Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents

Mary Ann O’Brien*, Aisha Lofters, Becky Wall, Regina Elliott, Tutsirai Makuwaza, Mary-Anne Pietrusiak, Eva Grunfeld, Bernadette Riordan, Cathie Snider, Andrew D. Pinto, Donna Manca, Nicolette Sopcak, Sylvie D. Cornacchi, Joanne Huizinga, Kawsika Sivayoganathan, Peter D. Donnelly, Peter Selby, Robert Kyle, Linda Rabeneck, Nancy N. BaxterJill Tinmouth, Lawrence Paszat

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.

We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method.

Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals.

Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention.

Trial registration
#NCT03052959, 10/02/2017.
Original languageEnglish
Number of pages16
JournalBMC Health Services Research
Publication statusPublished - 4 Apr 2024


  • MeSH terms
  • Chronic disease
  • Primary prevention
  • Nurses
  • Public health
  • Qualitative evaluation
  • Social determinants of health


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