Promoting Physical Activity in Latinas via Interactive Web-based Technology

描述(由申请人提供)：在美国，拉美裔女性(拉丁裔)报告的不活动比率高于非西班牙裔白人和男性，因此与相关健康状况(如癌症、高血压、心脏病、中风、糖尿病)的负担不成比例。文化因素、社会经济环境、语言和教育障碍限制了拉丁裔人获得促进身体活动生活方式的公共卫生干预措施。为了解决这一公共卫生危机，需要利用最先进的理论和方法进行有效的干预，以接触到这一高危人群。我们的研究团队有20多年的经验，通过各种渠道和环境开发和评估个人定制的、计算机专家系统驱动的体力活动干预措施(基于社会认知理论和跨理论模型)。在我们最近的试验(R21NR009864)中，我们从文化和语言上调整了针对久坐不动的拉丁裔的量身定制的干预措施，并对修改后的计划进行了一项小型随机试验(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)，并将他们的体力活动从基线的平均每周17分钟(SD=25.76)增加到6个月的147分钟(SD=241.55)，而接触对照组参与者的体力活动从基线的每周12分钟(SD=21.99)增加到6个月的97分钟(SD=118.49)。在我们的干预组中观察到的这些体力活动的改善，加上高保留率，参与者报告的对互联网交付计划的渴望，以及以互联网格式开发我们的计划的形成性工作，为测试针对拉丁裔需求量身定做的互联网干预提供了支持。因此，对于当前的应用，我们将在以前工作的基础上，进行一项有足够能量(N=200)的随机对照试验，以测试我们通过互联网提供的经过文化和语言修改的个性化体力活动干预相对于互联网健康接触控制条件(包括NHLBI为拉丁裔开发的心血管健康信息)的有效性。数据将在基线、6个月(治疗后)和12个月(维持)时收集，使用完善的体力活动测量(7天PAR，Actigraph)，以及一套全面的心理社会问卷。我们假设，在治疗结束时(第六个月)，干预参与者报告的每周中等强度体力活动的分钟数将显著多于健康接触对照组参与者。我们还将检查12个月后治疗效果的维持情况，干预-体力活动关系的潜在调解人和调解人，以及提供量身定制的互联网计划的成本。在拟议的研究中，我们寻求使用一种高覆盖、低成本、基于技术的战略来促进服务不足人群的体育活动，这一战略具有在更大范围内采用的巨大潜力，因此在美国缩小健康差距的潜力很大。

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.