Increasing Implementation of Evidence-Based Interventions at Low-Wage Worksites

描述（由申请人提供）：癌症和其他慢性病是美国的主要杀手和致残者，低收入的美国人是这些疾病的高危人群。多种基于证据的干预措施（EBI）可以改善慢性疾病风险行为，如癌症筛查、健康饮食、身体活动和戒烟，但EBI对社区环境的影响还很差。在接触低收入成年人的社区环境中，工作场所很突出，因为大多数低收入成年人都有工作，但工作场所实施促进健康的ebi的情况很低。一半的美国工人在小型或低工资的工作场所工作，在那里，这些ebi的实施和实施的准备程度特别低。尽管这些工作场所的决策者通常都有促进员工健康的动机，但他们通常没有专门的健康人员，并且在实施ebi时面临三大障碍：1)缺乏对ebi潜在益处的认识，2)缺乏选择ebi的知识，3)缺乏实施ebi的财政和人力资源。非营利组织和其他帮助这些工作场所的人面临着他们自己的障碍。组织对实现ebi的准备程度还没有得到很好的理解，而且很少有经过验证的度量是可用的，特别是对于工作场所。没有可靠和有效的工作场所准备措施，那些将帮助他们的人有困难：a)识别准备好的工作场所，b)帮助决策者做好准备，以增加他们实现成功的几率。拟议的研究将解决这两种障碍，并通过测试与美国癌症协会（一个全国性的非营利组织）合作开发的工作场所EBI传播项目HealthLinks的有效性，为传播和实施研究做出贡献。HealthLinks以创新扩散框架和创新扩散理论为基础，通过向ebi提供免费的现场信息和建议，以及提供免费的现场方案和协助实施的临时工作人员，解决小型和低工资工作场所的障碍。我们将通过一项三组随机对照试验来测试HealthLinks。工作场所将收到1)健康链接，或者2)健康链接的增强版本，通过增加工人健康委员会来解决小型工作场所缺乏人员的问题，或者3)作为延迟对照组，在研究结束时接收健康链接。我们将在基线、12个月（干预期结束时）和24个月（干预结束一年后评估维护情况）时测量工作场所的EBI实施情况。这一设计将测试HealthLinks和工人健康委员会的有效性。我们还将在基线、12个月和24个月时测量两者对工人健康行为的影响。最后，我们将开发、试验和验证工作场所准备就绪的度量，以实现ebi。

DESCRIPTION (provided by applicant): Cancer and other chronic diseases are leading killers and disablers in the United States, and low-income Americans are at high risk for these diseases. Multiple evidence-based interventions (EBIs) exist to improve chronic disease risk behaviors, such as cancer screening, healthy eating, physical activity, and tobacco cessation, yet EBI reach to community settings is poor. Among community settings for reaching low-income adults, worksites stand out because most low-income adults are employed, but worksite implementation of health-promoting EBIs is low. Half of American workers work in small or low-wage worksites, where implementation of these EBIs and readiness to implement are especially low. Even though decision-makers at these worksites are often motivated to promote worker health, they usually have no dedicated wellness staff and face three major barriers in implementing EBIs: 1) lack of awareness of the potential benefits of EBIs, 2) lack of knowledge to choose EBIs, and 3) lack of financial and personnel resources to implement EBIs. Non- profit organizations and others who would assist these worksites face their own barriers. Organizational readiness to implement EBIs is not well understood, and few validated measures are available, especially for worksites. Without reliable and valid measures of worksite readiness, those who would assist them have difficulty: a) identifying worksites that are ready, and b) helping decision-makers get ready to increase their odds of implementation success. The proposed research will address both sets of barriers and contribute to dissemination and implementation research by testing the efficacy of a worksite EBI dissemination program, HealthLinks, developed in partnership with the American Cancer Society, a non-profit organization operating nationwide. HealthLinks is based on diffusion of innovations framework and diffusion of innovations theory and addresses small and low-wage worksites' barriers by providing free on-site information and recommendations for EBIs and by providing free on-site programs and temporary staffing to assist implementation. We will test HealthLinks via a 3-arm randomized controlled trial. Worksites will receive either 1) HealthLinks, or 2) an enhanced version of HealthLinks that addresses small worksites' lack of personnel by adding worker wellness committees, or will 3) serve in a delayed control group that receives HealthLinks at study end. We will measure worksites' EBI implementation at baseline, 12 months (at the end of the intervention period), and 24 months (to assess maintenance one year after the intervention ends). This design will test the effectiveness of both HealthLinks and of worker wellness committees. We will also measure the effect of both on workers' health behaviors at baseline, 12 months, and 24 months. Finally, we will develop, pilot-test, and validate a measure of worksite readiness to implement EBIs. PUBLIC HEALTH RELEVANCE: The proposed project will answer key questions about implementing evidence-based health promotion interventions at small and low-wage worksites. Small, low-wage worksites will be randomized to receive HealthLinks (a free American Cancer Society program to disseminate evidence-based interventions), HealthLinks+ (which will include creating worksite wellness committees as part of the program), or to serve in a delayed control group. This approach will identify successful strategies for implementing evidence-based interventions at low-wage worksites to improve workers' cancer screening, healthy eating, physical activity, and tobacco cessation.