Using grassroots wellness coaching to enhance reach and sustainability of behavioral weight management

摘要 非裔美国成年人和来自经济不利环境的成年人面临的风险不成比例 然而，在传统的体重管理试验中， 体重减轻相对于他们的白色和社会经济地位较低的同行。可持续发展， 以社区为基础的行为干预，以解决国家肥胖危机是至关重要的，以减轻 得不到充分服务的人口面临着令人震惊的糟糕健康结果。事实上，启动和维护 健康的生活方式行为对服务不足、经济上处于不利地位的人提出了独特的挑战。 社区，但传统的行为体重管理交付模式在很大程度上忽视了社会和 这些文化资产存在于这些社区环境中。此外，以前测试过的基于社区的 干预措施没有充分利用社区成员作为其内部变革推动者的潜力， 社交网络。因此，本提案的总体目标是测试可行性、可接受性和初步 基层干预提供模式的有效性，其中包括培训社区成员进行招募 并保留其社交网络的成员，并提供基于证据的生活方式干预，以减少 肥胖和改善心脏代谢风险。其具体目的是：1）测试的可行性和可接受性 使用家庭聊天（以家庭为基础，同行领导的重点讨论）作为干预实施的模式， 真实世界，以社区为基础的设置; 2）评估家庭聊天干预的初步有效性 促进行为（体力活动、饮食）和身体（肥胖、空腹血糖、血糖）变化的模型 治疗后（12周）和随访（24周）时的心脏代谢风险标志物;以及3） 系统地评估-使用混合方法的方法-促进者和障碍，以可持续性， 模型拟议的初步试验将采用分组随机对照设计，其中参与者为 由病房分配到干预或延迟干预控制。共10个房屋聊天领袖（HCL） 将招募和培训（每种条件下5名HCL）。HCL将招募其社交网络的成员（N=80，18- 70岁）参加为期12周的生活方式干预，通过每周小组会议在 房子聊天领导人的家。亲自评估访视将由设盲的研究工作人员在0、12 周（治疗后）和24周（随访）满意度将在12周（术后）时进行面对面评估。 治疗）仅通过调查和离职面谈。可持续发展的促进因素和障碍将通过 结合深入访谈（与房屋聊天负责人），焦点小组（与参与者）和调查（与两者）， 24周拟议的干预措施提供模式利用社区资产并建设能力， 可以提供一种可行的方法来改善服务不足人群的健康状况。该试点试验将 提供可行性和初步有效性的第一个证据，这将作出有意义的贡献 去实地调查并进行更大规模的试验

ABSTRACT African American adults and adults from economically disadvantaged environments are at disproportionate risk for obesity yet are markedly underrepresented in traditional weight management trials and experience lower weight losses relative to their white and socioeconomically advantaged counterparts. Developing sustainable, community-based behavioral interventions to address the national obesity crisis is critical in order to mitigate the alarmingly poor health outcomes faced by underserved populations. Indeed, initiation and maintenance of healthy lifestyle behaviors presents unique challenges in underserved, economically disadvantaged communities, but traditional behavioral weight management delivery models largely disregard the social and cultural assets which exist within these community settings. Moreover, previously tested community-based interventions have not fully harnessed the potential of community members as agents of change within their social networks. Thus, the overall objective of this proposal is to test the feasibility, acceptability and preliminary effectiveness of a grassroots intervention delivery model which includes training community members to recruit and retain members of their social network and to deliver an evidence-based lifestyle intervention to reduce adiposity and improve cardiometabolic risk. The specific aims are: 1) to test the feasibility and acceptability of using house chats (home-based, peer-led focused discussions) as a model for intervention implementation in a real-world, community-based setting; and 2) to assess the preliminary effectiveness of the house chat intervention model for promoting change in behavioral (physical activity, diet) and physical (adiposity, fasting glucose, blood pressure) markers of cardiometabolic risk at post-treatment (12 weeks) and follow up (24 weeks); and 3) to systematically evaluate—using a mixed methods approach—the facilitators and barriers to sustainability of this model. The proposed pilot trial will utilize a group randomized controlled design wherein participants are assigned by ward to either intervention or delayed intervention control. A total of 10 house chat leaders (HCL) will be recruited and trained (5 HCL in each condition). HCL will recruit members of their social network (N=80, 18- 70 years of age) to participate in an 12-week lifestyle intervention delivered via weekly group meetings in the house chat leaders’ homes. In-person assessment visits will be conducted by masked research staff at 0, 12 weeks (post-treatment) and 24 weeks (follow-up). Satisfaction will be assessed in-person at 12 weeks (post- treatment) only via surveys and an exit interview. Facilitators and barriers to sustainability will be assessed via a mix of in-depth interviews (with house chat leaders), focus groups (with participants) and surveys (with both) at 24 weeks. The proposed intervention delivery model, which draws on community assets and builds capacity, could offer a viable approach to improve health outcomes for an underserved population. This pilot trial will provide the first evidence of feasibility and preliminary effectiveness, which will make a meaningful contribution to the field and inform a larger trial.