The Healthlines Service

The technology

You can watch a demonstration of the technology supporting the Healthlines Service here:

The Healthlines service incorporated the use of a range of technologies to address each of the components of the TECH conceptual model (TECH model (PDF, 126kB) that under-pinned the intervention design. In order to apply the model to a specific clinical condition we identified telehealth tools which had some evidence of effectiveness in that condition and which could be used to implement the strategies within the TECH model. Therefore the specific telehealth tools varied in different exemplar conditions, but were delivered by the Healthlines Service within a common framework.

The intervention was originally provided by staff from NHS Direct, which until March 2014 provided a range of telehealth services through a national network of call centres and a website. The Healthlines Service was based around regular telephone calls from a health advisor supported by interactive software. The advisors were not clinically qualified but had experience working for NHS Direct and had a further three weeks of training in health coaching, motivational interviewing, anti-depressant drug treatment, use of a computerised cognitive behavioural therapy (cCBT) programme, and the Healthlines telephone support software.

With the help of scripts (Depression script (PDF, 292kB)) generated by the interactive software the advisors supported participants in addressing their own health goals and directed them to relevant online resources, including reliable health information, interactive programmes and relevant apps and widgets (e.g. to help with increasing exercise). The advisors emailed links to appropriate websites to participants, or sent them the information by post.

Content of the intervention

After an initial assessment and goal-setting telephone call, the advisors telephoned each participant regularly over a 12 month period. As well as providing support in using the cCBT programme (depression) or BP self-monitoring programme (raised CVD risk), the telephone scripts (CVD script (PDF, 494kB)) included modules covering topics such as drug treatment, medication adherence, exercise and alcohol use.

For patients with raised CVD risk, the telephone scripts were modified from a computerised behavioural management programme originally developed in the USA by Bosworth et al. The standardised scripts generated by the software were based on recognised behaviour change principles, such as stimulus control, problem solving, cognitive restructuring, and goal setting. We modified the programme to reflect English management guidelines and referral options, wrote additional modules with new content and adapted the language to suit an English population.

The Healthlines web portal

Participants were given access to a Healthlines web portal (Healthlines portal (PDF, 730kB)), which linked to several resources, including the Living Life to the Full Interactive (LLTTFi) programme for patients with depression and a BP self-monitoring website for patients with raised cardiovascular risk. The web portal also provided information about the relevant health condition (depression or cardiovascular disease), and links to relevant patient-led organisations.

Life to the Full Interactive and Big White Wall

Life to the Full Interactive (Live life to the full interactive (PDF, 482kB)) is an interactive multi-media programme which delivers cCBT-based treatment for depression through six self-directed sessions, completed approximately every two weeks. Participants could also follow similar material in book form if the preferred. For patients with depression the Healthlines web portal also provided a link to Big White Wall (www.bigwhitewall.com) (Big White Wall (PDF, 390kB)), which is a digital mental health network including a clinically moderated online forum.

The BP self-monitoring system

Participants with raised CVD risk and high blood pressure were provided with access to a BP self-monitoring system (BP self monitoring (PDF, 544kB)). They were offered an Omron M3 validated home BP monitor and requested to take their BP twice daily for the first week and weekly thereafter, and to upload their readings to the Healthlines portal. The portal calculated average readings over the previous six days initially and then over the previous six weeks thereafter. Using these readings, the participant was automatically advised by the portal whether their BP was within their target, when to take their BP again and what to do if their BP was too high or too low. Target BP was based on UK guidelines, although an individual’s target could be modified by their GP. Average BP readings were reviewed by health advisors at each telephone call, and participants with above target readings were asked to see their GP to review their treatment.

Personal, co-ordinated care

In order to ensure co-ordination with primary care, the advisors sent regular progress reports to participants’ GPs by email and copied them to participants via the Healthlines portal. If patients were not improving the health advisors contacted participants’ GPs to recommend escalation of medication, enclosing a summary of current treatment guidelines (Letter to GP (PDF, 542kB)). This approach reflected our aim to support rather than to undermine the work of the participants’ main primary care providers. Each participant was telephoned by the same advisor on each occasion when possible, since we had identified it was important to avoid an anonymous ‘call-centre’ approach in order to promote participant engagement. Photographs of the advisors were provided on the Healthlines web portal to enhance the sense of personal care. To facilitate access to care, the Healthlines Service was available from 10am to 8pm on weekdays and 10am to 2pm on Saturdays.

Closure of NHS Direct

NHS Direct was closed down towards the end of the trial, therefore delivery of the intervention was paused for two months while it was transferred to a Solent NHS Trust.

The technology

You can watch a demonstration of the technology supporting the Healthlines Service here.

Open access software

Now that the research has ended we are able to make the software we developed freely available to developers who wish to use the content.  Please visit our Open Access Software page.