CoachToFit: Adapted Weight Loss Intervention for Individuals with Serious Mental Illness

CoachToFit：针对严重精神疾病患者的适应性减肥干预

• 批准号: 10247450
• 负责人: MATTHEW CHINMAN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10247450
• 关键词: Address; Area; Awareness; Body Weight decreased; Calories; Cardiovascular system; Caring; Cellular Phone; Chronic Disease; Clinic; Clinic Visits; Clinical; Cognitive; Cognitive deficits; Coupled; Disease; Disease Management; Education; Enrollment; Epidemic; Evaluation; Evidence based intervention; Focus Groups; General Population; Goals; Growth; Health; Health Care Costs; Health Promotion; Healthcare; Healthcare Systems; Improve Access; Individual; Informatics; International; Intervention; Interview; Lead; Leadership; Life Expectancy; Maintenance; Measures; Medical; Medical center; Mental Health; Methodological Studies; Modeling; Morbidity - disease rate; Motivation; Obesity; Online Systems; Outcome; Overweight; Ownership; Patient Preferences; Patients; Persons; Policies; Population; Population Intervention; Positioning Attribute; Process; Provider; Public Health Informatics; Publishing; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Readiness; Reporting; Research; Research Design; Sampling; Self Efficacy; Services; Sleeplessness; Specialist; Technology; Telephone; Testing; Time; Transportation; United States Department of Veterans Affairs; Veterans; Weight; Weight maintenance regimen; care delivery; clinically significant; comorbidity; cost; dashboard; data visualization; design; diaries; diet and exercise; disorder prevention; eHealth; education access; efficacy outcomes; efficacy testing; evidence base; experience; future implementation; innovation; intervention delivery; mHealth; member; mobile computing; mortality; mortality risk; online delivery; peer; peer support; physical inactivity; post intervention; programs; psychosocial; service delivery; severe mental illness; skills training; smartphone Application; tool; traditional care; treatment as usual; treatment group; treatment guidelines; trend; usability; user centered design; weight loss intervention

Background: Between 40% to 60% of individuals with serious mental illness (SMI) are obese. Obesity and physical inactivity result in increased rates of chronic diseases, increased risk of death, and substantial health care costs. Treatment guidelines recommend that individuals with SMI who are overweight should be offered evidence-based weight loss interventions, including psychosocial interventions. The VA’s weight management program, MOVE!, is attended by less than 5% of the overweight population and is not adapted to the cognitive needs and patient preferences for the population with SMI. Effective adapted weight management programs are not offered in VA because they are time-intensive and require the skills of trained providers who are often in short-supply. CoachToFit can address this gap in care. CoachToFit is a weight management program, adapted for the population with SMI, that includes a smartphone app delivering evidence-based weight management services with weekly telephonic support from a VA peer specialist who acts as a wellness coach. Peer specialists are individuals who draw upon lived experiences with SMI to provide services to others with SMI in clinical settings. CoachToFit was shown to have high rates of acceptability and usability and was efficacious for weight loss in a small sample. VA has an opportunity to address obesity in the population with serious mental illness, currently a substantial gap in care. Significance/Impact: This project addresses obesity in the population with SMI by evaluating a weight management program that is not only evidence-based, it is sustainable, transportable, appealing to patients, easy to use, and minimally burdensome to the healthcare system. This effort addresses two HSR&D priority areas: 1) Mental Health: Testing new models of care to improve access, cost, and/or outcomes, and 2) Health Care Informatics: Building the evidence base for ehealth/mhealth tools. Innovation: CoachToFit’s use of mobile technology is an important innovation in VA service delivery and its user-centered design involving individuals with SMI was the first of its kind. CoachToFit is enhanced by data visualization in real-time via a web-based dashboard used by VA peer specialists and their supervisor. We are aware of no other evidence-based mobile platforms to help people with SMI reduce their weight. Specific Aims: The project aims to 1) Test the efficacy of CoachToFit, compared to usual care, in decreasing weight among Veterans with SMI who are obese; 2) Assess the hypothesized mechanisms of action for CoachToFit, including self-efficacy, motivation, and readiness to change; and 3) Characterize factors that will inform future implementation and maintenance of CoachToFit using a multi-stakeholder qualitative post- intervention evaluation guided by the RE-AIM framework. Methodology: The study design includes a randomized controlled trial to test the efficacy of CoachToFit and assess the hypothesized mechanisms of action. This will include enrollment of obese Veterans with SMI from the mental health clinics at one VA medical center (n=256). Individuals will be randomized to CoachToFit or usual care. Those in CoachToFit will have access to the app and coaching for 6 months. Outcomes are assessed at 6- and 12-months. Efficacy outcomes utilize objective measures. The design also includes a multi- stakeholder qualitative post-intervention evaluation guided by the RE-AIM framework to characterize factors that will inform future implementation and maintenance of CoachToFit. This will include interviews with Veterans randomized to CoachToFit (n=30); interviews with staff stakeholders (n=18); a discussion with Veterans in local Veteran groups (n=2 groups; n=11 Veterans), and interviews with national leadership (n=3). Next Steps/Implementation: If CoachToFit is found to be efficacious, the VA National Center for Health Promotion and Disease Prevention, along with input from national leadership in Peer Support Services and Mental Health Informatics, will assist in integration into the VA context.

