Evidence

The prevalence of chronic diseases is steadily increasing, leading to poor health, high healthcare costs, and premature deaths. This is a global problem, with the World Health Organization estimating that 35 million deaths are caused by chronic diseases every year, and this number keeps rising.

Ongoing Initiatives Completed Initiatives
Evidence Header

Prevention and screening of chronic diseases before they start has been identified as the best way to prevent this rise in disease, with primary care providing the greatest opportunity for impact as most prevention and screening actions are offered in these settings; However,in our current healthcare system, most primary care providers lack the time, resources and tools to address cancer and chronic disease prevention and screening, and to integrate the many guidelines and resources that are focused on one specific disease, organ system, or lifestyle risk.

Traditional models of health care focus on one disease, but to prevent chronic diseases we need a proactive, comprehensive approach, and this is where The BETTER Program™ comes in. We take a personalized, comprehensive approach, by carefully blending the best available clinical evidence to inform patients about their chronic disease risk and how to improve their overall health. BETTER is unique because it addresses the root causes of chronic diseases and common risk factors for heart disease, diabetes, and cancer.

We bring together Clinicians, Policy Makers, Researchers, and Patients to improve chronic disease prevention. Frontline health care professionals such as nurses, dietitians, and pharmacists are trained on the BETTER approach and tools, becoming experts in prevention and a resource to their practice setting.

While The BETTER Program™ has been demonstrated to have a positive impact on patients’ health through a cluster randomized controlled trial, which found a 37% improvement in the screening and prevention of chronic diseases such as blood pressure, cancer, smoking, alcohol consumption, diet, and physical activity, research involving the program is ongoing to continue to build evidence for the program with diverse patient populations (e.g. vulnerable populations, cancer survivors), health care settings (e.g. public health), and health conditions (e.g. secondary prevention of chronic disease)

Ongoing Initiatives

2020-2022

BETTER Life Study

The goal of the BETTER Life study is to learn if the BETTER HEALTH: Durham program, which has been shown to help people 40-64 years take steps to prevent chronic disease, can be adapted for younger persons ages 18 to 39 years.

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2021-2024

BETTER Women

BETTER Women is a health promotion program that offers women free access to a volunteer peer health coach who is trained to help them reach and maintain their health and cancer screening goals. The goals are created by the participant and a peer health coach will be there along the participant’s journey to provide additional motivation and help them stay accountable.

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2021-2022

Virtual BETTER

The goal of Virtual BETTER is to assess the accessibility and acceptability of three different methods of delivering a BETTER Prevention Visit: telephone, video and in-person. Results from this study will also be used to assess the feasibility of a non-inferiority randomized control trial to compare outcomes between patients experiencing visits using these modalities.

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Completed Initiatives

Better WISE header
2016 – 2022

The BETTER WISE Project

The BETTER WISE project engages patients to become active participants in their health by integrating evidence-based guidelines and resources into an actionable, comprehensive approach that proactively addresses chronic disease prevention, screening and cancer survivorship, including screening for poverty and addressing lifestyle risks.

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2015 – 2020

BETTER HEALTH: Durham Study

The goal of the BETTER HEALTH: Durham study is to adapt the BETTER intervention guided by community-based participatory research (CBPR) principles in order to enhance chronic disease prevention and screening for persons 40 – 64 years of age.

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2015 – 2016

The TAP-BPS Project

The aim of this collaboration was to refine and integrate electronic versions of the BETTER Program tools (i.e. the BETTER App) into the TAPESTRY Application (or TAP-App) platform developed for use in the McMaster personal health record.

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Implementation Support
2012 – 2015

The BETTER 2 Program

The BETTER 2 Program engaged patients, clinicians, researchers and policy-makers to develop an integrated, comprehensive, longitudinal and sustainable approach to chronic disease prevention and screening within the various settings.

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Better Trial
2009 – 2012

The BETTER Trial

The BETTER trial’s aim was to improve prevention and screening for cancer and other chronic diseases in the family practice setting. The trial demonstrated an effective intervention that improved care by 37% at the individual patient level.

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Evidence – BETTER Mainpro program
 

The BETTER Mainpro+ Workshop

We can do BETTER – Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care Mainpro+ Workshop

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Publications

Journal Articles

2024

Chronic disease prevention and screening outcomes for patients with and without financial difficulty from BETTER WISE: Secondary analysis of cRCT data.

