BETTER Life Study

Emerging evidence from the BETTER HEALTH: Durham study supports the need for exploration of adaptation of the BETTER HEALTH intervention for younger adults living with low income.   People with lower income are more likely to be smoking, physically inactive, and lacking in fruit and vegetable consumption than those with higher income and thus are more likely to develop multiple chronic conditions earlier.

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.  We will focus on selected priority health neighbourhoods in the Durham Region of Ontario (identified by the Durham Region Health Department and community partners) and request feedback from eligible community residents.  We will also ask community residents to participate in adapted prevention practitioner visits to determine whether sessions are acceptable to them as a means of addressing chronic disease prevention and screening needs. The study builds on existing infrastructure of the BETTER program, the BETTER HEALTH: Durham research team, community advisory committee, and primary care group from the BETTER HEALTH: Durham study.

Specific study Objectives:

The BETTER Life study will:

  1. seek to understand individual, interpersonal and structural-level barriers to chronic disease prevention for younger adults living with low income using qualitative interviews and focus groups;
  2. adapt the BETTER HEALTH intervention based on these interviews and focus groups with younger adults as well as key stakeholders in multiple provinces (Ontario, Alberta, Newfoundland & Labrador;
  3. conduct acceptability testing of the adapted intervention with a small number of younger adults with low income in preparation for a future randomized trial.


Current restrictions from the COVID-19 pandemic may not allow for in-person recruitment strategies, data collection or prevention practitioner visits.  The BETTER Life research team will follow all Public Health guidelines for the Covid-19 pandemic and/or hold meetings virtually if in-person gatherings are not allowed.

Funding and timeline

This research is supported by a Canadian Institutes for Health Research (CIHR) catalyst grant and will be implemented between March 2020 and March 2022.

The BETTER Life is a study led by researchers at Women’s College Hospital, the University of Toronto, Sunnybrook Health Sciences Centre, St. Michael’s Hospital, University of Alberta, Memorial University, and Durham Region Health Department.

For more information about the BETTER Life study, please contact project lead Dr. Aisha Lofters at

The BETTER WISE project

Although most patients have multiple risks, most guidelines and resources are focused on one specific disease, organ system, or lifestyle risk.  Furthermore, cancer survivors and patients living in poverty achieve fewer prevention and screening goals and patients may lack awareness of how lifestyle contributes to cancer and chronic disease.  Building on the work of the BETTER trial and the BETTER 2 program, the BETTER WISE (Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening for Wellness of Cancer Survivors and Patients) project will conduct an intervention that includes electronic tools, pathways for cancer survivors, and a tool that screens for poverty. 

BETTER WISE is a 5-year project (2016-2021) that brings together diverse stakeholders (policy, practice, research, patients) in Alberta, Ontario, and Newfoundland and Labrador. The primary objective of the BETTER WISE project is to determine if patients aged 40-65, including cancer survivors (breast, colorectal, or prostate) and general health patients (i.e., patients without a previous history of breast, colorectal, or prostate cancer), randomized to receive an individualized visit with a Prevention Practitioner have improved cancer surveillance and general prevention and screening outcomes determined by a composite index as compared to standard care in a wait-list control group twelve months after the initial prevention visit

The BETTER WISE project will comprise of 3 phases:

  1. Knowledge harmonization and integration – Working with primary care practices and Prevention Practitioners, a revised BETTER WISE tool kit will include blended care pathways for cancer survivors (breast, colorectal, prostate) and cancer and chronic disease prevention and screening (CCDPS), including behavioural lifestyle risk factors and a screen for poverty.
  2. A pragmatic cluster randomized controlled trial – Sixteen primary care practices, 8 in Alberta, 4 in Ontario, and 4 in Newfoundland and Labrador will participate in the project. It is expected that 2-10 primary care providers (PCPs) from each primary care practice will be engaged, for a total of 64 PCPs across the 3 participating provinces. Patients will be randomized at the physician level to receive an early BETTER WISE intervention or to wait-list control. The BETTER WISE intervention is depicted below.BETTER Wise
  3. Evaluation of the impact of the intervention – The main outcome for the project will be the individual patient-level summary composite index defined as the proportion of CCDPS maneuvers for which the patient was eligible at baseline, that is met (according to pre-defined targets) at 12-month follow-up. Qualitative methods will be used to explore the facilitators and barriers to the implementation and uptake of the BETTER WISE intervention as well as to address any modifications needed to scale and spread the approach and the PP role.  An economic assessment will also be undertaken to inform the health care payer and policy makers of the projected cost-benefit impact of investing in the BETTER WISE approach.

For more information about the BETTER WISE project, please contact us.

More information on the Prevention Practitioner role can be found here.

The BETTER WISE project is made possible through a financial contribution from Alberta Innovates – Health Solutions.

Are you a patient participating in the BETTER WISE Project? You can complete your health survey by following the link below:

The BETTER WISE Project Team (2016 – 2021)

Project Lead: Dr. Donna Manca
Project Co-Leads: Dr. Kris Aubrey-Bassler, Dr. Denise Campbell-Scherer, Dr. Eva Grunfeld, Dr. Aisha Lofters, Dr. Melissa Shea-Budgell
Collaborators: A. Bencivenga, G. Bloch, J. Britten, J. Carroll, C. Davis, E. Denga, K. Dong, R. Elford, L. Green, N. Hans, F. Janke, D. Klein, P. Krueger, C. Leduc, R. Lewanczuk, K. McBrien, C. Meaney, R. Moineddin, C. Nykiforuk, M.A. O’Brien, S. Oddie, A. Pinto, M. Rose, S. Ross, G. Salvalaggio, C. Scrimshaw, N. Sopcak, W. Tink, M. Wilson
Community and Policy Partners: C. Campbell, C. Chan, P. Corcoran-Mooney, A. Gogan, R. Hiscock, J. MacWhirter, F. McCrate, B. Meade, K. Milley, R. Goodyear, A. Robinson Vollman, T. Wong
Statistical Analysis: R. Moineddin, C. Meaney.
Economic Assessment: K. McBrien
Project Coordination: C. Fernandes, M. Chow, S. Parsons, K. Sivayoganathan
Research Assistant: D. Ofosu
Students/Trainees: M.K. Blackbyrne, I. Carneiro, M. Kebbe, C. Siu