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%到60%的严重精神疾病（SMI）患者肥胖。肥胖和