Aubrey-Bassler, K., Patel, D., Fernandes, C., Lofters, A., Campbell-Scherer, D., Meaney, C., Moineddin, R., Wong, T., Pinto, A., Shea-Budgell, M., McBrien, K., Grunfeld, E., Manca, D.

BMJ Open

2023

Prevention and screening during the COVID-19 pandemic: Qualitative findings from the BETTER WISE project.

Sopcak, N., Wong, M., Fernandes, C., Ofosu, D., Khalil, I., Wong, T., Manca, D.P.

BMC Primary Care

Facilitators and barriers to the implementation of BETTER WISE, a chronic disease and prevention intervention in Canada: A qualitative study.

Sopcak, N., Fernandes, C., Ofosu, D., Wong, M., Khalil, I., Wong, T., Manca, D.P.

Global Implementation Research and Applications

Opportunities to improve quality of care for cancer survivors in primary care: findings from the BETTER WISE study

Lofters A., Khalil, I., Sopcak, N., Shea-Budgell, M., Meaney, C., Fernandes, C., Moineddin, R., Campbell-Scherer, D., Aubrey-Bassler, Manca, D.P.

Supportive Care in Cancer

Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic

Manca, D.P., Fernandes, C., Lofters, A., Aubrey-Bassler, K., Shea-Budgell, M., Campbell-Scherer, D., Sopcak, N., Meaney, C., Moineddin, R., McBrien, K., Krueger, P., Wong, T., Grunfeld, E.

BMC Primary Care

2021

Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial.

Lofters, A.K., O’Brien, M.A., Sutradhar, R., Pinto, A.D., Baxter, N.N., Donnelly, P., Elliott, R., Glazier, R.H., Huizinga, J., Kyle, R., Manca, D.M., Pietrusiak, M.A., Rabeneck, L., Riordan, B., Selby, P., Sivayoganathan, K., Snider, C., Sopcak, N., Thorpe, K., Tinmouth, J., Wall, B., Zuo, F., Grunfeld, E., Paszat, L.

BMC Public Health 03 August 2021; 21(1496).

What is a prevention visit? A qualitative study of a structured approach to prevention and screening – the BETTER WISE project.

Sopcak, N., Fernandes, C., O’Brien, M.A., Ofosu, D., Wong, M., Wong, T., Kebbe, M., Manca, D.

BMC Family Practice 19 July 2021; 22(153).

2019

The effectiveness of a proven chronic disease prevention and screening intervention in diverse and remote primary care settings: an implementation study on the BETTER 2 Program.

Aubrey-Bassler, K., Fernandes, C., Penney, C., Cullen, R. M., Meaney, C., Sopcak, N., Campbell-Scherer, D., Moineddin, R., Baxter, J., Krueger, P., Wilson, M., Pike, A., Grunfeld, E., Manca, D.

British Journal of General Practice (BJGP) Open 17 September 2019; bjgpopen19X101656.

2018

The BETTER WISE protocol: Building on existing tools to improve cancer and chronic disease prevention and screening in primary care for wellness of cancer survivors and patients – a cluster randomized control trial embedded in a mixed methods design.

Manca, D.P., Aguilar, C., Grunfeld, E., Aubrey-Bassler, K., Shea-Budgell, M., Lofters, A., Campbell-Scherer, D., Sopcak, N., O’Brien, M.A., Meaney, C., Moineddin, R., McBrien, K., Salvalaggio, G., Krueger, P.

BMC Cancer 2018: 18 (927)

2017

BETTER HEALTH: Durham – protocol for a cluster randomized trial of BETTER in community and public health settings.

Paszat, L., Sutradhar, R., O’Brien, M.A., Lofters, A., Pinto, A., Selby, P., Baxter, N., Donnelly, P.D., Elliott, R., Glazier, R.H., Kyle, R., Manca, D., Pietrusiak, M.A., Rabeneck, L., Sopcak, N., Tinmouth, J., Wall, B., Grunfeld, E.

BMC Public Health 2017: 17(754).

Patients’ perspectives on BETTER prevention and screening: Qualitative findings from Newfoundland & Labrador.

