Enhancing Quality and Access to Lifestyle Counseling and Health Behavior Change

描述（由申请人提供）：尽管不断作出努力，但少数种族和族裔在保健和结果方面仍然存在重大差异。持续的差距是由许多因素造成的，但质量不平等以及获得预防保健和慢性病管理的机会减少是需要紧急注意的措施之一，以缩小差距。卫生保健提供者（HCP）在帮助患者采用和保持健康的生活方式行为方面发挥着重要作用。但是，关于生活方式改变和健康行为改变的建议和咨询的可及性和质量存在差异。有许多以证据为基础的策略来促进健康行为改变，并在初级保健中提供生活方式咨询，但提供者可能没有意识到这些策略，对它们在种族和少数民族中的有效性了解有限，以及如何调整现有策略以满足患者的需求和偏好。提高以证据为基础的生活方式改变和健康行为改变咨询战略转化的一种方法是，确定利益攸关方对这些努力的优先事项和偏好，并制定与这些优先事项和偏好以及实践中可用资源相一致的基于实践的实施和评估计划。基于社区的参与性研究（CBPR）是一种方法，可用于确定提供者和患者的优先事项和偏好是否以及在何处趋同和偏离，就分歧问题达成共识，并制定基于实践的实施和评估计划，将现有的循证战略转化为护理。为响应RFA-HS-13-010《通过以患者为中心的结果研究的传播和实施缩小医疗保健差距》（U18），我们建议开展一个示范项目，通过与HCPs和患者合作，利用CBPR减少初级保健中生活方式改变和健康行为改变咨询的质量和可及性差异。本研究将分两个阶段进行。在第一阶段，我们将使用一个多层次的策略来确定和综合基于证据的策略，以改变生活方式和改变健康行为，这些策略是有针对性的，开发的，或通过系统的证据综合审查来评估种族和少数民族，并确定和优先考虑在HCPs和来自不同初级保健实践的患者中提供和使用生活方式改变和健康行为咨询的关注和偏好，这些都是国家PBRN的一部分。在第二阶段，我们将制定实施和评估计划，明确程序、结果和资源，这些都是将生活方式改变和健康行为改变的循证策略转化为初级保健所必需的，通过参与式规划和干预绘图，与HCPs和来自PPRNet实践的患者合作。我们还将评估在确定优先次序的过程以及制定和传播实施和评估计划的过程中，让PPRNet实践的提供者和患者参与进来的过程。

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.