Reaching Racial/Ethnic Minority Communities to Support Healthy Lifestyle Change: Virtual World Training for Community Health Workers

项目摘要/摘要 对于包括非裔美国人在内的少数族裔来说，糖尿病的负担更大。超重和 肥胖是患糖尿病的危险因素，在少数族裔中也更为普遍。 糖尿病预防计划和随后的翻译研究证明了一种生活方式的有效性 减少体重和2型糖尿病风险的干预措施。越来越多的证据支持接触努力 CHW帮助扩大我们的覆盖面，以降低服务不足社区的肥胖和糖尿病风险。研究是 需要确定标准、有效且可扩展的CHW培训模式，以帮助他们扩展我们的 在种族/少数民族社区，特别是处于危险中的非洲裔美国人。基于互联网的沉浸式3- 三维(3-D)虚拟世界环境为人们提供了通过标准化和 量身定制的方法，可以克服参与的常见障碍，并允许参与和 体验式教育机会。在我们以前的工作和经验的基础上，我们将量身定制/适应， 实施并评估基于互联网的3-D虚拟世界模型，以远程提供CHW培训计划 (CDC“健康之路”；RTH)支持社区卫生工作者努力教育处于危险中的非裔美国人社区 改变生活方式以降低肥胖和糖尿病的风险。我们将使用顺序混合方法设计来 解决这些具体目标：目标1.使用以社区为基础的参与性研究方法来指导总体 研究和通知我们的虚拟世界模型的定制和调整，以提供CHW培训计划；目标 2.进行随机先导研究(N=40名CHW)，比较主要结果(0，12周)的变化 在培训计划的面对面交付与虚拟世界交付之后。参与者将是经验丰富的非洲人 与其服务的高危人群具有相同特征的美国女性社区妇女。初级CHW结局 包括节目内容知识和交付技能、自我效能、坚持性和生活方式改变 行为；和目标3.开展终结性焦点小组，以完善CHW虚拟世界培训计划和 指导RO1后续开发的研究方法。如果我们的虚拟世界CHW培训模式 在这项研究中展示了希望，并在随机对照试验中显示了随后的有效性，它可以针对不同的情况量身定做/调整 并扩大到广泛的远程传播。

PROJECT SUMMARY/ABSTRACT The burden of diabetes is greater for racial/ethnic minorities, including African Americans. Overweight and obesity are risk factors for the development of diabetes and are also more prevalent in racial/ethnic minorities. The Diabetes Prevention Program and subsequent translation studies demonstrated the efficacy of a lifestyle intervention on reducing weight and risk of type 2 diabetes. Increasing evidence supports efforts to engage CHWs to help extend our reach to reduce obesity and diabetes risk in underserved communities. Research is needed to identify standard, effective, and scalable CHW training models to equip them to help extend our reach in racial/ethnic minority communities, especially at-risk African Americans. Internet-based immersive 3- dimensional (3-D) virtual world environments offer the opportunity to reach populations with standardized and tailored approaches that can overcome common barriers to participation and allow for engaging and experiential educational opportunities. Building on our prior work and experience, we will tailor/adapt, implement, and evaluate an internet-based 3-D virtual world model to remotely deliver a CHW training program (CDC “Road to Health”; RTH) to support CHWs' efforts to educate at-risk African American communities about lifestyle changes to reduce obesity and diabetes risk. We will use a sequential mixed-methods design to address these specific aims: Aim 1. Use community-based participatory research methods to guide the overall study and inform tailoring and adaptation of our virtual world model to deliver the CHW training program; Aim 2. Conduct a randomized pilot study (N=40 CHWs) to compare change in primary outcomes (0, 12 weeks) after the in-person versus virtual world delivery of the training program. Participants will be experienced African American female CHWs who share characteristics of the at-risk population they serve. Primary CHW outcomes include program content knowledge and delivery skill, self-efficacy, adherence, and change in lifestyle behaviors; and Aim 3. Conduct summative focus groups to refine the CHW virtual world training program and study methodology to guide subsequent development of an RO1. If our virtual world CHW training model shows promise in this study and subsequent effectiveness in an RCT, it could be tailored/adapted for diverse groups and scaled for broad remote dissemination.