Improving Health Habits: Self-Care Priorities

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DESCRIPTION (provided by applicant): Poor diet and physical inactivity among low-income, minority populations have been linked to greater risk of chronic disease conditions such as overweight/obesity and cancer. Safety net clinics that serve these low- income populations represent an untapped opportunity to involve impoverished individuals in health promotion. Few studies have examined the feasibility of using brief physician advice and multi-level, clinic- based interventions to improve poor dietary habits, increase physical activity, or reduce sedentary lifestyles among culturally diverse, low-income populations that typically comprise the patient population of these community health centers in Los Angeles urban areas. This exploratory project proposes to address this scientific gap by introducing and piloting a Multi-level, Patient-directed, Lifestyle Change, Health Promotion Program (MPLC-HPP) to address poor dietary habits and physical inactivity among low income, uninsured patient populations (primarily Latinos) served by the public sector clinics of the Venice Family Clinic (VFC) health center system in Los Angeles County. The program will include the development of 1) a simple-to- use Patient Health Behavior Priority Assessment (PHBPA) tool designed to assess patient priorities for behavior change; 2) a standard protocol for physicians to provide brief health advice using motivational interviewing (< 2 minutes per visit); 3) a protocol for distributing self-help aids for patient use (e.g., pedometer, exercise videos); and 4) a series of eight follow-up telephone counseling sessions by health educators to help patients address their lifestyle change priorities over time. We will conduct a single- blinded, sham-controlled pilot of the MPLC-HPP in 100 patient cases at two VFC clinics (n=50 in MPLC- HPP; n=50 in sham control). We will use quantitative outcome measures, including common biomarkers of oxidative stress and systemic inflammation (i.e., plasma carotenoids and high-sensitivity C-reactive protein levels) and psychometrically-tested self-report measures of nutrition and physical fitness, to accurately assess the magnitude of changes in diet and physical activity among study participants over a 12-month observation period. The feasibility of integrating the MPLC-HPP into the public sector health clinic setting will be evaluated, and is the primary aim of this project. The results will inform efforts to plan a larger, more ambitious successor study involving multiple clinics.