and having an ability to use instant messaging applications (e.g. WhatsApp or WeChat).
having a poor cognitive state or mental illness
being diagnosed with NCDs and undergoing regular follow-ups in outpatient clinics
participating in another related study
Parallel
Theory of planned behaviour
Other interventionThis theory holds that an intention to engage in a health-related behaviour is determined by the proximal factors of attitudes, subjective norms, and perceived behavioural control. Attitudes represent individuals perceived likelihood of performing and appraisal of the consequences of performing a health-promoting behaviour. Subjective norms are the social pressure perceptions to either perform or not perform a health-promoting behaviour. Finally, perceived behavioural control is an individual's perception of control regarding performing the behaviour.
Foot-in-the-door technique
Other interventionThe foot-in-the-door technique, which was introduced by Freeman and Fraser, emphasises the notion that individuals who initially comply with a small, easy request are more likely to later comply with a larger request. Compliance with the first request or target increases the individual's confidence and alters their self-perceived capability and willingness regarding further requests or targets. This technique can facilitate the recruitment process and enhance compliance.
Self-determination theory
Other interventionAccording to self-determination theory, behavioural regulation is more autonomous when it is internalised, as opposed to being regulated by external factors. Compared with external regulation, autonomous regulation is associated with increased self-efficacy, greater behavioural persistence, longer-term behavioural changes and more positive health behaviour. Autonomy is another influential determinant of behaviour that is emphasised by freedom of choice. There is some evidence that people who have greater autonomy demonstrating greater competence and self-efficacy in achieving behavioural change compared with those with less autonomy. As a result, increased autonomy will facilitate a gradual change in risky behaviours. Our intervention aims to first change the participants' attitudes and their subjective norms through risk communication. Using foot-in-the-door technique and self-determination theory, it will then increase participants' willingness to adopt a healthy lifestyle.
Follow-up booster intervention
Other interventionStaff will send WhatsApp/WeChat messages approximately once a week to remind the participants to adhere to their desired health-related lifestyle for the first 6 months. In addition, during the first week, the RA will send participants a link via WhatsApp/WeChat to a 1-minute video developed by the research team comprising content relevant to their selected health-related lifestyle. Four separate 1-minute videos will be compiled, each focusing on a different healthy lifestyle. These videos will indicate the health hazards of continuing this health risk behaviour and the benefits of adopting a healthy lifestyle. Moreover, the RA will encourage the participants to watch the video and ask any questions regarding the video content via WhatsApp/WeChat.
Practical Resource Hub for Healthy Life leaflet
Other interventionThe participants will be provided a Practical Resource Hub for Healthy Life leaflet containing information on various applications, including (i) 'Move Your Body', (ii) 'Eat Healthy', (iii) 'Live Alcohol Free', and (iv) 'Stay Away from Tobacco', which were developed by the Hong Kong Department of Health
a brief intervention using the Ask, Warn, Advise, Refer and Do-it- again (AWARD) model
Other interventionThe participants will receive a brief intervention using the Ask, Warn, Advise, Refer and Do-it- again (AWARD) model : (1) Ask about and assess health-risk behaviours; (2) Warn about the high morbidity and mortality risks associated with health-risk behaviours; (3) Advise on adopting healthy lifestyles to improve the participant's health; (4) Refer to hotline services, such as those for smoking cessation and alcohol treatment or the nearest district health centre to follow up their health status; and (5) Do it again if participants have not adopted a healthy lifestyle at follow-ups.
The composite event rate of adopting at least one of the four healthy lifestyles at 6 months.
The composite event rate of adopting at least one of the four healthy lifestyles at 6 months which is measured by using a behavioural risk-factor questionnaire. The higher rate of adopting at least one of the four healthy lifestyles indicate the more successful to help emergency department attendees to adoption of a healthy lifestyle and lead healthier lives.
The composite event rate of adopting at least one of the four healthy lifestyles adopted at 12 months
The composite event rate of adopting at least one of the four healthy lifestyles adopted at 12 months which is measured by using a behavioural risk-factor questionnaire. The higher rate of adopting at least one of the four healthy lifestyles indicate the more successful to help emergency department attendees to adoption of a healthy lifestyle and lead healthier lives.
Improvement in health-related quality of life at 6 months
Participants' change of health-related quality of life between baseline and 6-month follow-ups will use EuroQol 5-level scale (EQ-5D-5L) to measure the quality of life. It consists of two part. The first part has 5 questions and each question has choices 1 to 5. Large number means a worse outcome in the first part. The second part has one question which is a scale of 0 to 100. Large number means a better outcome in the second part.
Improvement in health-related quality of life at 12 months
Participants' change of health-related quality of life between baseline and 12-month follow-ups will use EuroQol 5-level scale (EQ-5D-5L) to measure the quality of life. It consists of two part. The first part has 5 questions and each question has choices 1 to 5. Large number means a worse outcome in the first part. The second part has one question which is a scale of 0 to 100. Large number means a better outcome in the second part.
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