Lifestyle-related factors such as obesity, inactivity, and poor diet contribute significantly to multimorbidity and primary care demand. Traditional lifestyle programmes often fail to engage working-age adults, underserved groups or people with language or cultural barriers. To address these issues we implemented a digital lifestyle coaching intervention delivered by trained health coaches to provide personalised behaviour-change support at scale.To assess the impact of digital lifestyle coaching on: 1. Weight, metabolic outcomes and HbA1c 2. A&E utilisation 3. Patient engagement and retention 4. Equity across diverse populationsA retrospective analysis was undertaken using operational data from NHS patients enrolled in the digital coaching service. The evaluation was conducted across multiple primary care sites serving approximately 500,000 patients Outcomes included weight change, HbA1c, medication use, A&E utilisation, and retention. Qualitative feedback was collected through user reports.Since implementation, more than 7,000 patients have participated in the intervention. Quantitative outcomes included: - Mean weight change −2.2 kg overall and −3.9 kg among 12-week completers - HbA1c reductions of −9.9 mmol/L in one cohort and −5.5 mmol/mol in another - 90% reduction in hypoglycaemia-related medication use in one region A&E utilisation 37.7% lower than system average in a high-need cohort Retention rates reached 80% where coaching was provided, compared with 15% in digital-only programmes. Patient feedback highlighted improved motivation, deeper understanding of nutrition and increased confidence in self-management. Cultural and multilingual adaptations supported strong engagement among ethnic minority and deprived populations. Engagement was particularly strong among underserved groups, indicating that culturally tailored coaching may help reduce health inequalities.Personalised digital coaching delivered by trained health coaches significantly improved metabolic outcomes and engagement in diverse communities. Combining behavioural science with cultural adaptation was essential for reaching underserved populations. These outcomes highlight the potential for scalable digital coaching models to support metabolic health at population level.Digital coaching interventions can deliver measurable health improvements, reduce A&E utilisation and support primary care sustainability when integrated into population-health pathways. This model demonstrates a scalable approach to strengthening primary care delivery and may inform international efforts to modernise primary care.

Lifestyle-related conditions such as type 2 diabetes, hypertension, obesity, and stress place increasing pressure on primary care. Traditional behavioural interventions often rely on structured education or group programmes that many patients find difficult to access. Demand for flexible, personalised support has grown as patients seek help managing long-term conditions and fluctuating symptoms alongside busy lifestyles. Primary care teams required an at-scale approach capable of providing sustained behaviour-change support without increasing clinician workload.A digital lifestyle coaching intervention was implemented across an organisation serving 500,000 patients across multiple primary care sites, supporting more than 7,000 patients to date. Patients were invited through routine clinical pathways, targeted outreach and proactive identification of at-risk/high need individuals. The innovative model combined one-to-one coaching with daily digital prompts, reflective check-ins and personalised behaviour-change plans. Coaches maintained regular asynchronous contact and scheduled calls, enabling continuity and accountability over several months. Scale was achieved by embedding the programme into existing long-term condition workflows, allowing large cohorts of patients to begin personalised coaching simultaneously. Strengths included the flexibility of remote engagement and the ability to support large numbers of patients in parallel. Safety checks were embedded at critical points and concerns about clinical safety addressed in DTAC, DPIA and DCB0129/0160-aligned safety assessment.Embedding the programme into routine pathways increased uptake and normalised lifestyle coaching as a core component of chronic disease management. Future development may include tighter integration with long-term condition recall, digital triage and social prescribing.The intervention demonstrated that large-scale personalised lifestyle support is feasible in primary care and can complement clinician-led care by improving self-management and reducing reliance on short, episodic consultations.Mean weight change of -3.9kg, HbA1c reduction of -9.9mmol/mol and 37.7% reduction in A&E utilisation reflect significant population-health improvement. This scalable digital lifestyle coaching model enabled sustained behaviour change, enhanced patient confidence with retention rates of 80% in diverse primary care communities.