Sopcak, N., Aguilar, C., Nykiforuk, C., O’Brien, MA., Aubrey-Bassler, K., Cullen, R., Heatherington, M., Grunfeld, E., Manca, D.

British Journal of General Practice (BJGP) Open 8 August 2017; BJGP-2017-0061.

Moderate mental illness as a predictor of chronic disease prevention and screening.

Salvalaggio, G., Meaney, C., Moinnedin, R., Grunfeld, E., Manca, D.

BMC Family Practice 2017: 18(73).

Family history of chronic disease: prevalence, accuracy and utility in prevention and screening.

Carroll, J.C., Campbell-Scherer, D., Permaul, J.A., Myers, J., Manca, D., Meaney, C., Moineddin, R., Grunfeld, E.

Canadian Family Physician 2017: 63(1)

2016

Implementation of the BETTER 2 Program: A qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.

Sopcak, N., Aguilar, C., O’Brien, MA., Nykiforuk, C., Aubrey-Bassler, K., Cullen, R., Grunfeld, E., Manca, D.

Implementation Science 2016: 11(158)

2015

Developing clinical decision tools to implement chronic disease prevention and screening in primary care: the BETTER 2 Program (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care).

Manca, D., Campbell-Scherer, D., Kandola, K., Aubrey-Bassler, K., Aguilar, C., Baxter, J., Meaney, C., Nykiforuk, C., Grunfeld, E.

Implementation Science 2015: 10 (107)

2014

On the analysis of composite measures of quality in medical research.

Moineddin, R., Meaney, C., Grunfeld, E.

Statistical Methods in Medical Research

Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation.

Manca, D.P., Aubrey-Bassler, K., Kandola, K., Aguilar, C., Campbell-Scherer, D., Sopcak, N., O’Brien, MA., Meaney, C., Faria, V., Baxter J., Moineddin, R., Salvalaggio, G., Green, L., Cave, A., Grunfeld, E.

Implementation Science 2014: 9 (135)

Finding a BETTER Way: A qualitative study exploring the Prevention Practitioner intervention to improve chronic disease prevention and screening in family practice.

Manca, D.P., Greiver, M., Carroll, J.C., Salvalaggio, G., Cave, A., Rogers, J., Pencharz, J., Aguilar, C., Barrett, R., Bible, S., Grunfeld, E.

BMC Family Practice 2014: 15 (66)

Guideline Harmonization and Implementation Plan for the BETTER Trial (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice).

Campbell-Scherer, D., Rogers, J., Manca, D., Lang-Robertson, K., Bell, S., Salvalaggio, G., Greiver, M., Korownyk, C., Klein, D., Carroll, J.C., Kahan, M.M., Meuser, J., Buchman, S., Barrett, R.M., Grunfeld, E.

Canadian Medical Association Journal Open (CMAJOpen) : 2(1): E1-10.

2013

Improving Chronic Disease Prevention and Screening in Primary Care: Results of the BETTER Pragmatic Cluster Randomized Controlled Trial.

Grunfeld, E., Manca, D., Moineddin, R., Thorpe, K.E., Hoch, J.S., Campbell-Scherer, D., Meaney, C., Rogers, J., Beca, J., Krueger, P., Mamdani, M.

BMC Family Practice 2013: 14 (175)

2011

Current Use of Electronic Medical Records in primary care of chronic disease: the implications for clinical governance.

Shaw, N.T., Aceti, V., Campbell-Scherer, D., Leyland, M., Mozgala, V., Patterson, L., Sunley, S., Manca, D., Grunfeld, E.

Clinical Governance: An International Journal 2011: 16(4); 353-363

Published Abstracts

2023

“It’s improving screening rates, it’s catching things early, and it’s empowering people”: A qualitative study of BETTER WISE.

Sopcak, N., Fernandes, C., Wong, M., Ofosu, D., Khalil, I., O’Brien, M.A., Wong, T., Manca, D.

The Annals of Family Medicine

Improving primary prevention and screening: Knowledge synthesis and actionable recommendations for the BETTER Program.

Manca, D.P., Campbell-Scherer, D., Fernandes, C., Grunfeld, E., Aubrey-Bassler, K., Lofters, A., Wong, T., Latko, K., Cheung, H., Wong, M., Nagase, F., Shea-Budgell, M.

