Implementing a multistage optimization strategy to identify the best combination of program adaptations to promote breastfeeding at the Lummi Indian Reservation

实施多阶段优化策略，以确定项目调整的最佳组合，以促进卢米印第安保留地的母乳喂养

• 批准号: 10570412
• 负责人: Jessica Long
• 金额: $ 12.68万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570412
• 关键词: Address; Age-Months; Alaska Native; American Indians; Appointment; Birth; Breast Feeding; COVID-19 vaccine; Cardiovascular Diseases; Cessation of life; Child; Child Health; Client; Cognitive; Collaborations; Communities; Community Health; Data; Diabetes Mellitus; Educational workshop; Enrollment; Epidemiology; Ethics; Experimental Designs; Goals; Health; Health Benefit; Health Priorities; Health Promotion; Health system; Hospitalization; Indian reservation; Infant; Infection; Interview; K-Series Research Career Programs; Leadership; Learning; Lummi; Malignant Neoplasms; Malignant neoplasm of ovary; Maternal and Child Health; Mentored Research Scientist Development Award; Mentorship; Methods; Outcome; Pacific Northwest; Parents; Participant; Persons; Population; Postpartum Period; Public Health; Publishing; Randomized Controlled Trials; Reporting; Research; Research Design; Research Personnel; Research Proposals; Research Training; Risk; Structure; Surveys; Testing; Training; Tribes; United States; United States Department of Agriculture; Woman; Work; career development; community based participatory research; community center; community engagement; cost; design; experience; health difference; health equity; health inequalities; implementation framework; implementation research; implementation science; implementation strategy; improved; infant death; innovation; lower income families; malignant breast neoplasm; member; novel; obesity in children; obesity risk; primary outcome; program costs; programs; public health priorities; racial and ethnic disparities; randomized trial; reservation-based; social culture; social health determinants; symposium; tribal health; uptake; vaccine trial

ABSTRACT The overall goal of this K01 award is to support Dr. Long in becoming an independent investigator specializing in the use of cutting edge implementation methods to address health inequities and improve the health of birthing parents and infants. The focal point of the proposed research is to adapt an existing national breastfeeding program to improve breastfeeding initiation and duration in American Indian and Alaskan Native (AI/AN) communities. Breastfeeding provides enormous immediate and long-term health benefits for both infants and birthing people, reducing the risk of obesity, diabetes, and death in children, and cancer, diabetes, and cardiovascular diseases in birthing people. However, there are important racial and ethnic disparities in breastfeeding rates in the United States, and AI/AN communities are both less likely to breastfeed and are at greater risk for many of the adverse health outcomes that breastfeeding protects against. This proposed research will use methods grounded in community engagement and health equity to assess barriers to breastfeeding among AI/AN residents at the Lummi Indian Reservation, and then test adaptations designed to address those barriers and improve breastfeeding uptake and duration. The proposed work will use a novel optimization design that will allow for multiple strategies to be tested and will place priority on both efficacy and cost of program adaptations. The specific aims of this proposal are: 1) to assess barriers to breastfeeding in Lummi parents and identify adaptations to the existing promotion program to address those barriers; 2) to test adaptations to the program to identify an optimal adapted program; and 3) to determine acceptability, appropriateness, and feasibility of the adapted components. This proposed work has been designed to address a key public health priority identified by leadership at Lummi Tribal Health Center, and the work will be carried out in partnership with Lummi Tribal Health Center leaders and in collaboration with a community advisory board. These research aims are one aspect of a comprehensive training plan designed in coordination with an exemplary interdisciplinary mentorship team. Dr. Long will receive mentorship, training, and coursework in implementation science, community-based participatory research, and integration of health equity into research design. The specific training goals of this proposal include 1) gaining proficiency in the use of implementation science frameworks; 2) learning and applying advanced implementation science study designs; and 3) learning to conduct ethical equity-focused implementation research. The final goal is to provide Dr. Long with mentorship and support in career development, and this research and training plan will provide opportunities to publish original research, present at conferences and workshops, and gain visibility within her field. The resulting data from the proposed research will provide the basis for an R01 application to test and scale the findings through a randomized controlled trial. This proposed work will build on Dr. Long’s existing expertise in epidemiology and implementation science, and provide the training, experience, and data for her to transition to independence.

摘要 这一K01奖项的总体目标是支持龙博士成为一名专门从事 使用先进的实施方法来解决健康不平等问题和改善生育健康 父母和婴儿。拟议研究的重点是调整现有的国家母乳喂养 改善美洲印第安人和阿拉斯加原住民母乳喂养开始和持续时间的计划(AI/AN) 社区。母乳喂养对婴儿和婴儿都有巨大的直接和长期的健康益处 生育，降低肥胖、糖尿病和儿童死亡的风险，以及癌症、糖尿病和 分娩人群的心血管疾病。然而，存在着重要的种族和民族差距。 美国的母乳喂养率和AI/AN社区都不太可能母乳喂养，而且 母乳喂养可以预防的许多不良健康后果的风险更大。这项拟议的研究 将使用基于社区参与和健康公平的方法来评估母乳喂养的障碍 在Lummi印第安人保留地的AI/AN居民中，然后测试旨在解决这些问题的适应 阻碍和改善母乳喂养的吸收和持续时间。建议的工作将使用一种新颖的优化设计 这将允许测试多种策略，并将计划的有效性和成本放在优先位置 改编。这项建议的具体目标是：1)评估Lummi父母母乳喂养的障碍和 确定对现有促销计划的适应，以解决这些障碍；2)测试对 程序以确定最佳改编程序；以及3)确定可接受性、适当性和 调整后的组件的可行性。这项拟议的工作旨在解决一个关键的公共卫生问题 Lummi部落健康中心领导层确定的优先事项，这项工作将与合作伙伴一起开展 与Lummi部落健康中心领导人合作并与社区顾问委员会合作。 这些研究目标是综合培训计划的一个方面，该计划是与 模范的跨学科辅导团队。Long博士将接受指导、培训和课程安排 实施科学、以社区为基础的参与性研究以及将卫生公平纳入研究 设计。该提案的具体培训目标包括：1)熟练使用执行程序 科学框架；2)学习和应用先进的实施科学研究设计；以及3)学习 开展以伦理公平为重点的实施研究。最终目标是为龙博士提供指导 和职业发展方面的支持，这项研究和培训计划将提供发表 原创研究，在会议和研讨会上发表，并在她的领域内获得知名度。生成的数据 将为R01应用程序提供基础，以通过 随机对照试验。这项拟议的工作将建立在龙博士现有的流行病学和 实施科学，并为她向独立过渡提供培训、经验和数据。