Digital Health Supported Weight Management Intervention Delivered by Community Health Workers among Public Housing Residents

项目总结 超重/肥胖与多种慢性病的死亡率密切相关，包括与肥胖有关的慢性病 癌症。对于面临健康差距的人群，包括种族/族裔少数群体和/或低收入个人， 肥胖和癌症的高患病率，促进营养行为改变的干预措施， 体力活动和体重是国家健康的优先事项。不断增长的知识库记录了 社区卫生工作者支持改善行为改变的干预措施，至少部分是由于他们的 对干预措施应如何适应社会和环境背景的独特见解。在那里的时候 在使用数字技术提供健康干预方面迅速扩大，出现了 很少有关于非专业卫生工作者在美国使用这些技术的潜在研究，包括 社区卫生工作者。然而，目前还不清楚数字技术是否单独对减肥有效， 特别是在面临健康差距的人群中，或者如果采取更强烈的干预措施，包括 需要社区卫生工作者和数字技术的结合才能成功地推广 面临健康差距的人群中的体重减轻。在拟议的研究研究中，我们将以权重为目标 波士顿公共住房开发项目中低收入和肥胖居民的管理 主要来自种族/少数民族群体。这份R01提案旨在检查 结合mHealth技术和网站驱动的行为咨询的干预方法 社区卫生工作者。我们的假设是，在一项为期12个月的整群随机试验(n=504)中，比较3 接受社区保健工作者激励的公共房屋发展项目(n=168名参与者) 访谈行为咨询+mHealth自我监测/短信反馈(MHealth CHW)， 相比之下，只收到mHealth自我监控/短信反馈的3个开发人员(n=168) (仅限mHealth)，与仅接受评估的3个发展项目(n=168)(控制组)，两者都是 只有mHealth CHW和mHealth才会超越仅限评估的对照，而mHealth CHW将超越 MHealth仅在12个月后体重减轻方面。对于次要结果，我们将研究干预措施 对饮食和身体活动行为的影响。我们还将考察社会认知的中介作用 参与者特征和社会情境变量对组织绩效的理论构建及其调节作用 干预的效果。最后，我们将进行成本效益分析。我们的结果将使我们能够更好地 了解面临健康差距的人群中有效的体重管理方法， 它可以应用于其他可改变的癌症危险行为，并扩展到更大的联邦网络中 公共住房管理部门。

PROJECT SUMMARY Overweight/obesity is strongly linked to mortality from multiple chronic diseases, including obesity-related cancers. For health disparity-facing populations, including racial/ethnic minority and/or low income individuals, who have both high prevalence of obesity and cancer, interventions promoting behavioral change for nutrition, physical activity, and weight are a national health priority. A growing knowledge base documents the efficacy of community health worker supported interventions for improving behavioral change due, at least in part, to their unique insights into how an intervention should be adapted to social and environmental contexts. While there has been a rapid expansion in the use of digital technologies for delivering health interventions, there has been little study of the potential use of these technologies in the U.S. by non-professional health workers, including community health workers. Yet, it is not yet clear if digital technologies alone are efficacious for weight loss, particularly among health disparity-facing populations, or if a more intense intervention consisting of a combination of community health workers plus digital technologies will be needed to successfully promote weight loss among health disparity-facing populations. In the proposed research study, we will target weight management among obese residents of Boston's public housing developments who are low-income and predominately from racial/ethnic minority groups. This R01 proposal seeks to examine the efficacy of an intervention approach that combines mHealth technology plus website-driven behavioral counseling from community health workers. Our hypothesis is that in a 12-month cluster-randomized trial (n=504) comparing 3 public housing developments (n=168 participants) who receive community health worker motivational interviewing behavioral counseling plus mHealth self-monitoring/text message feedback (mHealth+CHW), versus 3 developments (n=168) who receive the mHealth self-monitoring/text message feedback only (mHealth only), versus 3 developments (n=168) who receive assessment only (control group), both mHealth+CHW and mHealth only will outperform assessment only control and mHealth+CHW will outperform mHealth only in terms of weight loss at 12 months. For secondary outcomes, we will examine intervention effects on diet and physical activity behaviors. We will also examine mediating effects of Social Cognitive Theory constructs and moderating effects of participant characteristics and social contextual variables on the effect of the intervention. Finally, we will conduct a cost-effectiveness analysis. Our results will enable a better understanding of efficacious approaches to weight management among health disparity-facing populations, which may be applied to other modifiable cancer risk behaviors and be extended into the larger federal network of public housing administrations.