Promoting Physical Activity in Latinas via Interactive Web-based Technology

描述（由申请人提供）：在美国，拉丁裔妇女（Latinas）报告的不运动率高于非西班牙裔白人和男性，因此受到相关健康状况（如癌症、高血压、心脏病、中风、糖尿病）的不成比例的负担。文化因素、社会经济环境、语言和教育障碍限制了拉丁美洲人获得促进身体积极生活方式的公共卫生干预措施。为了应对这一公共卫生危机，需要利用最先进的理论和方法进行有效干预，以覆盖这一高危人群。我们的研究小组有超过20年的经验，通过各种渠道和环境开发和评估个性化的，计算机专家系统驱动的身体活动干预（基于社会认知理论和跨理论模型）。在我们最近的试验（R21NR009864）中，我们在文化和语言上对久坐的拉丁裔进行了量身定制的干预，并对修改后的程序进行了小型随机试验（N=93）。共有81名参与者完成了为期6个月的研究（87%的保留率），并将他们的身体活动从基线时的平均每周17分钟（SD=25.76）增加到六个月时的147分钟（SD=241.55），而接触控制组的参与者则将他们的身体活动从基线时的每周12分钟（SD=21.99）增加到六个月时的97分钟（SD=118.49）。这些观察到的干预组在体力活动方面的改善，以及高保留率，参与者报告的对互联网交付项目的渴望，以及以互联网形式开发我们项目的形成性工作，为测试针对拉丁美洲人需求的互联网干预提供了支持。因此，对于目前的应用，我们将在之前工作的基础上进行一项充分有力的（N=200）随机对照试验，以测试我们的文化和语言修改，通过互联网提供的个性化体育活动干预的有效性，相对于互联网健康接触控制条件（包括NHLBI为拉丁美洲人开发的心血管健康信息）。数据将在基线、6个月（治疗后）和12个月（维持期）收集，使用完善的身体活动测量（7天PAR， Actigraphs）以及一套全面的社会心理问卷。我们假设在治疗结束时（第六个月），干预参与者每周报告的中等强度身体活动时间明显多于健康接触控制参与者。我们还将研究12个月后治疗效果的维持，干预-身体活动关系的潜在中介和调节因素，以及提供量身定制的互联网计划的成本。在拟议的研究中，我们试图通过高覆盖范围、低成本、以技术为基础的策略，在服务不足的人群中促进体育活动，这种策略有很大的潜力被更大规模地采用，从而有很大的潜力减少美国的健康差距

DESCRIPTION (provided by applicant): In the U.S., Latino women (Latinas) report higher rates of inactivity than their non-Hispanic White and male counterparts and thus are disproportionately burdened by related health conditions (e.g., cancer, hypertension, heart disease, stroke, diabetes). Cultural factors, socioeconomic circumstances, language and educational barriers limit Latinas access to public health interventions that promote physically active lifestyles. To address this public health crisis, effective interventions that leverage state-of-the-art theory and methods are needed to reach this at-risk population. Our research group has over 20 years experience developing and evaluating individually-tailored, computer expert system-driven, physical activity interventions (based on Social Cognitive Theory and the Transtheoretical Model) through various channels and settings. In our recent pilot (R21NR009864), we culturally and linguistically adapted our tailored intervention for sedentary Latinas and conducted a small randomized trial of the modified program (N=93). A total of 81 participants completed the 6- month study (87 percent retention) and increased their physical activity from a mean of 17 minutes per week (SD=25.76) at baseline to 147 minutes (SD=241.55) at six months whereas contact control participants increased their physical activity from 12 minutes per week (SD=21.99) at baseline to 97 minutes (SD=118.49) at six months. These observed improvements in physical activity in our intervention group, along with high retention rates, participant-reported desire for an Internet-delivered program, and formative work developing our program in an Internet format lend support for testing an Internet intervention tailored to the needs of Latinas. Therefore, for the current application, we will build on our previous work by conducting an adequately powered (N=200) randomized controlled trial to test the efficacy of our culturally and linguistically modified, individually tailored physical activity intervention delivered via the Internet relative to an Internet wellness contact control condition (including cardiovascular health information developed for Latinos by the NHLBI). Data will be collected at baseline, 6 months (post-treatment), and 12 months (maintenance) using well- established physical activity measures (7-Day PAR, Actigraphs), as well as a comprehensive set of psychosocial questionnaires. We hypothesize that at end of treatment (month six) intervention participants will report significantly more minutes of moderate intensity physical activity per week than the wellness contact control participants. We will also examine the maintenance of treatment effects at 12 months, potential mediators and moderators of the intervention-physical activity relationship, and the costs of delivering the tailored Internet program. In the proposed study we seek to promote physical activity among an underserved population using a high-reach, low-cost, technology-based strategy, which has great potential for adoption on a larger scale and thus high potential for reducing health disparities in the U.S.