RFA-DP-19-001, Health Promotion and Disease Prevention Research Centers

摘要

ABSTRACT Residents of North Carolina and the rural southeastern US experience some of the highest chronic disease rates and greatest health disparities in the country, influenced significantly by social determinants of health (SDH). The goals of this application are to: (1) with our community partners, build and maintain a strong Center infrastructure to support applied prevention research, translate research findings, and disseminate evidence- based products, and (2) determine the processes by which our proven lifestyle intervention (Med-South Lifestyle Program - MSLP) can be efficiently translated into public health and clinical practice supported by community-based resources to combat food insecurity. The MSLP, based on the Mediterranean diet but tailored to the taste preferences and food availability of a southern low-resource population, has resulted in positive health outcomes for hypertension, diabetes, and obesity. Although the scientific rationale for implementing lifestyle interventions is robust, evidence is limited on supporting the broad-scale implementation of these interventions in clinical and public health settings. We propose an Implementation Core Research Project with 3 phases informed by multiple implementation theories and the Knowledge into Action Framework. Our research is designed to determine the processes by which the MSLP can be most efficiently and effectively translated into public health (local health departments) and clinical (community health centers) practice to positively impact chronic disease risk reduction among minority, rural, and medically underserved populations. In Phase 1, we will identify facilitators and barriers to implementation and develop, pilot test, and refine implementation strategies that will be used to take the MSLP to scale. In Phase 2, we will apply an effectiveness-implementation hybrid design to compare two formats for scaling up MSLP on implementation outcomes (primary aim) and confirm MSLP impact on behavioral and clinical outcomes (secondary aim). In Phase 3, we will initiate MSLP's full-scale implementation in North Carolina in coordination with NC's current transition to Medicaid Managed Care where state health department (HD) policies will “guide plans and providers toward implementation of a whole-person centered, well-coordinated system of care, which addresses both medical and non-medical drivers of health.” We are discussing integrating the MSLP in the coverage plans of several health insurance companies applying to serve as Pre-paid Health Plans in the new Medicaid Managed care system. We will use our nationally recognized Center for Training and Research Translation to disseminate MSLP materials along with other evidence-based interventions produced by HPDP and the PRC Network, highlighting those supporting the new CDC-funded programming. Finally, we will continue working with the State HD to inform a robust Statewide Resource Platform - a database and call center linking public health and clinical practitioners to resources in their communities addressing social determinants of health like food insecurity. The Platform will track connections and monitor outcomes.