Web-Based Weight Management for Individuals with Mental Illness

描述（由申请人提供）：肥胖和缺乏身体活动已经达到流行病的程度，导致慢性病发病率增加，过早死亡，以及大量的医疗保健费用。超重在患有严重精神疾病（SMI）的人群中更为普遍，部分原因是药物导致的体重增加和社会劣势。由于重度精神障碍患者通常有认知缺陷，因此需要专门的方法来帮助他们控制体重。研究人员发现，专注于饮食和活动的专门面对面干预可以帮助重度精神障碍患者控制体重。然而，这些循证实践并未得到广泛传播。使用这些干预措施的障碍包括个人不愿意参加团体，难以找到经常前往诊所的交通工具，缺乏训练有素的临床医生，以及临床医生没有足够的时间提供干预措施。这些障碍很可能可以通过为重度精神障碍患者量身定制的基于网络的体重干预来解决。专门的基于网络的方法已经被研究并发现在这一人群中是有效的，并且可以提供密集的内容，并且对临床医生的时间要求最低。目的：该提案的研究人员最近开发了一个基于网络的原型系统，称为“Help-MI”（精神疾病患者健康电子学习），该系统为重度精神疾病患者提供有限的饮食教育。当前的项目扩展并评估了这个Help-MI系统。该项目的目标是：1)建立在Help-MI原型的基础上，开发一个全面的基于网络的系统，提供以证据为基础的体重管理计划，该计划以饮食和活动为重点，满足重度精神障碍患者的需求；2)与对照组比较，评估重度精神分裂症患者使用Help-MI的有效性；3)从重度精神障碍患者的角度描述使用Help-MI的优势、劣势和障碍。方法：这是一项随机对照试验，共有90名重度精神障碍患者在社区精神卫生中心接受治疗，这些患者体重超标，处方药物的常见副作用是体重增加。参与者被分配到Help-MI组或对照组。研究评估在基线、3个月和6个月进行。比较两组随时间的结果变化。意义：通过减肥，患有精神疾病的人可以降低他们的医疗问题的风险，并改善他们的生活质量和预期寿命。一个基于网络的帮助个人减肥的系统可以在医疗中心、诊所和基于农村和城市地区的社区项目中广泛传播。

DESCRIPTION (provided by applicant): Obesity and physical inactivity have reached epidemic proportions, resulting in increased rates of chronic disease, premature death, and substantial health care costs. Excess weight is even more prevalent in populations with serious mental illnesses (SMI), in part due to medication- induced weight gain and social disadvantage. Since individuals with SMI often have cognitive deficits, specialized approaches are required to help people manage their weight. Researchers have found that specialized in-person interventions focused on diet and activity can help individuals with SMI manage their weight. However, these evidence-based practices have not been widely disseminated. Barriers to the use of these interventions include reluctance of individuals to participate in groups, difficulty finding transportation for frequent visits to clinics, a shortage of trained clinicians, and inadequate clinician time to provide the interventions. It is likely that these barriers can be addressed with a web-based weight intervention that is tailored for individuals with SMI. Specialized web-based approaches have been studied and found to be effective in this population, and can deliver content that is intensive and engaging with minimal requirements for clinician time. Objectives: The investigators on this proposal recently developed a prototype web-based system, called "Help-MI" (Health eLearning for Persons with Mental Illness), that provides limited diet education to individuals with SMI. The current project extends and evaluates this Help-MI system. The project's objectives are to: 1) build on the Help-MI prototype to develop a comprehensive web-based system that delivers an evidence-based weight management program that is focused on diet and activity, and that meets the needs of individuals with SMI; 2) evaluate the effectiveness, in individuals with SMI, of Help-MI compared with a control group; and, 3) characterize, from the perspective of individuals with SMI, the strengths, weaknesses, and barriers to the use of Help-MI. Methods: This is a randomized, controlled trial of 90 individuals with SMI at a community mental health center who are overweight and prescribed medications that have weight gain as a common side-effect. Participants are assigned to Help-MI or a comparison group. Research assessments occur at baseline, 3, and 6 months. Changes in outcomes are compared over time between the two groups. Significance: By losing weight, individuals with mental illness can decrease their risk for medical problems, and improve their quality of life and life expectancy. A web-based system that helps individuals lose weight could be feasible to disseminate broadly at medical centers, clinics, and community based programs in both rural and urban areas. PUBLIC HEALTH RELEVANCE: Obesity and physical inactivity have become serious problems for individuals with mental illness, resulting in increased rates of chronic disease, premature death, and substantial health care costs. Although in-person psychoeducational interventions help individuals with mental illness manage their weight, these interventions are often not used because they require frequent travel to treatment programs and substantial time from clinicians. This project addresses these barriers by developing and evaluating the effectiveness of a web-based computer system that is focused on diet and exercise education, and designed to help individuals with mental illness manage their weight.