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

项目摘要 超重/肥胖与多种慢性疾病的死亡率密切相关，包括与肥胖有关的疾病。 癌的对于面临健康风险的人群，包括种族/少数民族和/或低收入人群， 肥胖和癌症的高发病率，促进营养行为改变的干预措施， 身体活动和体重是国家健康的优先事项。越来越多的知识库记录了 社区卫生工作者支持的干预措施，以改善行为变化，至少部分原因是， 对干预措施应如何适应社会和环境背景的独特见解。虽然 在使用数字技术提供卫生干预方面， 几乎没有研究这些技术在美国的潜在用途，由非专业卫生工作者，包括 社区卫生工作者。然而，目前尚不清楚数字技术是否单独对减肥有效， 特别是在面临健康问题的人群中，或者如果采取更密集的干预措施， 社区卫生工作者和数字技术的结合将需要成功地促进 在面临健康问题的人群中减肥。在拟议的研究中，我们将以体重为目标 管理波士顿公共住房开发区的肥胖居民，他们是低收入和 主要来自种族/少数民族群体。本R01提案旨在研究 结合移动健康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个月的随机分组试验（n = 504）中， 接受社区卫生工作者激励的公共住房开发项目（n = 168名参与者） 访谈行为咨询加mHealth自我监测/短信反馈（mHealth + CHW）， 与仅接受mHealth自我监测/短信反馈的3例患者（n = 168）相比 （仅mHealth），而3个发展（n = 168）只接受评估（对照组），两者 mHealth + CHW和仅mHealth将优于仅评估对照，mHealth + CHW将优于 mHealth仅在12个月时的体重减轻方面。对于次要结果，我们将研究干预 对饮食和身体活动行为的影响。我们还将研究社会认知的中介效应 参与者特征和社会背景变量对参与者行为的理论建构及其调节作用 干预的效果。最后，我们将进行成本效益分析。我们的成果将使我们能够更好地 了解在面临健康问题的人群中进行体重管理的有效方法， 这可以应用于其他可改变的癌症风险行为，并扩展到更大的联邦网络 公共住房管理。

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.