The Annals of Family Medicine

2020

PCR101: Qualitative evaluation of the BETTER HEALTH intervention: views of community residents living in low income neighborhoods.

O’Brien, M.A., Lofters, A., Grunfeld, E., Makuwaza, T., Riordan, B., Manca, D., Sopcak, N., Cornacchi, S., Siva, K., Selby, P., Rabeneck, L., Baxter, N.

Abstracts from the 48th NAPCRG Annual Meeting. November 20, 2020, Virtual.

OP223: The BETTER Program: from clinical trials to nation-wide implementation.

Lofters, A., Grunfeld, E., Manca, D., Ivers, N., Paszat, L., Fernandes, C., O’Brien, M.A.

Abstracts from the 48th NAPCRG Annual Meeting. November 20, 2020, Virtual.

Patients’ perspectives of BETTER WISE a chronic disease prevention and screening project.

Sopcak, N., Kebbe, M., Fernandes, C., Manca, D.

International Journal of Qualitative Methods 2020: 19: 1-92.

2014

Abstract P-51: Facilitators and Barriers to the Implementation of the BETTER 2 Program: Qualitative Evaluation of a New Approach to Chronic Disease Prevention and Screening (CDPS).

Sopcak, N., Aguilar, C., Aubrey-Bassler, K., Cullen, R., Heatherington, M., Manca, D

Abstracts of the Cancer and Primary Care Research International (Ca-PRI) Network Seventh Annual Meeting: New Partnerships in Primary Care Research. June 10-13, 2014, Winnipeg, Manitoba, Canada. European Journal of Cancer Care 2014: 23 (Sup1): 1-23.

Abstract P-50: Finding a BETTER Way: A Chronic Disease Prevention and Screening Program.

Manca, D., Grunfeld, E., Aubrey-Bassler, K., Kandola, K., Campbell-Scherer, D., Moineddin, R., Meaney, C., Sopcak, N., Aguilar, C.

Abstracts of the Cancer and Primary Care Research International (Ca-PRI) Network Seventh Annual Meeting: New Partnerships in Primary Care Research. June 10=13, 2014, Winnipeg, Manitoba, Canada. European Journal of Cancer Care 2014: 23 (Sup1): 1-23.

Family history in primary care: feasibility, accuracy and utility in chronic disease prevention and screening.

Carroll, JC., Campbell-Scherer, D., Permaul, J., Myers, J., Manca, D., Meaney, C., Moineddin, R., Grunfeld, E.

Canadian Family Physician 2014; 60 (Sup1): S1-S43

Finding a BETTER Way: A Program to Facilitate Chronic Disease Prevention ad Screening in Primary Care.

Manca, D., Aguilar, C., Baxter, J., Campbell-Scherer, D., Kandola, K., Aubrey-Bassler, K., Meaney, C., Grunfeld, E.

Canadian Family Physician 2014; 60 (Sup1): S1-S43

How can we do BETTER? Contrasting perspectives on a new approach to chronic disease prevention and screening (CDPS) in Newfoundland and Labrador.

Sopcak, N., Manca, D., Aguilar, C., O’Brien, M., Aubrey-Bassler, K., Cullen, R., Heatherington, M., Grunfeld, E.

International Journal of Qualitative Methods 2014: 13(1): 589-627.

2013

Evidence Synthesis, Translation, Tool Development and Implementation Plan for the BETTER 2 (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) Project.

Campbell–Scherer DL, Salvalaggio G, Aguilar C, Carroll J, Aubrey K, Rogers J, Meaney C, Korownyk C, Grunfeld E, Manca D.

Family Medicine Journal 2013: 45 (Sup4)

Doing it BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening): a qualitative evaluation of a personalized approach to prevention and screening.

Manca, D., Aguilar, C., Carroll, J., Cave, A., Greiver, M., Patterson, L., Pencharz, J., Salvalaggio, G., Grunfeld, E.

Family Medicine Journal 2013: 45 (Sup4)

On the analysis of composite endpoints in primary care.

Moineddin, R., Meaney, C., Grunfeld, E.

Family Medicine Journal. 2013; 45 (Sup2).

