Native American Youth Cardiovascular Disease Prevention: Implementation of Culturally-Tailored Evidence-Based After School and Home Visitation Programs for Healthy Eating and Physical Activity

项目摘要--项目3 美国城市原住民社区在心血管疾病方面存在显著和持续的差异 疾病、肥胖和糖尿病及其可预防的行为前兆、饮食和体力活动。这 研究实施了两个多层次的循证干预(EBI)：明尼苏达网络和斯坦福 与六个美国印第安人课后计划和社区服务组织合作的目标 明尼阿波利斯，圣保罗和明尼苏达州德卢斯。这些计划的采用和维护可以 通过结构化的、以证据为基础的参与式方法来增强和提高效力 调整干预措施以满足文化、组织背景和更广泛的社会经济背景，并 融入了当地的创新。这项提案准备通过以社区为基础的 参与性研究(CBPR).包括医疗保健提供者明尼阿波利斯印第安人在内的联盟 社区诊所(NACC，初级保健系统)，明尼阿波利斯、圣保罗和明尼苏达德卢斯学校 地区的印度课后教育计划(学校系统)，印度社会服务提供者分部 工作家庭精神家访计划(社会服务提供者系统)，公共卫生部门 和明尼苏达大学的研究人员。该联盟将使用基于证据的10个步骤来实现 成果(GTO)调整和实施方法，以增强实施的保真度、可及性和 在课外计划和社区服务组织中的接受度和可持续性。原生的 美国组织领导力和项目交付人员将接受量身定制的指导和培训 EBI课程和有效的实施战略。实施战略的有效性将是 采用阶梯式楔形研究设计进行评估。本研究以社会生态模型为多层次 干预框架，RE-AIM作为其实施过程评估的测量框架。 执行成果包括组织领导支持、工作人员执行能力和 干预保真度(计划范围、干预内容、交付、接收和剂量)。一项重要的创新 拟议研究的一个方面是它使用基于证据的执行战略来加强 计划和工作人员以广泛的覆盖面、高参与度和 与当地文化和背景保持一致，具有很强的忠诚度。拟议的项目将使用已被证明有效的 建立计划组织领导力和计划交付人员的实施战略 实施能力，成功地让城市美洲原住民家庭参与基于优势的、文化上的- 促进青少年体育活动和健康饮食的扎实计划。持续的计划参与度 在美国城市原住民家庭中推广健康饮食和体育锻炼行为，这将 在这个负担沉重的社区中降低未来的心血管疾病风险。

PROJECT SUMMARY – Project 3 Urban Native American communities experience significant and persistent disparities in cardiovascular diseases, obesity and diabetes, and their preventable behavioral precursors, diet and physical activity. This study implements two multi-level evidence-based interventions (EBIs) Minnesota NET-Works and Stanford GOALS in partnership with six American Indian after school programs and community-serving organizations in the Minneapolis, St Paul and Duluth Minnesota. Adoption and maintenance of these programs can be enhanced and effectiveness strengthened through a structured, evidence-based participatory approach that tailors the interventions to meet the cultural, organizational contextual, and broader socioeconomic context and incorporates local innovations. This proposal is poised to achieve these goals through a community-based participatory research (CBPR).Coalition including the healthcare provider Minneapolis Native American Community Clinic (NACC, primary care system), Minneapolis and St Paul and Duluth Minnesota School Districts' Indian Education after school programs (school system), the social service provider Division of Indian Work's Family Spirit Home Visitation program (social service provider system), departments of public health and University of Minnesota researchers. The Coalition will use the evidence-based 10-step Getting to Outcomes (GTO) tailoring and implementation approach to enhance implementation fidelity, reach and acceptance, and sustainability among the after school programs and community-serving organizations. Native American organization leadership and program delivery staff will receive mentoring and training in the tailored EBI curricula and in effective implementation strategies. Implementation strategy effectiveness will be assessed using a stepped wedge study design. The study uses the Social Ecological Model as its multilevel intervention framework, and RE-AIM as its implementation process evaluation measurement framework. Implementation outcomes include organizational leadership support, staff implementation capacity, and intervention fidelity (program reach, intervention content, delivery, receipt and dose). An important innovative aspect of the proposed research is its use of evidence-based implementation strategies to strengthen the capacity of the programs and staff to implement the interventions with broad reach, high participation, and strong fidelity by aligning with local culture and context. The proposed project will use proven effective implementation strategies to build program organizational leadership and program delivery staff implementation capacity to successfully engage urban Native American families in strengths-based, culturally- grounded programs to promote youth physical activity and healthy eating. Sustained program engagement among urban Native American families will promote healthy eating and physical activity behaviors that will reduce future cardiovascular disease risk in this highly burdened community.