Many patients present to primary care with concerns linked to anxiety, low mood, sleep difficulties, inactivity and long-term conditions that require sustained self-management support. Traditional primary care involves brief clinical consultations with limited opportunity for regular follow-up or coaching. This often leads to repeated appointments, increased demand and frustration for patients who struggle to maintain progress. Practices sought an at-scale solution to offer continuous, personalised wellbeing support without increasing clinician workload.A digital self-management tool was introduced across practices serving 500,000 people to help patients build healthier routines through personalised support. This innovative programme was offered to individuals with frequent attendance patterns, multimorbidity, or persistent wellbeing challenges. Implementation followed a staged approach, beginning with small cohorts to understand adoption patterns and refine onboarding. Patients chose goals related to sleep, emotional wellbeing, physical activity or lifestyle behaviours. The tool provided daily nudges, behavioural prompts, reflective check-ins and progress was monitored through a structured wellbeing framework. Strengths included accessibility outside appointment hours and ability for patients to engage at their own pace. Safety checks were embedded at critical points and concerns about clinical safety addressed in DTAC, DPIA and DCB0129/0160-aligned safety assessment.Teams learned that identifying suitable patients early—such as frequent attenders or those managing multiple long-term conditions—enhanced impact. Future developments may include integration with social prescribing, group coaching or condition-specific pathways.The experience showed that digital self-management support can complement primary care by empowering patients, reducing administrative demand and offering continuity between clinical interactions. Engagement was strongest when practices introduced the tool as part of a broader personalised care approach.82% patients using the personalised digital self-management tool felt more in control of their health, 68% reported improved wellbeing and appointment utilisation decreased by 15% in frequent attenders. This solution represents a scalable, cost-effective and patient-centred approach to enhancing holistic care.

The Kosovo Non-Communicable Disease Cohort (KOSCO), a collaborative study between the Swiss TPH, NIPHK, and UP, has been implemented in Kosovo since 2019. The AQH project in collaboration with NIPHK are implementing behaviour change interventions to facilitate improvement in lifestyle behaviours.This study assesses the impact of behaviour change interventions on health behaviours, participants’ stages of health behaviour change, as well as describes experiences and perceived benefits of motivational counselling.Study participants (n=907) were recruited from 12 municipalities participating in the KOSCO study. For the quantitative study, data on lifestyle behaviours and stages for behavioural change were used. For the qualitative study, in-depth interviews were conducted with 26 cohort participants who had undergone motivational counselling.Quantitative study: 13% of study participants are smokers, 86% do not adhere to WHO recommendations for physical activity, 93% do not consume fruits and vegetables based on WHO recommendations, and 61% are obese. In all lifestyle behaviours: physical activity, nutrition, smoking, alcohol consumption participants were in precontemplation phase. Qualitative study: Participants who received motivational counselling describe positive experiences and willingness to start to change their health behaviors. Main barriers for physical activity behaviors are: lack of outdoor facilities for physical activity, weak health conditions, and insufficient knowledge on types of exercises.More tailored primary healthcare approaches in accordance with patients’ views need to be considered for behaviour change interventions to efficiently facilitate lifestyle behaviour change.To improve the health behaviours, the following tailored approaches are suggested: a) strengthened referral mechanism b) specialized services for smoking cessation; c) delivery of group physical activity sessions.

Lifestyle-related risk factors remain major contributors to cardiometabolic morbidity. Rural populations frequently face barriers to accessing preventive programmes, including transport challenges, limited local services and reduced health literacy. WONCA Europe emphasises equity, continuity, prevention and community orientation; Principles that can be operationalised through structured lifestyle interventions combining personalised support with accessible behaviour-change pathways. This project evaluated the delivery and impact of an integrated lifestyle referral model incorporating exercise, weight management support, smoking-cessation and alcohol reduction interventions.A mixed-methods evaluation was undertaken. During routine consultations, clinicians conducted structured lifestyle assessments, using patient responses to guide referrals to one of four evidence-based pathways: supervised exercise programmes, weight management support, smoking cessation services or alcohol reduction programmes. Many participants enrolled in a 12-week combined intervention programme. Quantitative data captured referral volumes across programme types, while qualitative insights were obtained from patient feedback and discussions, analysed thematically to explore drivers of engagement, perceived benefits and barriers.Between January-October 2025, 391 patients were referred. 64 accessed smoking cessation support, six participated in health-coach alcohol reduction sessions, 84 joined weight management programmes and 155 enrolled in supervised exercise interventions. 82 patients were unable to book due to capacity limitations. Participants reported improved motivation, confidence and knowledge, with particularly strong uptake among older adults and those with complex health needs.Structured lifestyle pathways demonstrated strong engagement and patient benefit, particularly when referrals were personalised and accessible. Interventions that matched individual needs supported sustainable behaviour change, motivation, confidence and social connection, promoting equitable preventive care. Capacity limitations restricted access for some, highlighting the importance of expanding provision and maintaining ongoing follow-up to maximise long-term health impact.Structured, personalised lifestyle intervention pathways enhances preventive care, empowers patients and strengthens community-oriented primary healthcare. Combining supervised exercise, behavioural weight management, targeted smoking and alcohol reduction support aligns with WONCA priorities and supports long-term population health. Expanding programme capacity will improve reach and outcomes in rural populations.