背景：40%至60%的严重精神疾病（SMI）患者肥胖。肥胖和 缺乏身体活动导致慢性病发病率增加，死亡风险增加， 护理费用。治疗指南建议，应向超重的SMI患者提供 基于证据的减肥干预措施，包括心理社会干预措施。VA的体重管理 程序，MOVE！，只有不到5%的超重人口参加，并且不适应认知 SMI人群的需求和患者偏好。有效的适应性体重管理计划 在VA中不提供，因为它们是时间密集型的，需要训练有素的提供者的技能，这些提供者通常 供不应求。CoachToFit可以解决护理中的这一差距。CoachToFit是一个体重管理计划， 适用于患有SMI的人群，其中包括提供基于证据的体重的智能手机应用程序 管理服务与每周电话支持从VA同行专家谁作为一个健康教练。 同行专家是指利用SMI的生活经验为他人提供服务的个人， 临床环境中的SMI。CoachToFit被证明具有较高的可接受性和可用性， 在小样本中有效减肥。弗吉尼亚州有机会解决人口肥胖问题， 严重的精神疾病，目前在护理方面存在很大差距。 意义/影响：该项目通过评估体重来解决SMI人群中的肥胖问题。 管理计划，不仅是以证据为基础，它是可持续的，可移植的，吸引病人， 易于使用，并且对医疗保健系统的负担最小。这一努力解决了两个HSR&D优先事项 领域：1）心理健康：测试新的护理模式，以改善可及性、成本和/或结果，以及2）健康 护理信息学：为电子健康/移动健康工具建立证据基础。 创新：CoachToFit对移动的技术的使用是VA服务交付的重要创新， 以用户为中心的设计，涉及个人与SMI是第一次。CoachToFit通过数据增强 通过VA同行专家及其主管使用的基于Web的仪表板实时可视化。我们 没有其他基于证据的移动的平台可以帮助SMI患者减轻体重。 具体目的：该项目旨在1）测试CoachToFit与常规护理相比， 肥胖的SMI退伍军人的体重; 2）评估 CoachToFit，包括自我效能，动机和改变的准备;以及3）描述将 为未来CoachToFit的实施和维护提供信息， 由RE-AIM框架指导的干预评估。 方法：研究设计包括一项随机对照试验，以测试CoachToFit的疗效， 评估假设的作用机制。这将包括招募患有SMI的肥胖退伍军人， 一个VA医疗中心的心理健康诊所（n=256）。个人将被随机分配到CoachToFit或 常规护理CoachToFit中的用户将可以使用该应用程序并进行为期6个月的辅导。评估结果 在6个月和12个月时。疗效结局采用客观指标。该设计还包括一个多- 在RE-AIM框架的指导下进行利益相关者定性干预后评价，以描述因素 这将为CoachToFit的未来实施和维护提供信息。这将包括采访 随机分配到CoachToFit的退伍军人（n=30）;与员工利益相关者的访谈（n=18）;与 当地退伍军人团体的退伍军人（n=2组; n=11名退伍军人），以及与国家领导人的访谈（n=3）。 下一步/实施：如果CoachToFit被发现是有效的，VA国家卫生中心 沿着国家领导人在同伴支助服务方面的投入， 心理健康信息学，将有助于融入VA背景。