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

抑郁和缺乏运动是肥胖等心脏代谢疾病的主要诱因， 糖尿病和心血管疾病。低工资工人占美国所有工人的三分之一。 对许多行业来说都是必不可少的，更有可能是身体不活跃的， 他们的健康状况和抑郁症，但他们利用预防保健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雇员健康方面取得了成功，但低工资工人 很难参与，部分原因是社会弱势的沉重负担（例如，粮食和住房不安全，时间 财政限制）。很少有，如果有的话，专门针对抑郁症的工作场所干预措施 低收入工人及其独特的社会风险因素。这项研究是概念化的使用计划， 使低工资工人参与设计干预措施以提高参与度的适应方法 和可行性这项拟议的研究将采用一个基于证据的8个会议的电话传递抑郁症 对在职成年人的干预，在工作中做好，并为低工资工人增加关键的增强措施： 对健康的社会决定因素的评估和转诊（例如，粮食和住房不安全、财政压力）， 促进身体活动，并通过生态瞬时个性化短信行为支持 评估和干预。将制定和测试经调整的干预措施"工作愉快“， 分三个阶段：（1）对低工资工人进行定性访谈，以了解健康的社会决定因素， 参与的障碍和促进因素，以及干预偏好（目标1）;（2）单臂试验（N=10）， 离职面谈，以完善干预内容和实施（目标2）;（3）试点随机对照试验 将Be Well at Work-PLUS与等待名单条件进行比较（N=60;目标3）。这个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局，并提供数据， 申请R 01疗效试验。为了实现这些研究目标，McCurley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率和参与度，（2）移动的 健康，特别是短信，以增加干预的可行性和吸收;和（3）随机 对照试验设计。职业发展计划包括与专家定期指导， 实施科学，移动的健康，随机行为干预试验，以及教学课程 讲习班，通过演讲和出版物传播成果，并支持编写赠款 和额外的技能发展，以推进博士McCurley的职业生涯作为一个独立的行为科学家。这 K23提案将使McCurley博士成为一名独立的研究人员，开发干预措施， 融合技术和行为科学，以解决抑郁症，健康行为，健康的社会决定因素， 和心脏代谢疾病。

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.