Evolution of the eCHAT: Case-finding to improve health and happiness

Abstract

Risky lifestyle behaviours and mental health issues have considerable impact on health and well-being, therefore early detection and intervention in general practice is likely to have substantial long-term health gains. However general practitioners have time restraints in systematically exploring these issues when patients consult for other reasons, and patients may feel disquiet when asked about specific ―bad‖ behaviours in isolation. A patient-centred approach is for patients to self-administer an instrument dealing with multiple domains in which they can identify unhealthy behaviours or problematic mood states, and indicate which if any they would like help to address. Aims: To describe the development of the Case-finding and Help Assessment Tool (CHAT) designed to identify unhealthy behaviours and negative mood states in primary care and community settings, and report on various studies assessing its feasibility of use, acceptability, validity (including the innovative Help question) and progression of the electronic version, eCHAT. Method: Various studies were conducted in NZ primary care and community settings to evaluate the feasibility and acceptability of CHAT amongst diverse ethnic adult populations and to validate both the tool and the innovative Help question against appropriate reference standards. Initial acceptability and feasibility testing of the eCHAT was conducted. Findings: CHAT is feasible to use in primary care and community settings, has high patient and provider acceptability and has criterion-related validity. eCHAT allows for added diagnostic tools and integrated decision supports. Conclusion: The CHAT differs from existing tools because it is a generic approach for all adults looking at both behaviours and mood states that impact on health and well-being, with a wholeperson not a disease focus. It builds on current theoretical models of behavioural change. It is positioned to contribute to contemporary national and international integrated models of primary care delivery which are premised on the concepts of patient-centredness, joint decision-making and self-management. The eCHAT has important clinical, policy and research implications regarding individual health care, population-based strategies and health promotion. While this thesis focuses on work conducted between 2001 to 2010, research and implementation of eCHAT is progressing in primary care and community settings in NZ and internationally.