Be Well at Work-Plus: Engaging low-wage workers in the design and implementation of a depression and physical activity intervention

抑郁和缺乏运动是导致肥胖等心脏代谢性疾病的主要因素， 糖尿病和心血管疾病。低薪工人，占美国工人总数的三分之一。 对许多行业来说都是必不可少的，他们更有可能身体不活跃，心脏代谢 条件和抑郁，然而，他们利用预防性护理的可能性是高薪工人的一半。 有针对性的工作场所倡议在改善员工健康方面取得了成功，但低薪工人却 难以参与，部分原因是社会不利因素的沉重负担(例如，食物和住房不安全、时间 和财务限制)。如果有的话，工作场所对抑郁症的干预措施几乎没有专门针对 低工资工人及其独特的社会风险因素。这项研究的概念是使用计划的 让低薪工人参与设计干预措施以增加参与度的适应办法 和可行性。这项拟议的研究将采用基于证据的8次电话传递的抑郁症 对在职成年人的干预，做好工作，并为低工资工人增加关键的增强： 评估和转介健康的社会决定因素(例如，粮食和住房不安全、经济压力)， 身体活动促进，通过生态瞬间提供个性化短信行为支持 评估和干预。将开发和测试适应的干预措施，Be Well at Work-Plus 分三个阶段：(1)对低薪工人进行定性访谈，以了解健康的社会决定因素， 参与的障碍和促进者，以及干预偏好(目标1)；(2)单臂飞行员(N=10) 退出访谈以完善干预内容和提供(目标2)；(3)试点随机对照试验 将在工作中做得更好与等待名单的情况进行比较(N=60；目标3)。这一迭代过程将产生结果 关于Be Well at Work Plus的可行性、可接受性和初步临床结果，并为 申请R01疗效试验。为了配合这些研究目标，麦柯利博士设计了一个培训计划 获得(1)实施科学方面的专门知识，包括有计划地调整循证干预措施 和参与式设计方法，以提高低收入群体的覆盖面和参与度，(2)移动 健康，具体地说，短信，以增加干预的可行性和接受度；以及(3)随机 对照试验设计。职业发展计划包括定期与以下领域的专家进行指导 实施科学、移动健康、随机行为干预试验以及教学课程 和讲习班，通过专题介绍和出版物传播成果，并支持赠款的编写 以及额外的技能发展，以推动麦柯利博士作为一名独立行为科学家的职业生涯。这 K23提案将使麦柯利博士成为一名独立调查员，制定干预措施 融合技术和行为科学来解决抑郁症、健康行为、健康的社会决定因素、 和低收入人群的心脏代谢性疾病。

Depression and physical inactivity are leading contributors to cardiometabolic diseases such as obesity, diabetes, and cardiovascular disease. Low-wage workers, who comprise one-third of all workers in the U.S. and are essential to many industries, are more likely to be physically inactive and to have cardiometabolic conditions and depression, yet they are half as likely as higher wage workers to utilize preventive care. Targeted workplace initiatives have been successful in improving employee health, but low-wage workers are difficult to engage, in part due to a high burden of social disadvantage (e.g., food and housing insecurity, time and financial constraints). There are few, if any, workplace interventions for depression that specifically target low-wage workers and their unique social risk factors. This study was conceptualized using a planned adaptation approach that involves low-wage workers in the design of the intervention to increase engagement and feasibility. The proposed study will adapt an evidence-based 8-session telephone-delivered depression intervention for working adults, Be Well at Work, and add critical enhancements for low-wage workers: assessment and referrals for social determinants of health (e.g., food and housing insecurity, financial stress), physical activity promotion, and personalized text message behavioral support via ecological momentary assessment and intervention. The adapted intervention, Be Well at Work-PLUS, will be developed and tested in three phases: (1) qualitative interviews with low-wage workers to understand social determinants of health, barriers and facilitators of engagement, and intervention preferences (Aim 1); (2) a single-arm pilot (N=10) with exit interviews to refine the intervention content and delivery (Aim 2); (3) a pilot randomized controlled trial comparing Be Well at Work-PLUS to a waitlist condition (N=60; Aim 3). This iterative process will yield results on feasibility, acceptability, and preliminary clinical outcomes of Be Well at Work-PLUS and provide data to apply for an R01 efficacy trial. To compliment these research aims, Dr. McCurley has designed a training plan to gain expertise in (1) implementation science, including planned adaptation of evidence-based interventions and participatory design methods for improving reach and engagement in low-income groups, (2) mobile health, specifically, text messaging for increased intervention feasibility and uptake; and (3) randomized controlled trial design. The career development plan involves regular mentorship with experts in implementation science, mobile health, randomized behavioral intervention trials, as well as didactic courses and workshops, dissemination of results through presentations and publications, and support for grant writing and additional skill development to advance Dr. McCurley’s career as an independent behavioral scientist. This K23 proposal will position Dr. McCurley to become an independent investigator developing interventions that fuse technology and behavioral science to address depression, health behavior, social determinants of health, and cardiometabolic diseases in low-income populations.