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) 患者患有肥胖症。肥胖和 缺乏身体活动会导致慢性病发病率增加、死亡风险增加以及严重健康问题 护理费用。治疗指南建议超重的 SMI 患者应接受治疗 基于证据的减肥干预措施，包括社会心理干预措施。 VA 的体重管理 计划 MOVE! 的超重人群参与人数不足 5%，并且不适应认知能力 SMI 人群的需求和患者偏好。有效的适应性体重管理计划 VA 不提供这些服务，因为它们非常耗时，并且需要经过培训的提供者的技能，而这些提供者通常 处于供应短缺状态。 CoachToFit 可以解决护理方面的这一差距。 CoachToFit 是一个体重管理计划， 适合 SMI 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，并由担任健康教练的 VA 同行专家提供每周电话支持。 同行专家是利用 SMI 的生活经验为其他人提供服务的个人 临床环境中的 SMI。 CoachToFit 被证明具有很高的可接受性和可用性，并且 在小样本中对减肥有效。 VA 有机会解决以下人群的肥胖问题 严重的精神疾病，目前护理缺口很大。 意义/影响：该项目通过评估体重来解决 SMI 人群的肥胖问题 管理计划不仅是基于证据的，而且是可持续的、可移植的、对患者有吸引力的， 易于使用，并且对医疗保健系统的负担最小。这项工作解决了 HSR&D 的两个优先事项 领域：1) 心理健康：测试新的护理模式以改善获取、成本和/或结果，以及 2) 健康 护理信息学：建立电子医疗/移动医疗工具的证据基础。 创新：CoachToFit 对移动技术的使用是 VA 服务交付及其应用的一项重要创新。 以用户为中心的设计涉及 SMI 患者，这在此类设计中尚属首次。 CoachToFit 通过数据得到增强 通过 VA 同行专家及其主管使用的基于网络的仪表板进行实时可视化。我们是 意识到没有其他基于证据的移动平台可以帮助 SMI 患者减轻体重。 具体目标：该项目旨在 1) 测试 CoachToFit 与常规护理相比在减少 患有 SMI 且肥胖的退伍军人的体重； 2) 评估假设的作用机制 CoachToFit，包括自我效能、动机和改变的准备程度； 3) 描述影响因素 使用多利益相关者定性事后报告为 CoachToFit 的未来实施和维护提供信息 RE-AIM框架指导下的干预评估。 方法：研究设计包括一项随机对照试验，以测试 CoachToFit 的功效和 评估假设的作用机制。这将包括通过 SMI 注册肥胖退伍军人 退伍军人管理局一处医疗中心的心理健康诊所 (n=256)。个人将被随机分配到 CoachToFit 或 平时的护理。 CoachToFit 会员将可以使用该应用程序并接受为期 6 个月的辅导。评估结果 6 个月和 12 个月时。功效结果利用客观测量。该设计还包括一个多 以 RE-AIM 框架为指导的利益相关者干预后定性评估，以表征因素 这将为 CoachToFit 的未来实施和维护提供信息。这将包括采访 退伍军人随机接受 CoachToFit (n=30)；与工作人员利益相关者的访谈（n=18）；与讨论 当地退伍军人团体中的退伍军人（n=2 个团体；n=11 名退伍军人），以及对国家领导层的采访（n=3）。 后续步骤/实施：如果发现 CoachToFit 有效，VA 国家健康中心 宣传和疾病预防，以及国家领导层在同行支持服务和 心理健康信息学将有助于融入 VA 背景。