Techquity by FAITH!: A cluster randomized controlled trial to assess the efficacy of a community-informed, cardiovascular health promotion mobile hlth intervention with digital health advocate support

项目摘要/摘要 与所有种族/民族相比，非裔美国人(AA)成年人的心血管健康状况最差 (CVH)由美国心脏协会(AHA)生命必需品8(LE8；由研究PI共同开发)评分，其中 导致了心血管疾病死亡率的差异。LE8指标包括4种健康行为和4种 临床因素(如饮食、体力活动、睡眠、血压等)。为了解决CVH差异，AHA 支持整合与社会文化相关的移动健康(MHealth)干预措施，以在 通过利用社会资本和跨部门合作，使未得到充分服务的人群受益。然而，有一种稀缺的 有效的、与文化相关的、以证据为基础的干预措施。利用我们的信仰！(养育 非洲裔美国人改善总体健康状况！)计划，一个建立在社区基础上的参与式计划 研究(CBPR)的努力，我们与AA社区共同设计了一个文化定制的CVH mHealth干预 会员。社区消息灵通的信仰！APP随后在NIMHD资助的随机临床试验中进行了测试 (RCT)，信仰！试验，来自罗切斯特和明尼阿波利斯-圣保罗AA教堂的参与者(N=85) (MSP)、MN.我们的学习找到了信仰！APP在CVH评分和行为方面有显著改善 (宾夕法尼亚州饮食)..参与者认为该应用程序对CVH教育是公平的，并建议整合 数字/技术支持，以增强应用程序功能。我们的主要目标是与AA教会合作，推广CVH和 数字医疗公平(DHE，“Techquity”)和这些社区内的数字医疗准备情况 设计了DHE工具包和数字健康倡导者(DHAS)网络。 P50 NOSI补充提案与NIMHD健康差距研究框架一致，如下所示 它解决了CVH差异和数字健康不平等的多方面性质。我们提出了三个目标：目标1 邀请AA教堂共同设计一个与文化相关的DHE工具包。我们将使用形成性/定性研究 在20个AA社区成员的焦点小组系列中进行流程。主要结果是工具包的可接受性和 满足感。AIM 2将培训20名DHA进行数字医疗准备和CVH推广，以整合到 移动健康干预。目标3将评估社区知情的移动健康干预的影响(信仰！应用程序) 通过150名再生障碍性贫血成人的随机对照试验，DHA支持再生障碍性贫血成人的CVH。主要结果是改变 LE8评分从基线到随机化后6个月。次要成果包括数字健康 就绪性和心理社会措施(社会支持、自我调节和健康生活方式的公认障碍)。 成立的社区指导委员会将为所有活动提供投入。我们的项目具有创新性，因为我们的 多层次战略包括参与式设计DHE工具包、科学合理的DHA培训和整合 行为理论知情的、经验支持的mHealth生活方式干预对CVH和DHE的影响 在AAA中。如果成功，我们的结果可以为使用基于证据的移动健康工具来促进 最佳CVH，同时解决AA之间的数字鸿沟。

PROJECT SUMMARY/ABSTRACT Compared to all racial/ethnic groups, African-American (AA) adults have the lowest cardiovascular health (CVH) scores by the American Heart Association (AHA) Life's Essential 8 (LE8; co-developed by study PI), which has resulted in cardiovascular disease mortality disparities. The LE8 metric includes 4 health behaviors and 4 clinical factors (eg, diet, physical activity [PA], sleep, blood pressure, etc). To address CVH disparities, AHA endorses integrating socioculturally relevant, mobile health (mHealth) interventions to promote CVH among underserved populations by leveraging social capital and cross-sector collaboration. However, there is a paucity of effective, culturally relevant, evidence-based interventions available. Leveraging the FAITH! (Fostering African-American Improvement in Total Health!) Program, an established community-based participatory research (CBPR) effort, we co-designed a culturally tailored, CVH mHealth intervention alongside AA community members. The community-informed FAITH! App was then tested in an NIMHD-funded randomized clinical trial (RCT), the FAITH! Trial, among participants (N=85) from AA churches in Rochester and Minneapolis-Saint Paul (MSP), MN. Our study found the FAITH! App resulted in significant improvements in CVH scores and behaviors (diet, PA).. Participants viewed the app as equitable for CVH education, and suggested integrating digital/technical support to enhance app features. Our major goal is to engage AA churches to promote CVH and digital health equity (DHE, “Techquity”) and digital health readiness within these communities through a co- designed DHE toolkit and Digital Health Advocates (DHAs) network. The P50 NOSI supplement proposal aligns with the NIMHD Health Disparities Research Framework as it addresses the multi-faceted nature of CVH disparities and digital health inequities. We propose 3 aims: Aim 1 engagesAA churches to co-design a culturally relevant DHE toolkit. We will use a formative/qualitative research process in a focus group series with 20 AA community members. Primary outcomes are toolkit acceptability and satisfaction. Aim 2 will train 20 DHAs in digital health readiness and CVH promotion for integration into an mHealth intervention. Aim 3 will assess the impact of a community-informed, mHealth intervention (FAITH! App) with DHA support on CVH among AA adults through a cluster RCT of 150 AA adults. Primary outcome is change in LE8 score from baseline to 6-months post-randomization. Secondary outcomes include digital health readiness and psychosocial measures (social support, self-regulation, and perceived barriers to healthy lifestyle). An established community steering committee will provide input for all activities. Our project is innovative as our multilevel strategy includes participatory design of a DHE toolkit, scientifically sound DHA training and integration of a behavioral theory-informed, empirically-supported mHealth lifestyle intervention to influence CVH and DHE among AAs. If successful, our results can pave the way for use of evidence-based mHealth tools to promote optimal CVH while addressing the digital divide among AAs.