The 'Farmers Have Hearts' Study: Can a workplace cardiovascular health check followed by health promotion texts and/or health coaching by phone improve behaviours affecting heart and circulatory system health in livestock farmers?

Plain English summary of protocol

Background and study aims
Death rates have been falling in Ireland generally, but farmers show the slowest reduction of any socio-economic group. Irish farmers are are at high risk for cardiovascular disease (CVD, diseases of the heart and blood circulation system), the leading cause of death worldwide. Most CVD is caused by unhealthy lifestyle behaviours (including factors relating to work and the workplace) and are therefore preventable. CVD can reduce a person's ability to do physical activity and work, which can then undermine the profitability, competitiveness and sustainability of farming.
Farmers remain a 'hard to reach’ group in terms of engaging with health promotion initiatives. Whilst farmers respond positively to healthcare screening in places where the go as part of their farming activities, they are not as likely to commit to long-lasting sustainable health behaviour change. There is a gap in existing research in relation to what prompts farmers to adopt behaviour change to improve their health.
This study will investigate whether a tailored intervention is effective in prompting Irish farmers to adopt sustainable behaviour change to improve their health. Specifically, the study will investigate whether the programme results in effective follow-up use of GP services, sustainable cardiovascular health behaviour change, and reduced CVD risk.
Additionally, this study will compare and contrast two sub-groups of Irish farmers who will be recruited from two different settings (marts (livestock markets) and dairy co-ops). ‘Mart farmers’ tend to be largely involved in beef/cattle farming, to have smaller farm holdings and to be sole traders. ‘Co-op farmers’ tend to be largely engaged in dairy farming and are suppliers to agricultural processing companies. In this study the agricultural processor is Glanbia Ireland, a maker of cheese, butter and other dairy products. The recruitment of the farmers will take place in marts and Glanbia Ireland co-ops in the South-East, Midland, Mid-East and South-West regions of Ireland. The farmers take part in the health checks based on self-referral, meaning it is completely up to them whether they take up the offer of the health check.
This research has been awarded a Teagasc Walsh Fellowship. It will be carried out in partnership between the National Centre for Men’s Health at IT Carlow, Teagasc, the HSE, the Irish Heart Foundation (IHF) and Glanbia. The findings from this study will provide insight into the cardiovascular health status of Irish farmers and a better understanding of ways to encourage this group to improve their cardiovascular health by making changes to their lifestyle and health behaviours. The learnings will also inform decision-making on health behaviour change support systems for farmers using different approaches such as Teagasc knowledge transfer and extension workers, mart workers and Glanbia advisors.

Who can participate?
Male farmers aged over 18 years.

What does the study involve?
All participants will get a cardiovascular health check at baseline and at 52 weeks in a workplace (livestock marts or dairy co-ops). These cardiovascular health checks are carried out by a qualified nurse from the Irish Heart Foundation who will measure cholesterol and other lipids (fats) in blood, blood glucose, blood pressure, carbon monoxide in breath (for smokers), weight, height and waist measurement. The nurse will also collect information on medical history and health and lifestyle behaviours, including family history of diabetes, heart disease and/or stroke, last GP visit (including last cardiovascular health check), use of current medication for heart disease/diabetes (which medication and whether it is taken as prescribed), smoking (yes/no, how many), use of alcohol (yes/no, how many standard units a week, binge drinking), levels of physical activity (work-related, leisure), experienced stress. The cardiovascular health check also includes lifestyle counselling to suggest behaviour changes to improve health.
After the first health check, the participants are asked to take part in a face-to-face questionnaire and are offered a choice of three behaviour change support interventions to improve their cardiovascular health status:
1. M-health. This consists of general cardiovascular health-promoting text messages (three text messages per week for 4 months). Participants are asked to reply to a text message twice per month. M-health uses mobile and wireless technologies to support health objectives. While health promotion interventions based on text messaging are relatively new, evidence suggests that they are effective in relation to health behaviour change. M-health, and specifically text messaging, has been found to be an effective health intervention tool: it is fast, cheap and has a far reach within all socio-economic groups. Although farmers lag behind in their use of internet technology compared to the general Irish population, the majority of farmers, regardless of age, regularly use a mobile phone for talking and messaging.
2. Health coaching by phone. The health coach is an interactive intervention based on reflective listening and motivational interviewing that aims to encourage and support the participant with making and sustaining lifestyle changes to improve their cardiovascular health. This intervention is based on the theory of the Stages of Change. Health coaching supports people to gain personal insight, knowledge and confidence to engage in changing a behaviour by focusing on goal setting, personal empowerment and increased self-efficacy.
3. Health coaching in combination with M-health. This intervention group receives both interventions at the same time.
Participants may also choose to be part of a control group. Participants in this group take the cardiovascular health checks at baseline and 52 weeks also take part in a follow-up questionnaire by phone at 26 weeks after the health check. They do not receive any health behaviour change intervention.

