IVR-Supported Interventions for Cancer Prevention in the Deep South

描述(申请人提供)：每年有超过572,000名美国人死于癌症，其中约三分之一与缺乏体育锻炼、不良饮食和超重有关，因此是可以预防的。虽然确切的机制尚未确定，但体力活动(PA)可能通过促进体重控制或独立地通过改变与此类癌症相关的生物途径(改善能量代谢、降低循环中的性激素和胰岛素浓度)来影响乳腺癌和结肠癌的风险。美国癌症学会指南强调了每周150分钟中等强度PA在降低癌症风险方面的重要性。然而，美国大部分地区都不活跃，南部地区的PA水平特别低。在这个以农村为主的地区，教育水平和收入水平较低，加上非裔美国人(美国最大的少数族裔群体，他们中的大多数生活在南方，报告的不活动率很高)在PA和障碍(儿童保育、费用)方面的文化差异，可能会限制PA信息的获取和/或导致相关的癌症差异。远程医疗干预可以克服这些障碍，因为它不需要频繁的诊所就诊、昂贵的技术或识字，因此可能是在南方腹地推广PA和扩大深南癌症控制网络正在进行的社区卫生工作者努力的一种有希望的方法。大多数远程医疗干预依赖于工作人员咨询，但可以使用交互式语音响应(IVR)系统自动执行此类流程，以提高成本效益、覆盖范围和潜在的传播能力。鉴于我们团队过去使用IVR系统自我监控HIV危险行为的成功，以及在PA方面的这一领域研究的匮乏，我们通过广泛的形成性研究(11个关于PA障碍、干预需求/偏好的焦点小组，关注PA障碍、深南癌症控制社区健康顾问和来自农村和城市AL县的社区成员)，调整了现有的IVR系统格式，用于PA推广和降低癌症风险，现在建议在试点随机对照试验中(N=60)测试所产生的基于家庭的IVR支持的PA(HIP)干预。研究目标是记录呼叫IVR系统的意愿，审查新开发的干预模块，解决焦点小组中确定的PA障碍，以及基于社会认知理论(SCT)的贝塔测试定制算法，为R01资助的全功率随机对照试验做准备，以测试该方案的有效性，并最终通过深南癌症控制网络传播。在基线和3个月时将评估PA(7天标准杆，加速计)、体能(6MWT)、体重和身体组成(体脂百分比，BIA)。主要目标包括评估 髋关节介入治疗降低南方腹地癌症风险的可行性、可接受性和初步疗效。次要目标包括探索从基线到3个月的体能、体重/成分和SCT变量变化的手臂差异，并评估通过IVR系统报告的中等强度PA在两个时间点(基线前7天和3个月评估)的分钟/周和加速计之间的关系。

DESCRIPTION (provided by applicant): Each year, more than 572,000 Americans die of cancer and approximately a third of these deaths are linked to physical inactivity, poor diet, and excess weight and thus can be prevented. While exact mechanisms have yet to be determined, physical activity (PA) may impact breast and colon cancer risk by promoting weight control or perhaps independently by altering biologic pathways related to such cancers (improving energy metabolism, reducing circulating concentrations of sex hormones and insulin). ACS guidelines emphasize the importance of > 150 min/week of moderate-intensity PA in reducing cancer risk. However, most of the U.S. is inactive, with particularly low PA levels found in the South. Low education and income levels in this largely rural area, along with cultural differences regarding PA and barriers (childcare, costs) reported by African Americans (largest racial minority group in U.S., most of whom live in the South and report high rates of inactivity) may limit access to PA information and/or contribute to related cancer disparities. Telehealth interventions can overcome such obstacles by not requiring frequent clinic visits, expensive technology, or literacy and thus may represent a promising approach to promoting PA in the Deep South and extending ongoing community health worker efforts by the Deep South Network for Cancer Control. Most telehealth interventions have relied on staff counseling, but such processes can be automated using an Interactive Voice Response (IVR) system to enhance cost-effectiveness, reach, and potential disseminability. Given our team's past success using IVR systems for self monitoring of HIV risk behaviors and the paucity of research in this area on PA, we adapted the existing IVR system format for PA promotion and cancer risk reduction in the Deep South through extensive formative research (11 focus groups on PA barriers, intervention needs/preferences with Deep South Cancer Control community health advisors and community members from rural and urban AL counties) and now propose to test the resulting Home-based IVR-supported PA (HIP) intervention in a pilot RCT (N=60) with a waitlist control. Study goals are to document willingness to call IVR system, vet newly developed intervention modules addressing the PA barriers identified in focus groups, and beta-test Social Cognitive Theory (SCT) based tailoring algorithms in preparation for an R01-funded fully powered RCT to test the efficacy of the program and eventual dissemination through the Deep South Network for Cancer Control. PA (7-Day PAR, accelerometers), fitness (6MWT), and body weight and composition (% body fat, BIA) will be assessed at baseline and 3 months. Primary aims include assessing the feasibility, acceptability, and preliminary efficacy of the HIP intervention for cancer risk reducton in the Deep South. Secondary aims include exploring arm differences in changes in fitness, body weight/composition, and SCT variables from baseline to 3 months and assessing the relationship between min/week of >moderate intensity PA reported via IVR system vs. accelerometers at 2 time points (7 days before baseline and 3 month assessment).