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

在在线社区中传播基于理论的骨骼健康计划

• 批准号: 8290809
• 负责人: EUN-SHIM NAHM
• 金额: $ 5.58万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8290809
• 关键词: Academic Medical Centers; Activities of Daily Living; Address; Adoption; Adult; Advisory Committees; Age; Aging; American; Baltimore; Binding Sites; Bone Density; Bone Diseases; Calcium; Caring; Collaborations; Communities; Community Healthcare; Community Practice; Control Groups; Data Collection; Development Plans; Dimensions; Effectiveness; Electronics; Exercise; Exhibits; Fall prevention; Foundations; Fracture; Frequencies; Goals; Grant; Guidelines; Health; Health Promotion; Health Resources; Health Services Research; Health behavior; Health behavior change; Hip region structure; Home environment; Incidence; Individual; Intake; Internet; Intervention; Knowledge; Life; Linear Models; Long-Term Effects; Maintenance; Maryland; Measures; Methodology; Methods; Modeling; Modification; Nature; Osteoporosis; Outcome; Outcome Measure; Pain; Participant; Pharmacotherapy; Physical activity; Prevention strategy; Preventive; Primary Health Care; Provider; Public Health; Randomized Controlled Trials; Research; Resources; Safety; Schools; Screening procedure; Self Efficacy; Site; Smoking; Source; Target Populations; Testing; Time; Trust; United States; United States National Institutes of Health; University Hospitals; Use Effectiveness; Vitamin D; Woman; age related; base; bone health; calcium intake; cost; design; diet and exercise; disorder prevention; dissemination research; evidence base; expectation; experience; falls; follow-up; group intervention; high risk; improved; innovation; interest; literacy; member; men; nutrition; prevent; programs; rapid growth; social cognitive theory; statistics; theories; tool; usability; user-friendly

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.

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。据估计，美国有1000万50岁及以上的人患有骨质疏松症，大约50%的50岁以上的女性和25%的男性在其余生中将经历与骨质疏松症相关的骨折。最近的研究进展已经产生了有效的措施来改善和维持骨骼健康，包括锻炼、饮食、筛查测试、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，许多人没有意识到骨骼健康问题的严重性。只有11%-44%的骨质疏松症高危成年人服用钙和维生素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骨骼健康问题。必须做出更大努力，有效传播循证研究成果，以改善公众的骨健康行为。随着互联网的日益普及，它可以成为这一努力的有效工具。尽管有大量可用的在线卫生资源，但缺乏调查有效方法来打包和交付这些资源以产生积极的公共卫生结果的研究。我们之前的R21赠款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。在我们先前发现的基础上，使用结合了SCT和RE-AIM框架的两个模型(REACH、有效性、采用、实施、维护)的创新方法，在该提案中，我们提议了一项大规模在线研究(N=768)，将比较两种基于SCT的在线骨健康干预措施在50岁及以上的成年人中的长期影响，目标是两个大型在线社区(SeniorNet，MyHealtheVet)。这两项干预措施是(1)为期8周的基于SCT的在线骨健康(To-bone Health)计划和(2)为期12个月的to-bone Health Plus计划，包括to-bone Health计划和两周一次的以理论为基础的电子通讯，对每个人的骨健康行为进行为期10个月的跟踪(“助推器”干预)。干预措施的影响将在修改后的RE-AIM框架的以下维度上进行评估：(A)有效性(知识、选定的骨健康行为、跌倒事件、与初级保健提供者发起关于骨健康的讨论、电子健康素养)；(B)REACH(计划达到的参与者数量)；(C)实施(计划使用)；(D)维护(参与者的骨健康行为维护)。有效性方面的评估将使用随机对照试验，采用3组设计(2个干预组和1个对照组)，并重复测量(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。其他影响方面将使用描述性统计进行评估。随着在线社区的快速发展，这项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，并作为其他针对在线社区的健康促进项目的传播模式。公共健康相关性：在美国，骨骼健康是一个重要的公共健康问题，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措施来改善和维持骨骼健康。然而，许多人没有意识到骨健康问题的重要性，也没有遵循推荐的骨健康行为指南。为了最大限度地提高互联网的普及率，这项创新的研究将考察两种在线激励性健康促进干预措施对改善成年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，拟议的研究结果将通过将当前的面对面健康促进工作推进到作为示范方法的在线环境，从而显著促进公共卫生。