Physical activity (PA) is a key component of chronic disease prevention and management, yet remains insufficiently promoted in routine primary care. General practitioners (GPs) play a central role in PA counselling, and evidence suggests that their personal activity levels may influence their clinical practice. Understanding PA habits among GPs is therefore essential for strengthening PA promotion in primary care settings.To assess PA levels among GPs in the Hauts-de-France region, and to explore associations between PA levels, gender, working hours, and PA promotion practices during consultation.A cross-sectional descriptive and analytical study was conducted between February and June 2025 among practising GPs in the Hauts-de-France region. An online questionnaire incorporating the validated short International Physical Activity Questionnaire (IPAQ) was distributed through professional networks and mailing lists. Collected variables included sociodemographics, weekly working hours, PA promotion habits, and use of adapted physical activity (APA) prescriptions. Data analysis included descriptive statistics and comparative tests, with statistical significance set at p < 0.05.Among 449 respondents, 268 complete responses were included in the analysis. Based on the IPAQ scoring system, 44%of GPs reported a high PA level, 40% a moderate level, and 16% a low level. Although 95.5% declared promoting PA in consultations, only 54% reported doing so systematically. APA prescription and follow-up were reported by 28% and 25% of respondents, respectively. No significant association was found between PA level and gender or weekly working hours. However, GPs with higher PA levels were significantly more likely to promote PA to all their patients (p = 0.02).While GPs demonstrate relatively high personal PA levels, this does not translate into systematic counselling or APA prescription practices. Barriers may include limited training, lack of practical tools, and insufficient integration of PA resources within primary care structures.Despite satisfactory PA levels among GPs, PA promotion and APA prescription remain suboptimal. Enhancing GP training, developing user-friendly prescription tools, and strengthening links with community PA resources could improve the integration of physical activity into everyday primary care practice.

Physical inactivity is a leading risk factor for chronic diseases and mortality. Mobile health (mHealth) interventions with behavioral incentives may promote physical activity in real-world settings, but evidence on long-term effectiveness at the population scale remains limited. Leumit FIT is a digital program deployed nationwide within Leumit Health Services (LHS) that provides rewards, such as fitness products and healthy-lifestyle vouchers, to encourage higher daily step counts.To evaluate whether sustained engagement with an incentive-based step-tracking app is associated with a change in daily physical activity among the general population.We conducted a longitudinal analysis of anonymized step-tracking data from 75,253 LHS members aged ≥14 years who used the Leumit FIT application for at least one month. Daily steps were recorded via smartphone accelerometers and aggregated at the participant-month level. A linear regression model was applied to estimate within-individual changes in physical activity associated with each month of app usage, adjusting for age, sex, ethnicity, BMI, calendar year, and seasonal variation.Participants used the app for a median of 16 months. The mean baseline physical activity was 4,799 steps/day. Each additional month of app usage was associated with a statistically significant increase of approximately 60 steps/day (p < 0.05). After 24 months of continuous engagement, users achieved an average increase of ~1,400 daily steps. The trend was sustained without a plateau across the observation period.A nationwide mHealth incentive program demonstrated durable improvements in physical activity over more than 2 years of follow-up.Scalable digital interventions may contribute meaningfully to preventive health strategies by motivating clinically relevant behavioral improvements.