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.

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
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.
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.
Completed Initiatives
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.
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.
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.
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.
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.
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.
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
Publications
Journal Articles
Harmonization of clinical practice guidelines for primary prevention and screening: Actionable recommendations and resources for primary care.
BMC Primary Care
BETTER LIFE – guidelines for chronic disease preventive care for people aged 18-39 years: a literature review
BMC Primary Care
2023
Prevention and screening during the COVID-19 pandemic: Qualitative findings from the BETTER WISE project.
BMC Primary Care
Facilitators and barriers to the implementation of BETTER WISE, a chronic disease and prevention intervention in Canada: A qualitative study.
Global Implementation Research and Applications
Opportunities to improve quality of care for cancer survivors in primary care: findings from the BETTER WISE study
Supportive Care in Cancer
2021
Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial.
BMC Public Health
What is a prevention visit? A qualitative study of a structured approach to prevention and screening – the BETTER WISE project.
BMC Family Practice
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.
British Journal of General Practice (BJGP) Open
2017
BETTER HEALTH: Durham – protocol for a cluster randomized trial of BETTER in community and public health settings.
BMC Public Health
Patients’ perspectives on BETTER prevention and screening: Qualitative findings from Newfoundland & Labrador.
British Journal of General Practice (BJGP) Open
Moderate mental illness as a predictor of chronic disease prevention and screening.
BMC Family Practice
Family history of chronic disease: prevalence, accuracy and utility in prevention and screening.
Canadian Family Physician
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.
Implementation Science
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).
Implementation Science
2014
On the analysis of composite measures of quality in medical research.
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.
Implementation Science
Finding a BETTER Way: A qualitative study exploring the Prevention Practitioner intervention to improve chronic disease prevention and screening in family practice.
BMC Family Practice
Guideline Harmonization and Implementation Plan for the BETTER Trial (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice).
Canadian Medical Association Journal Open (CMAJOpen)
2013
Improving Chronic Disease Prevention and Screening in Primary Care: Results of the BETTER Pragmatic Cluster Randomized Controlled Trial.
BMC Family Practice
2011
Current Use of Electronic Medical Records in primary care of chronic disease: the implications for clinical governance.
Clinical Governance: An International Journal
Published Abstracts
2023
“It’s improving screening rates, it’s catching things early, and it’s empowering people”: A qualitative study of BETTER WISE.
The Annals of Family Medicine
Improving primary prevention and screening: Knowledge synthesis and actionable recommendations for the BETTER Program.
The Annals of Family Medicine
2020
PCR101: Qualitative evaluation of the BETTER HEALTH intervention: views of community residents living in low income neighborhoods.
Abstracts from the 48th NAPCRG Annual Meeting. November 20, 2020, Virtual.
OP223: The BETTER Program: from clinical trials to nation-wide implementation.
Abstracts from the 48th NAPCRG Annual Meeting. November 20, 2020, Virtual.
Patients’ perspectives of BETTER WISE a chronic disease prevention and screening project.
International Journal of Qualitative Methods
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).
European Journal of Cancer Care
Abstract P-50: Finding a BETTER Way: A Chronic Disease Prevention and Screening Program.
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.
Canadian Family Physician
Finding a BETTER Way: A Program to Facilitate Chronic Disease Prevention ad Screening in Primary Care.
Canadian Family Physician
How can we do BETTER? Contrasting perspectives on a new approach to chronic disease prevention and screening (CDPS) in Newfoundland and Labrador.
International Journal of Qualitative Methods
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.
Family Medicine Journal
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.
Family Medicine Journal
On the analysis of composite endpoints in primary care.
Family Medicine Journal
Building on Existing Tools to Improve Chronic Disease Prevention and Screening: Results of the BETTER Trial.
Family Medicine Journal
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.
International Journal of Qualitative Methods
Non-Peer Reviewed Publications
2020
Prevention before treatment: How an OICR investigator is shifting the paradigm of chronic disease in Canada.
OICR News. July 23, 2020 Edition.
BETTER Recognized in PMH Implementation Kit.
Family Medicine Research Newsletter. October 2019 Edition.
2018
BAP in Research: BETTER WISE.
CCMI BAP Community of Practice Newsletter. December 2018 Edition.
New care model increases preventive behaviour in patients.
Folio website. July 4, 2018.
The BETTER Institute.
Family Medicine Research Newsletter. July 2018 Edition.
BETTER Program Receives CPAC Grant.
Family Matters: Your updates from the University of Alberta Department of Family Medicine. May/June 2018 Edition.
2017
Exercise aids in treating illnesses
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.
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.
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.
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
Research Teams: The BETTER 2 Program
Covenant Health Research Publication (newsletter)
2011
Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice: the BETTER Project
Covenant Health Research Publication (newsletter)