Web-based chronic disease dietary self-management program for African Americans

描述(由申请人提供)：本申请旨在开发和翻译一种医疗技术，通过开发和测试创新的基于网络的技术Cookin‘up Health来减少慢性疾病优先领域内的健康差距，该技术用于自我管理非裔美国人与高血压和糖尿病相关的饮食。通过初级保健提供者提供的干预措施解决并应对了充分提供保健服务的关键障碍-知识、文化和基础设施。迫切需要开发有效的、文化上适当的、以慢性病为重点的饮食干预措施，这些干预措施可以由卫生保健提供者轻松快速地提供，并随时供非裔美国人患者使用。非裔美国人的糖尿病和高血压患病率比普通人群高得不成比例，而且更有可能遭受这些疾病的晚期衰弱后果。由于肥胖和不健康的饮食习惯，非裔美国人患上与饮食有关的慢性病和并发症的风险尤其大。改变饮食的一个主要障碍是传统的“南方烹饪”中发现的高脂肪和高盐食物，许多南方的非裔美国人一生中的大部分时间都吃这种食物。饮食习惯是高血压和糖尿病的一个重要的可改变的危险因素。高血压和糖尿病是可以控制的疾病，需要积极的医疗管理和自我管理来控制疾病。非洲裔美国人获得自我管理所需的医疗信息的机会往往有限。在过去的十年里，临床医生提供的营养和其他生活方式建议一直在下降，尽管国家建议医生为所有患有饮食相关慢性病的患者提供咨询。与患者相处的时间有限是营养咨询的主要障碍，特别是考虑到许多预防性建议和在大多数初级保健实践中看到的大量患者。拟议的干预措施包括两个综合组成部分--一个互动网站和一系列单独定制的电子通讯。该网站使用烹饪节目主题来教育和展示更健康的传统食谱版本，并以易于使用、互动和具有文化针对性的形式提供食物选择和准备信息。在阿巴拉契亚低文化、低收入的农村妇女中，更有限版本的Cookin‘up Health已经被证明在减少膳食脂肪和增加水果和蔬菜消费方面有效。拟议的方案将建立在先前方案的工作和成果的基础上，对其进行调整以适应新的人口并扩大其覆盖范围。对于目标1，我们将翻译烹饪健康干预措施，以满足患有糖尿病或高血压的低收入非裔美国患者的文化和饮食特征以及疾病管理需求。对于目标2，我们将进行一项研究，以评估患者和提供者对转换后的干预措施的可用性和满意度。如果优先人口和供应商可行，第二阶段将提供扩大范围和技术的机会。 与公共卫生相关：非裔美国人的糖尿病和高血压发病率比普通人群高得不成比例，更有可能遭受这些疾病的晚期衰弱后果，以及较短的预期寿命。饮食习惯是高血压和糖尿病的一个重要的可改变的危险因素。迫切需要开发一种有效的、文化上合适的、以慢性病为重点的饮食干预措施，这种干预措施可以由卫生保健提供者轻松快速地提供，并容易被非裔美国人患者使用。

DESCRIPTION (provided by applicant): This application addresses the development and translation of a medical technology to reduce health disparities within the priority area of chroni disease through the development and testing of an innovative web-based technology, Cookin' Up Health, for the self-management of diet related to hypertension and diabetes in African Americans. Delivered via primary care providers, the intervention addresses and responds to key barriers to adequate healthcare delivery-knowledge, culture, and infrastructure. There is a critical need for the development of effective, culturally appropriate, chronic disease focused dietary interventions that can be easily and quickly delivered by health care providers and readily used by African American patients. African Americans have disproportionately higher rates of diabetes and hypertension than the general population and are more likely to suffer the late-term debilitating consequences of these conditions. African Americans are particularly at risk for diet-related chronic diseases and complication because of obesity and unhealthy eating habits. A major barrier to making dietary changes is the high fat and salty foods found in traditional "southern cooking," which many African Americans in the South have eaten for most of their lives. Dietary habits are an important modifiable risk factor for hypertension and diabetes. Hypertension and diabetes are manageable diseases that require a both active medical management and self-management to control the disease. African Americans often have limited access to healthcare information needed for self-management. Nutritional and other lifestyle advice provided by clinicians has been declining over the last decade despite national recommendations for physicians to counsel all patients with diet-related chronic disease.Limited time spent with patients is the major barrier to nutrition counseling particularly given the many preventive recommendations and high volume of patients seen in most primary care practices. The proposed intervention consists of two integrated components-an interactive website and a series of individually tailored electronic newsletters. The website uses a cooking show theme to educate and demonstrate healthier versions of traditional recipes and provides food selection and preparation information in an easy-to-use, interactive, and culturally targeted format. A more limited version of Cookin' Up Health has already been shown to be effective in reducing dietary fat and increasing fruit and vegetable consumption among rural, low-literate, low-income women living in Appalachia. The proposed program will build on the work and outcomes of this earlier program, adapting it for a new population and expanding its reach. For Aim 1, we will translate the Cookin' Up Health intervention to address the cultural and dietary characteristics and disease management needs of low- income African American patients with diabetes or hypertension. For Aim 2, we will conduct a study to assess patient and provider usability and satisfaction with the translated intervention. If feasible with the priority populatin and providers, Phase II offers opportunity for expansion in scope and technology. PUBLIC HEALTH RELEVANCE: African Americans have disproportionately higher rates of diabetes and hypertension than the general population and are more likely to suffer the late-term debilitating consequences of these conditions, as well as shorter life expectancies. Dietary habits are an important modifiable risk factor for hypertension and diabetes. There is a critical need for the development of an effective, culturally appropriate, chronic disease focused dietary intervention that can be easily and quickly delivered by health care providers, and readily used by African American patients.