BETTER for All: Creating Sustainable Pathways to Chronic Disease Prevention
Can preventative health be more attainable with an accountability partner; particularly one who shares language, life experiences, interests and or other supportive qualities?
The BETTER for All program is a GTA-based evidence-based peer health coaching (PHC) program focused on eliminating barriers to care and reducing the risk of cancer and other chronic diseases for newcomers to Canada and in racialized communities. It is built on a national BETTER (Building on Existing Tools to Improve Chronic Disease Prevention & Screening in Primary Care) program.
BFA offers personalized support for chronic disease prevention and access to a Peer Health Coach (PHC) for up to six months for adults aged 40-69.
A service innovation – prevention practitioners and peer health coaches
Developed by primary care providers for primary care providers, the BFA program trains health care professionals to become experts in chronic disease prevention. The program introduced the Prevention Practitioner; a healthcare professional working in, or directly linked with, primary care who has enhanced skills in cancer and chronic disease prevention and screening.
BFA provides a framework and the tools for a paradigm shift from a siloed, management approach to a personalized, comprehensive, proactive approach to chronic disease prevention and screening that is intended to enhance and facilitate current efforts in primary care.
Prevention Practitioners come from many backgrounds, including nursing, dietetics, pharmacy, and kinesiology. All health care professionals with a link to primary care can be successful in this role. The Prevention Practitioner plays a key role in getting a community member started on their road to good health. Prevention practitioners hold a person-centred visit with participants to review their medical history, family history, and health behaviours and support them in setting specific, measurable, achievable, realistic, and timely goals.
Following the goal setting meeting, clients are given a “prevention prescription” and are matched with a Peer Health Coach with similar intersecting identity factors to support achieving their health goals. Peer Health Coaches are motivated adults from diverse backgrounds who are recruited, screened, and onboarded through 40+ hours of training. They provide ongoing support to help participants work toward risk reduction and prevention goals.
Sustaining what works
Building on the BETTER Women pilot, we investigated how peer-delivered approaches strengthen trust and follow-through needed for sustained lifestyle changes in targeted populations.
Access Alliance’s BETTER for All (BFA) Sustainability Project explored how to sustain and scale BFA. The project aimed to identify the organizational, relational, and operational conditions required to sustain the BFA program and its associated health benefits over time. Specific objectives included exploring strategies to maintain participant engagement, strengthen preventive health behaviours, support equitable and culturally responsive program delivery, and identify resources and partnerships necessary for long-term sustainability within multidisciplinary primary care and community settings.
We found that BFA shows potential to reduce health inequities by integrating prevention within community-based care. Its influence may extend beyond individual behaviour change to building community capacity, promoting culturally responsive care, and fostering trust in health systems. The sustainability assessment provides insights to support embedding the program in routine practice, improve referral pathways, and strengthen cross-sector collaboration. BFA has the potential to align prevention efforts more closely with the lived experiences of underserved populations.
Strengths include peer-led engagement and culturally tailored care, while challenges include staffing constraints and language barriers. Our project identified what is needed to sustain the program, so prevention can be integrated into routine care over the long-term. This would mean benefits could reach more people consistently, over time, improving the health of our clients and communities.
Sustaining BFA requires ongoing investment in workforce capacity, stronger partnerships, and integration into existing health and community systems. The program’s long-term success will depend on its ability to adapt to evolving community needs while staying true to its core principles of equity, accessibility, and prevention.
Find out more about how the BFA program has worked, and our sustainability findings in this conference presentation:
If you have questions about the sustainability project, please contact Ezza Jalil at research@accessalliance.ca.
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