Engaging diverse colorectal cancer survivors in the design of an adaptive text message-based intervention to improve diet quality

结直肠癌(CRC)是美国癌症死亡的第二大原因。干预措施是 在受儿童权利公约影响的众多不同文化群体中，可获得性和有效性将大大 改善公共卫生。饮食干预在降低结直肠癌死亡率方面有着特别的希望，因为 有证据表明，富含全谷类的高纤维饮食与较低的死亡率有关。 与中国铁建合作。然而，15%的结直肠癌幸存者食用高纤维饮食。因此，我们的目标是开发一个可扩展的 增加全谷物摄入量和减少儿童可接受的精粮摄入量的干预措施 不同文化背景的幸存者。短信是一种很有前途的干预组件，可用于 广泛的儿童权利公约幸存者。然而，大多数研究都开发并测试了“一刀切”的静态 泛化能力有限的程序。为了解决这一差距，我们建议开发一种持续自适应的文本 使用强化学习(RL)的基于消息的干预。RL是一种机器学习，可以 用于基于参与者特征(例如种族/民族、语言)随时间优化文本消息， 参与和/或行为。阿奎莱拉博士(co-I)开发了一种使用RL进行短信干预的方法 增加患有抑郁症和糖尿病的低收入人群的体力活动；消息以英语或 西班牙语。虽然很有希望，但RL算法是否可以用于改善饮食行为尚不清楚。在这 建议，我们将开发一种基于全粒度的RL算法来优化文本消息的内容和定时 通过短信评估摄入量。由能力、机会、动机-行为(COM- B)模型的基础上，提出了一种嵌入式混合方法研究。在目标1中，我们将在以下四个重点小组中 黑人、拉丁裔、非拉丁裔白人和亚裔美国人/太平洋岛民CRC幸存者(5-8人/组)和20名半 结构化面谈。我们的目标是了解CRC幸存者的能力、机会和动机 健康的饮食和对短信的偏好。利用这些数据，我们将完善我们的理论框架，并 修改/更新我们的&gt；200节食短信资料库，这些短信来自以前在非Latinx白人癌症中的工作 幸存者。在目标2中，在目标1的通知下，我们将使用RL开发自适应文本消息干预 提高儿童权利公约幸存者消费的全谷物的比例。我们将确定 干预措施的可行性和可接受性，并评估其对饮食的影响(全谷物、精制谷物、 总纤维)，在60名CRC幸存者中进行了为期12周的单臂研究，其中 确认为黑人、拉丁裔、非拉丁裔白人和亚裔美国人/太平洋岛民。我们的多学科和 多元文化团队拥有完成这项研究所需的专业知识。我们的提案将提供可扩展的饮食 具有广泛普遍性的干预措施，我们最终将在随机对照试验中进行测试。改进 结直肠癌幸存者的饮食质量有可能降低结直肠癌死亡率，并对公众健康产生重大影响。

Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. Interventions that are accessible and effective in the large, culturally diverse populations of people affected by CRC will greatly improve public health. Dietary interventions hold particular promise for reducing CRC mortality because strong evidence supports that a high-fiber diet rich in whole grains is associated with lower mortality among people with CRC. Yet, <15% of CRC survivors consume a high-fiber diet. Therefore, our goal is to develop a scalable intervention to increase intake of whole grains and reduce intake of refined grains that is acceptable to CRC survivors of varied cultural backgrounds. Text messages are a promising intervention component for reaching a wide range of CRC survivors. However, most studies have developed and tested “one size fits all” static programs with limited generalizability. To address this gap, we propose to develop a continuously adaptive text message-based intervention using reinforcement learning (RL). RL is a type of machine learning that can be used to optimize text messages over time based on participant characteristics (e.g., race/ethnicity, language), engagement, and/or behavior. Dr. Aguilera (co-I) has developed a text message intervention that uses RL to increase physical activity in low income people with depression and diabetes; messages are sent in English or Spanish. While promising, it is not known if a RL algorithm can be used to improve diet behavior. In this proposal, we will develop a RL algorithm to optimize text message content and timing based on whole grain intake assessed through text messages. Informed by the Capability Opportunity Motivation – Behavior (COM- B) model, we propose an embedded mixed method study. In Aim 1, we will conduct four focus groups among Black, Latinx, non-Latinx white, and Asian American/Pacific Islander CRC survivors (5-8/group) and 20 semi- structured interviews. We aim to understand CRC survivors’ capabilities, opportunities, and motivations for a healthy diet and preferences for text messages. Using these data, we will refine our theoretical framework and revise/update our library of >200 diet-focused text messages from previous work in non-Latinx white cancer survivors. In Aim 2, informed by Aim 1, we will develop an adaptive text message intervention using RL to increase the proportion of grains consumed that are whole grains among CRC survivors. We will determine the intervention’s feasibility and acceptability and estimate its effect on diet (intake of whole grains, refined grains, total fiber) in a 12-week single-arm study among 60 CRC survivors, approximately equal numbers of whom identify as Black, Latinx, non-Latinx white, and Asian American/Pacific Islander. Our multidisciplinary and multicultural team has the expertise needed to complete this study. Our proposal will inform a scalable dietary intervention with broad generalizability that we will ultimately test in a randomized controlled trial. Improving CRC survivors’ diet quality has potential to reduce CRC mortality and have great public health impact.