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

摘要 非洲裔美国成年人和来自经济不利环境的成年人面临着不成比例的风险 但在传统的体重管理试验中，肥胖者的比例明显偏低，体验更低 相对于白人和具有社会经济优势的同龄人，体重减轻了。发展可持续发展， 以社区为基础的行为干预以解决全国肥胖危机至关重要，以缓解 未得到充分服务的人口面临令人震惊的糟糕的健康结果。事实上，启动和维持 在服务不足、经济困难的人中，健康的生活方式带来了独特的挑战 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 存在于这些社区环境中的文化资产。此外，之前测试的基于社区的 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，这项建议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，包括培训社区成员招募 并留住他们的社交网络成员，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。具体的目的是：1)测试以下各项的可行性和可接受性 使用家庭聊天(基于家庭的、同行主导的重点讨论)作为实施干预的模式 真实世界、基于社区的环境；以及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)和体力(肥胖、空腹血糖、血液)变化的模型 治疗后(12周)和随访(24周)时的心脏代谢风险标记物；以及3) 系统地评估--使用混合方法--可持续发展的促进者和障碍 模特。拟议的试点试验将采用分组随机对照设计，参与者为 由病房分配给干预或延迟干预对照。共有10位内部聊天主管(HCL) 将被招募和培训(每种条件下5个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，通过每周一次的小组会议在 家庭聊天室领导的家。面对面的评估访问将由蒙面研究人员在0，12进行 2周(治疗后)和24周(随访)。满意度将在12周时进行面对面评估(后 治疗)，仅通过调查和离职面谈。促进者和可持续性障碍将通过 深度访谈(与内部聊天负责人)、焦点小组(与参与者)和调查(两者都有)的组合，请访问 24周。拟议的干预交付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结果。这项试点试验将 提供可行性和初步有效性的第一证据，这将做出有意义的贡献 到现场通知更大规模的试验。

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.