New Media Obesity Treatment in Community Health Centers

社区卫生服务中心肥胖治疗新媒体

• 批准号: 8721946
• 负责人: Gary G Bennett
• 金额: $ 60.99万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8721946
• 关键词: Adoption; American; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body Weight Changes; Body Weight decreased; Caring; Chronic Disease; Clinical; Collaborations; Community Health Centers; Comorbidity; Counseling; Diabetes Mellitus; Diet; Disadvantaged; Environment; Epidemic; Evidence based intervention; Exposure to; Face; Feedback; Health; Health Services; High Density Lipoprotein Cholesterol; Individual; Insulin Resistance; Internet; Intervention; Intervention Trial; Maintenance; Minority Groups; Modeling; Monitor; North Carolina; Obesity; Outcome; Participant; Patients; Physical activity; Plasma; Play; Population; Primary Health Care; Provider; Public Health; Randomized; Relative (related person); Research; Resources; Risk; Risk Factors; Risk Marker; Role; Rural; Site; System; Target Populations; Technology; Telephone; Testing; Text; Translations; Triglycerides; Voice; ancillary care; arm; base; behavior change; clinically significant; cost; eHealth; evidence base; experience; fasting plasma glucose; high risk; novel; obesity prevention; obesity treatment; patient population; primary care setting; primary outcome; programs; racial and ethnic; randomized trial; response; skills training; socioeconomics; success; treatment strategy; waist circumference; weight loss intervention

DESCRIPTION (provided by applicant): We know little about how to deliver efficacious behavioral obesity treatments to socioeconomically disadvantaged patients in the primary care setting. This is a major public health challenge. Socioeconomically disadvantaged populations have the greatest exposure to obesogenic risk factors and the highest rates of obesity and related chronic diseases. However, there has been little success in promoting clinically significant weight loss outcomes in this population. There is emerging evidence supporting the efficacy of eHealth weight loss approaches, particularly when they include interpersonal support from care providers. Our group has conducted preliminary studies of eHealth obesity treatment interventions in community health centers. Community health centers are particularly important primary care settings because they mainly serve socioeconomically disadvantaged patients - thus targeting those with greatest need - while offering great dissemination potential. Primary care providers in these settings may play an important role in stimulating patient behavior change. However, it is unclear how to optimally involve community health center providers in obesity treatment interventions, given their clinical demands and limited ancillary resources. We propose a novel, systems-based intervention approach that integrates and informs primary care providers without being burdensome. In keeping with the best evidence, it includes ancillary care providers as interventionists. Tailored skills training, self-monitoring and feedback are offered using eHealth technologies. The study will be conducted in collaboration with Piedmont Health Services, Inc. (PHS), a community health center system in rural North Carolina. The PHS patient population has great racial/ethnic and geographic diversity, but is unified by profound socioeconomic disadvantage and high rates of obesity and related chronic diseases (e.g. diabetes and CVD). We propose a cluster randomized trial in which the six PHS community health centers will be randomized into one of two treatment arms: 1) standard primary care; or 2) primary care plus a 12-month eHealth behavioral weight loss intervention (iOTA), which includes interactive self-monitoring and feedback, tailored skills training materials 18 telephone counseling calls, and provider counseling. The primary outcome is weight change at 12 months. Participants will be PHS patients with obesity and a cardiometabolic comorbidity. Participants will be followed over 12 months with assessments at baseline and 6 and 12 months post baseline.

描述(由申请人提供)：我们对如何在初级保健环境中向处于社会经济不利地位的患者提供有效的行为肥胖治疗知之甚少。这是一个重大的公共卫生挑战。社会经济上处于不利地位的人口最容易受到肥胖风险因素的影响，肥胖率和相关慢性病的发病率也最高。然而，在这一人群中推广临床上有意义的减肥效果方面几乎没有成功。有新的证据支持电子健康减肥方法的有效性，特别是当它们包括来自护理人员的人际支持时。我们小组在社区卫生中心进行了电子健康肥胖治疗干预的初步研究。社区卫生中心是特别重要的初级保健机构，因为它们主要为社会经济上处于不利地位的患者提供服务--从而针对那些最有需要的人--同时提供巨大的传播潜力。这些环境中的初级保健提供者可能在刺激患者行为改变方面发挥重要作用。然而，考虑到社区卫生中心提供者的临床需求和有限的辅助资源，目前尚不清楚如何以最佳方式让他们参与肥胖治疗干预。我们提出了一种新颖的、基于系统的干预方法，它整合并通知初级保健提供者，而不会造成负担。根据最好的证据，它包括辅助护理提供者作为干预者。使用电子健康技术提供量身定制的技能培训、自我监控和反馈。这项研究将与皮埃蒙特健康服务公司(PHS)合作进行，PHS是北卡罗来纳州农村的社区健康中心系统。小儿麻痹症患者群体具有很大的种族/民族和地理多样性，但由于严重的社会经济劣势以及肥胖率和相关慢性病(如糖尿病和心血管疾病)的高比率而统一。我们提出了一项整群随机试验，将六个PHS社区卫生中心随机分成两个治疗组之一：1)标准初级保健；或2)初级保健加为期12个月的eHealth行为减肥干预(IOTA)，其中包括交互式自我监测和反馈、定制技能培训材料18个电话咨询电话和提供者咨询。主要结果是12个月时体重发生变化。参与者将是患有肥胖症和心脏代谢性共病的PHS患者。参与者将被跟踪超过12个月，在基线以及基线后6个月和12个月后进行评估。