What are the possible benefits and risks of participating?
The Farmers Have Hearts Programme reaches out to those who can be hard-to-reach and tend not to participate in preventive health, such as health checks. All farmers attending the livestock mart can get a free cardiovascular health check and brief lifestyle counselling, carried out by a qualified nurse from the Irish Heart Foundation. Results are provided during the health check and participants receive tailored hands-on practical advice on how to improve their cardiovascular health. In case of detected risk factors for CVD, participants are referred to their GP for further examination and (if needed) treatment. The cardiovascular health checks takes place in the workplace, the livestock mart, which is a space in which farmers feel safe and respected.
All participants receive an invitation for the free repeat cardiovascular health check, 52 weeks after the first health check. As part of the study, all participants are offered follow-up support by phone and/or text messaging offering personal tailored advice to encourage simple lifestyle changes to improve cardiovascular health. All members of the Farmers Have Hearts research team are Garda vetted and trained to look out for emotional and/or medical needs and advise participants to contact relevant support services. All communication as part of the study is strength-based, supportive and non-judgmental and in line with the Irish NALA (literacy) guidelines. All participants will receive information about national and local support services as well as the free Irish Heart Help number. All participants will receive for cardiovascular health booklets relevant to them and a copy of the health booklet ‘Staying fit for farming’ which contains health information tailored to the needs of farmers and includes useful addresses of support organisations.
We are mindful that participants in this study are largely from a lower socio-economic status group, have lower educational attainment and are middle-aged or older. The language used to explain the study, informed consent and questionnaires will need to be accessible, clear and understandable. All interventions are based on motivational interviewing. We also acknowledge that some participants might be nervous about the health check and that the results might cause worry. The health checks will be carried out by fully qualified Irish Heart Foundation nurses. Those with risk factors for CVD will be referred, as appropriate, to their GP by the nurse in line with standard Irish Heart Foundation operational procedures. Additionally, the nurse will flag up any identified need for emotional support identified during the health check and/or lifestyle counselling.
The principal researcher’s contact details will also be made available on the information sheet. Participants can make contact with the researcher if they feel the need to do so in relation to the study, their study participation and/or their health.

Where is the study run from?
Institute of Technology Carlow (Ireland)

When is the study starting and how long is it expected to run for?
May 2018 to December 2021 (updated 15/06/2021, previously: December 2019)

Who is funding the study?
Teagasc - The Agriculture and Food Development Authority (Ireland)

Who is the main contact?
1. Ms Diana van Doorn (public contact), diana.vandoorn@itcarlow.ie
2. Dr Noel Richardson (scientific contact, noel.richardson@itcarlow.ie

Study website

Contact information

Dr Noel Richardson
Scientific

Kilkenny Road
Carlow
Ireland
Carlow
R93 V960
Ireland

ORCID ID	0000-0002-2060-2338
Phone	00353 872860152
Email	noel.richardson@itcarlow.ie

Ms Diana van Doorn
Public

Kilkenny Road
Carlow
Ireland
Carlow
R93 V960
Ireland

ORCID ID	0000-0003-2007-2020
Phone	00353 874176749
Email	diana.vandoorn@itcarlow.ie

Study information

Eligibility

Locations

Countries of recruitment

• Ireland
• Isle of Man

Study participating centres

Sponsor information

Funders

Funder type

Government

Results and Publications

Study outputs

Additional files

36059 BasicResults.pdf

Editorial Notes

17/01/2023: The basic results have been uploaded as an additional file.
09/11/2022: Publication reference added.
14/12/2021: The following changes were made to the trial record:
1. The acronym was changed from FHH to FHHH-CHP
2. The data sharing statement was added.
15/06/2021: The following changes were made to the trial record:
1. The overall end date was changed from 01/05/2020 to 12/12/2021.
2. The intention to publish date was changed from 01/11/2019 to 30/05/2022.
3. The plain English summary was updated to reflect these changes.
25/08/2020: Publication reference added.
09/05/2019: The following changes were made to the trial record:
1. The recruitment end date was changed from 01/04/2019 to 08/04/2019.
2. The overall trial end date was changed from 31/12/2019 to 01/05/2020.
3. The intention to publish date was changed from 01/08/2019 to 01/11/2019.
4. The total final enrolment number was added.