Dissemination of a Theory-Based Bone Health Program in Online Communities

描述（由申请人提供）：骨骼健康在美国是一个重要的公共卫生问题。估计有1000万50岁及以上的美国人患有骨质疏松症，大约50%的女性和25%的50岁以上的男性在他们的余生中会经历骨质疏松相关的骨折。最近的研究进展已经产生了有效的措施来改善和保持骨骼健康，包括运动、饮食、筛选试验、药物治疗和预防跌倒的策略。然而，这些发现还没有完全融入成年人的日常生活，许多人还没有意识到骨骼健康问题的严重性。只有11-44%的骨质疏松高危人群服用钙和维生素D补充剂，55岁以上的女性中有三分之一没有与护理人员讨论过骨骼健康问题。必须作出更大的努力，有效地传播循证研究成果，以改善公众的骨骼健康行为。随着互联网的日益普及，它可以成为实现这一目标的有效工具。尽管有大量可用的在线卫生资源，但一直缺乏调查有效方法的研究，以打包和提供这些资源，以产生积极的公共卫生成果。我们之前的R21资助项目显示了使用基于社会认知理论（SCT）的在线健康促进干预的一些初步效果。在我们之前的研究结果的基础上，我们采用了一种创新的方法，结合了SCT和RE-AIM框架的两种模型（Reach, Effectiveness, Adoption, Implementation, Maintenance），在本提案中，我们提出了一项大规模的在线研究（N = 768），将比较两种基于SCT的在线骨骼健康干预措施对50岁及以上成年人的长期影响，目标是两个大型在线社区（SeniorNet, MyHealtheVet）。这两种干预措施是(1)一个为期8周的基于sct的在线骨骼健康（TO-BoneHealth）计划和(2)一个为期12个月的TO-BoneHealth Plus计划，包括TO-BoneHealth计划，随后是每两周的基于理论的电子通讯，随访每个人的骨骼健康行为（“加强”干预）10个月。将根据修订后的RE-AIM框架的以下方面评估干预措施的影响：(a)有效性（知识、选定的骨骼健康行为、跌倒发生率、开始与初级保健提供者讨论骨骼健康问题、电子健康素养）；(b)覆盖范围（该方案覆盖的参与者人数）；(c)执行（方案使用）；(d)维持（参与者骨骼健康行为维持）。有效性维度将采用随机对照试验进行评估，采用3组设计（2个干预组和1个对照组），重复测量（基线、8周、6、12和18个月）。有效性维度的主要分析方法将涉及混合线性模型分析。其他影响维度将使用描述性统计进行评估。随着在线社区的快速发展，本研究的结果将对当前的电子健康实践和研究做出重大贡献，并为其他针对在线社区的健康促进项目提供传播模型。公共卫生相关性：骨健康是美国一个重要的公共卫生问题，大约有1000万50岁及以上的美国人患有骨质疏松症。已经发现了几种有效的方法来改善和维持骨骼健康。然而，许多人没有意识到骨骼健康问题的重要性，也没有遵循骨骼健康行为的建议指南。为了最大限度地普及互联网，这项创新研究将检验两种在线激励健康促进干预措施对改善成年人骨骼健康行为的影响。随着活跃的在线社区的快速增长，拟议研究的结果将通过将当前面对面的健康促进工作推进到在线设置作为一种模式方法，为公共卫生做出重大贡献。

DESCRIPTION (provided by applicant): Bone health is a significant public health issue in the United States. An estimated 10 million Americans age 50 and older are living with osteoporosis, and approximately 50% of women and 25% of men over age 50 will experience an osteoporosis-related fracture in their remaining lifetime. Recent research advancements have produced effective measures to improve and maintain bone health, including exercise, diet, screening tests, pharmacotherapies, and fall prevention strategies. These findings, however, have not been fully incorporated into the daily lives of adults, and many are unaware of the magnitude of bone-health problems. Only 11-44% of adults at high risk for osteoporosis take calcium and vitamin D supplements, and one third of women over age 55 have not discussed bone health issues with their care providers. Greater efforts must be made to effectively disseminate evidence-based research findings to improve bone health behaviors of the public. The Internet, with its increasing popularity, can be an effective tool in this endeavor. Despite a great deal of available online health resources, there has been a lack of research investigating effective methods to package and deliver these resources to yield positive public health outcomes. Our prior R21 grant project showed some preliminary effectiveness of using a social cognitive theory (SCT)-based online health promotion intervention. Expanding upon our prior findings and using an innovative approach combining two models of the SCT and the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), in this proposal, we propose a large scale online study (N = 768) that will compare the long-term impact of two SCT-based online bone health interventions in adults age 50 and older targeting two large online communities (SeniorNet, MyHealtheVet). The two interventions are (1) an 8-week SCT-based Online Bone Health (TO-BoneHealth) program and (2) a 12-month TO-BoneHealth Plus program, including the TO-BoneHealth program followed by biweekly theory- based eNewsletters with follow-up of each individual's bone health behaviors ("booster" intervention) for 10 months. The interventions' impact will be assessed on the following dimensions of the modified RE-AIM framework: (a) Effectiveness (knowledge, selected bone health behaviors, fall incidence, initiation of a discussion about bone health with a primary care provider, eHealth literacy); (b) Reach (number of participants the program reached); (c) Implementation (program usage); and (d) Maintenance (participants' bone health behavior maintenance). The Effectiveness dimension will be assessed using a randomized controlled trial employing a 3-group design (2 intervention and 1 control groups) with repeated measures (baseline, 8 weeks, 6, 12, and 18 months). The primary analytic approach for the Effectiveness dimension will involve mixed linear models analyses. Other impact dimensions will be assessed using descriptive statistics. With the rapid growth of online communities, findings from this study will significantly contribute to current eHealth practice and research and serve as a dissemination model for other health promotion projects targeting online communities. PUBLIC HEALTH RELEVANCE: Bone health is a significant public health issue in the United States, with approximately 10 million Americans age 50 and older living with osteoporosis. Several effective measures have been found to improve and maintain bone health. Many individuals, however, are unaware of the significance of bone health problems and do not follow recommended guidelines for bone health behaviors. Maximizing the popularity of the Internet, this innovative study will examine the impact of two online motivational health promotion interventions on improving mature adults' bone health behaviors. With the rapid growth of active online communities, findings from the proposed study will significantly contribute to public health by advancing current face-to-face health promotion efforts to online settings serving as a model approach.