Building on Existing Tools to Improve Chronic Disease Prevention and Screening: Results of the BETTER Trial.

Manca, D., Rogers, J., Moineddin, R., Meaney, C., Campbell-Scherer, D., Thorpe, K., Mumdani, M., Hoch, J., Beca, J., Krueger, P., Patterson, L., Aguilar, C., Grunfeld, E. on behalf of the BETTER Trial Investigators.

Family Medicine Journal. 2013; 45 (Sup2)

The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice) Project: A Qualitative Exploration of the Prevention Practitioner Role.

Manca, D., Aguilar, C., Sopcak, N.

International Journal of Qualitative Methods 2013: 12(1): 742-836.

2012

Development of Clinical Interventions for the Better Project (Building on Existing Tools to Improve Chronic Disease Prevention in Family Practice).

Campbell- Scherer, D., Rogers, J., Lang – Robertson, K., Bell, S., Grunfeld, E., Manca, D.

Family Medicine Journal. 2012; 44 (Sup1)

2011

Screening And Primary Prevention In Primary Care In Patients With Co-morbid Depression: Evidence Review And Tool Identification for The Better Coalition.

Salvalaggio,G., Campbell-Scherer, D., Steele, L., Mozgala, V., Lang-Robertson, K., Bell, S.,Rogers, J., Manca, D., Grunfeld, E.

Family Medicine Journal 2011; 43(Sup1)

Non-Peer Reviewed Publications

2020

Prevention before treatment: How an OICR investigator is shifting the paradigm of chronic disease in Canada.

Grunfeld, E.

OICR News. July 23, 2020 Edition.

2019

Cancer SCN Research.

Cancer Strategic Clinical Network (SCN).

Cancer SCN Quarterly Update. January – March 2019 Edition.

BETTER Recognized in PMH Implementation Kit.

Department of Family Medicine, University of Alberta.

Family Medicine Research Newsletter. October 2019 Edition.

2018

BAP in Research: BETTER WISE.

Centre for Collaboration, Motivation, and Innovation.

CCMI BAP Community of Practice Newsletter. December 2018 Edition.

New care model increases preventive behaviour in patients.

Young, L.

Folio website. July 4, 2018.

The BETTER Institute.

Department of Family Medicine, University of Alberta.

Family Medicine Research Newsletter. July 2018 Edition.

BETTER Program Receives CPAC Grant.

Department of Family Medicine, University of Alberta.

Family Matters: Your updates from the University of Alberta Department of Family Medicine. May/June 2018 Edition.

2017

Exercise aids in treating illnesses

Waldman, D.

Alberta Health Services, Alberta Innovates, Issue 26.

Improving cancer and chronic disease prevention and screening through the BETTER WISE Project

Access Improvement, Alberta Health Services. Volume 3.1.

2016

CLASP 1 AND CLASP 1 Renewals – The BETTER 2 Program.

Canadian Partnership Against Cancer.

Cancerview website. August 17, 2016 Edition.

Improving cancer and chronic disease prevention and screening through the BETTER WISE Project

Cancer Cares, Alberta Health Services.

2015

NWT BETTER Program

The Bear Facts: A Newsletter for Employees of the Government of the Northwest Territories

2014

Empowering healthy lifestyle choices: NWT-specific videos being used in push to prevent chronic diseases.

Thompson, R.

Northern News Services. November 6, 2014 Edition.

Assessing the cost of sitting: Study shows Canadians at higher risk of chronic conditions due to sedentary lifestyles.

Anselmi, E.

Northern News Services

Making BETTER Choices.

The Bear Facts: A Newsletter for the Employees of the Government of the Northwest Territories

Putting science back into the Family Medicine Forum

College of Family Physicians of Canada website

Projects and Initiatives Around the North: NWT BETTER Program

The Canadian Circumpolar Health Newsletter

2013

Improve your health.

Dooley, D.

The Labradorian. November 19, 2013 Edition.

Research Teams: The BETTER 2 Program

Manca, D., Aguilar, C., Sopcak, N.

Covenant Health Research Publication (newsletter)

2011

Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice: the BETTER Project

Aguilar, C., Campbell-Scherer, D., Salvalaggio, G., Manca, D.

Covenant Health Research Publication (newsletter)