Prevent Non-communicable Diseases Through Screening and Educating Emergency Department Attendees to Adopt Healthy Lifestyles
A Proactive Approach to Prevent Non-communicable Diseases Through Screening and Educating Emergency Department Attendees to Adopt Healthy Lifestyles: A Randomised Clinical Trial
1 other identifier
interventional
1,172
1 country
1
Brief Summary
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.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jun 2025
Typical duration for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
March 17, 2025
CompletedFirst Posted
Study publicly available on registry
March 21, 2025
CompletedStudy Start
First participant enrolled
June 10, 2025
CompletedPrimary Completion
Last participant's last visit for primary outcome
June 30, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
January 31, 2028
January 29, 2026
January 1, 2026
2.1 years
March 17, 2025
January 28, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
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.
from baseline to 6 months
Secondary Outcomes (3)
The composite event rate of adopting at least one of the four healthy lifestyles adopted at 12 months
from baseline to 12 months
Improvement in health-related quality of life at 6 months
from Baseline to 6 months
Improvement in health-related quality of life at 12 months
from baseline to 12 months
Study Arms (2)
WhatsApp/WeChat with video
EXPERIMENTALParticipants in the intervention group will receive a brief health warning and advice on health-risk behaviours. In addition, they 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.
Placebo
PLACEBO COMPARATORParticipants in the control group will receive brief advice on adopting healthy lifestyles through regular text messages.
Interventions
This 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.
The 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.
According 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.
Staff 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.
The 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
The 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.
Eligibility Criteria
You may qualify if:
- 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).
You may not qualify if:
- 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
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
The Nethersole School of Nursing, The Chinese University of Hong Kong
Hong Kong, Hong Kong
Related Publications (1)
Li WHC, Wong EL, Xia W, Chen H, Tsui SH, Chan YC, Cheung KY, Leung YF, Ho LKL, Choi KC, Chung OJ. A proactive approach to prevent non-communicable diseases through screening and educating emergency department attendees to adopt healthy lifestyles: Study protocol for a pragmatic, multicenter, randomized controlled trial. PLoS One. 2025 Jul 3;20(7):e0327558. doi: 10.1371/journal.pone.0327558. eCollection 2025.
PMID: 40608754DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Ho Cheung William Li, PhD
The Nethersole School of Nursing, CUHK
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- PARTICIPANT
- Purpose
- PREVENTION
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Professor
Study Record Dates
First Submitted
March 17, 2025
First Posted
March 21, 2025
Study Start
June 10, 2025
Primary Completion (Estimated)
June 30, 2027
Study Completion (Estimated)
January 31, 2028
Last Updated
January 29, 2026
Record last verified: 2026-01
Data Sharing
- IPD Sharing
- Will share
- Time Frame
- After the project has been completed and the results of the project has been published
- Access Criteria
- Request could be sent to Principal Investigator (williamli@cuhk.edu.hk)
The relevant anonymized patient level data, full dataset, technical appendix, and statistical code are available on reasonable request. The approval from the Principal Investigator for the purpose of data use is required.