Enhancing Quality and Access to Lifestyle Counseling and Health Behavior Change

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DESCRIPTION (provided by applicant): Despite ongoing efforts, racial and ethnic minorities continue to experience significant disparities in health care and outcomes. Persistent disparities are due to many factors, but unequal quality and reduced access to preventive care and chronic disease management are among the measures that are in need of urgent attention to reduce disparities. Health care providers (HCP) play an important role in helping patients to adopt and maintain healthy lifestyle behaviors. But, there are disparities in access and quality of provider advice and counseling about lifestyle modification and health behavior change. There are many evidence-based strategies to promote health behavior change and provide lifestyle counseling in primary care, but providers may not be aware of these strategies, have limited understanding about their effectiveness in racial and ethnic minorities, and how to adapt existing strategies to meet the needs and preferences of patients. One way to increase the translation of evidence-based strategies for lifestyle modification and health behavior change counseling is to identify the priorities and preferences for these efforts among stakeholders and develop practice-based implementation and evaluation plans that are consistent with these priorities and preferences and the resources that are available in the practice. Community-based participatory research (CBPR) is an approach that can be used to determine if and where the priorities and preferences of providers and patients converge and diverge, reach consensus on divergent issues, and develop practice-based implementation and evaluation plans to translate existing evidence-based strategies into care. In response to RFA-HS-13-010, Closing the Gap in Healthcare Disparities through Dissemination and Implementation of Patient Centered Outcomes Research (U18), we propose to conduct a demonstration project that uses CBPR to reduce disparities in quality and access to lifestyle modification and health behavior change counseling in primary care by working collaboratively with HCPs and patients. This research will be implemented in two phases. During Phase I, we will use a multilevel strategy to identify and synthesize evidence-based strategies for lifestyle modification and health behavior change that were targeted, developed, or evaluated in racial and ethnic minorities through a systematic evidence synthesis review and identify and prioritize the concerns and preferences about the delivery and use of lifestyle modification and health behavior counseling among HCPs and patients from diverse primary care practices that are part of a national PBRN. In Phase II, we will develop implementation and evaluation plans that specify the procedures, outcomes, and resources that are necessary to translate evidence-based strategies for lifestyle modification and health behavior change into primary care collaboratively with HCPs and patients from PPRNet practices using participatory planning and intervention mapping. We will also evaluate the process of engaging provider and patient from PPRNet practices in the prioritization process and the development and dissemination of implementation and evaluation plans.