Promotora-Led Intervention to Promote Weight Loss in Latinas at-risk for Diabetes

描述（由申请人提供）：本K23提案的总体目标是培养Matthew J. O'Brien， MD， MSc作为肥胖和糖尿病预防的独立研究者，特别关注拉丁裔-这些相关疾病的高风险人口群体。虽然有人试图将循证糖尿病预防计划（DPP）转化为社区环境，但这些研究中很少包括拉丁裔。社区卫生工作者或推广人员是受过培训的非专业人员，他们提供健康教育，可以在拉丁美洲人的减肥和糖尿病预防工作中发挥领导作用。以前的研究表明，促进者是一种有效的非专业卫生人力，但没有发表的研究将这种干预模式应用于拉丁美洲人的糖尿病预防。O’brien博士计划在DPP的指导下，通过开发一种以促进者为主导的生活方式干预（PLI）来解决这一知识差距，以促进拉丁美洲人的减肥和降低心脏代谢风险。该研究将分为三个阶段，以解决相应的具体目标：第一阶段使用焦点小组来探索糖尿病风险拉美裔体重相关行为的社会和文化背景，并将研究结果应用于PLI的发展；第二阶段包括在单臂试验中进行PLI试验，并评估其可行性和可接受性；第三阶段将在一项随机对照试验中测试PLI对改变高危拉美人体重和心脏代谢指标的影响。为了顺利完成拟议的研究计划，O'Brien博士将通过正式课程和结构化指导接受以下三个方面的额外培训：1)定性方法；2)减肥与糖尿病预防的随机对照试验；3)肥胖、糖尿病和新陈代谢的基础。天普大学在这些研究领域都有国际公认的研究人员，他们将作为奥布莱恩博士的导师。拟议研究的地点是由O'Brien-Puentes de Salud博士（“健康之桥”）建立的一个社区卫生中心，该中心为拉丁裔人口服务，自2007年以来，它一直是几项基于促销的研究的地点，涉及目标人群。

DESCRIPTION (provided by applicant): The overall goal of this K23 proposal is to train Matthew J. O'Brien, MD, MSc for a career as an independent investigator in obesity and diabetes prevention, with a specific focus on Latinas-a demographic group at high risk for these related disorders. While there have been attempts to translate the evidence-based Diabetes Prevention Program (DPP) into community settings, very few of these studies have included Latinas. Community health workers, or promotoras, are trained lay people who provide health education, and could serve as leaders of weight loss and diabetes prevention efforts in Latinas. Previous research has demonstrated that promotoras are an effective lay health workforce, but no published studies have applied this intervention model to diabetes prevention in Latinas. Dr. O'Brien plans to address this gap in knowledge by developing a promotora-led lifestyle intervention (PLI), informed by the DPP, to promote weight loss and reduce cardiometabolic risk in Latinas. There are 3 Phases to the proposed research that will address corresponding specific aims: Phase 1 uses focus groups to explore the social and cultural context surrounding weight-related behaviors in Latinas at-risk for diabetes, applying the findings to develop PLI; Phase 2 involves piloting PLI in a single-arm trial, and assessing its feasibility and acceptabilit; Phase 3 will test the effects of PLI on changing at-risk Latinas' weight and cardiometabolic markers in a randomized controlled trial. In order to successfully complete the proposed research plan, Dr. O'Brien will receive additional training through formal coursework and structured mentorship in the following 3 areas: 1) qualitative methods; 2) randomized controlled trials for weight loss and diabetes prevention; and 3) foundations in obesity, diabetes, and metabolism. Temple University is home to internationally-recognized researchers in each of these areas of study, who will serve as Dr. O'Brien's mentors. The site for the proposed research is a community health center founded by Dr. O'Brien-Puentes de Salud ("Bridges of Health")-which serves a Latino population and has been the site of several promotora-based studies involving the target population since 2007.