Adapting Online Obesity Treatment for Primary Care Patients in Poverty

为贫困初级保健患者采用在线肥胖治疗

• 批准号: 10722366
• 负责人: Po-hun Chou
• 金额: $ 18.81万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722366
• 关键词: Address; Adherence; Adoption; Adult; Affect; Aftercare; Behavioral; Body Weight decreased; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Clinical; Clinical Trials; Communities; Consolidated Framework for Implementation Research; Data; Data Collection; Decision Making; Dementia; Development; Diabetes Mellitus; Effectiveness; Eligibility Determination; Epidemic; Face; Family; Feedback; Food; Funding; Goals; Health Priorities; Health Services Research; Health behavior; Healthcare; High Prevalence; Individual; Internet; Intervention; Knowledge; Link; Literature; Low income; Malignant Neoplasms; Measures; Mental Depression; Mental Health; Mentors; Methods; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Obesity; Outcome; Participant; Pathway interactions; Patients; Persons; Physical activity; Population; Population Heterogeneity; Positioning Attribute; Poverty; Primary Care; Primary Care Physician; Process; Provider; Public Health; Readiness; Recommendation; Reduce health disparities; Research; Research Activity; Research Methodology; Research Personnel; Resources; Rhode Island; Risk; Role; Services; Severities; Site; Social Marketing; Structure; Testing; Time; Training; Treatment/Psychosocial Effects; Underserved Population; United States National Institutes of Health; Weight; Weight maintenance regimen; Work; career; community engaged research; cost; design; disadvantaged background; dissemination research; implementation evaluation; implementation outcomes; implementation research; improved; insight; intervention refinement; obesity treatment; patient population; patient retention; patient screening; physical conditioning; primary care clinic; primary care patient; primary care provider; programs; prototype; recruit; research to practice; response; screening; social factors; social health determinants; socioeconomic disadvantage; socioeconomic disparity; structural determinants; syndemic; theories; tool; treatment program; treatment research; uptake; usability; weight loss program

Project Summary Poverty affects over 37 million individuals in the U.S., subjecting them to syndemics – clustered, mutually enhancing epidemics such as obesity, diabetes, and depression that arise from and perpetuate socioeconomic inequality. Syndemic theory underscores a pathway to mitigate syndemics by intervening on a single target within the cluster. Obesity’s high prevalence in poverty; role in increasing leading causes of death (e.g., cardiovascular disease, cancer, dementia); and adverse psychosocial effects (e.g., increased depression) make it a crucial, high priority target. While structural and social factors contribute to obesity in poverty, research shows the effectiveness of individual-level interventions in improving health behaviors and weight when highly responsive to overburdened populations’ needs. At the same time, evidence guiding refinement of interventions is sparse as participants with socioeconomic disadvantage are underrepresented in obesity treatment research. Reflecting this phenomenon, Rx Weight Loss, a fully automated online obesity treatment, has seen limited use among patients with low income despite past work showing it can be delivered effectively through primary care at low cost. Since 72.8% of adults in poverty have a usual primary care provider, and 83% have Internet access, this gap in adoption represents a significant opportunity for public health impact through adaptation of RxWL that increases relevance for traditionally underserved populations. Further, this research is poised to fill a critical gap in obesity treatment literature. Thus, this application aims to revise RxWL content and the process by which primary care providers refer patients to the program (referenced collectively as the “RxWL package”) to maximize responsiveness, reach, and effectiveness for those in poverty. Using mixed methods data collection, this project structures research activities using the Social Marketing Assessment and Response Tool (SMART) and examines implementation outcomes identified by the Consolidated Framework for Implementation Research (CFIR). Primary care provider (n = 23) and patient (n = 16) stakeholders will provide feedback on the existing RxWL package (Aim 1); insights and scientific knowledge will be integrated to produce a low-cost RxWL package prototype (i.e., a PDF with embedded links approximating the intended program) for usability testing (n = 8 providers, 10 patients; Aim 2); and data will drive development of a finalized RxWL package to disseminate through primary care and evaluate in an open trial (n = 12 providers, 32 patients; Aim 3). Aim 3 will examine both implementation and preliminary clinical outcomes, including effects on weight loss and syndemic sequelae; obtain insights for further refinement; and indicate readiness for a larger R- funded clinical trial. Revising RxWL holds high potential to reduce health disparities for those from socioeconomically disadvantaged backgrounds. Moreover, findings will make significant contributions to the literature on recruitment and retention of patients in poverty in obesity treatment research; adaptation of obesity treatment to fit the unique needs of traditionally underserved populations; and impact of social determinants of health on the course of obesity treatment.

项目摘要 贫困影响美国超过3700万人，使他们受到联合系统的影响 - 聚集，相互增强 肥胖症，糖尿病和抑郁症等流行病是由社会经济不平等永久存在的。集团 理论强调了通过介入群集中的单个目标来减轻Syndemics的途径。肥胖很高 贫困的患病率；在增加主要因素死亡原因（例如心血管疾病，癌症，痴呆症）中的作用；和 不利的社会心理影响（例如抑郁症增加）使其成为至关重要的高优先级目标。而结构和社会 因素导致贫困的肥胖症，研究表明了个人水平干预措施改善的有效性 健康行为和体重对人口过高的需求高度响应时。同时，证据 指导干预措施的改进很少 肥胖治疗研究。反映这一现象，Rx减肥，一种完全自动化的在线肥胖治疗 在低收入的患者中，有限的使用量有限，过去的工作表明可以有效地通过 低成本的初级保健。由于有72.8％的贫困成年人拥有通常的初级保健提供者，而83％的成年人有互联网 访问，这种采用差距是通过适应RXWL的重大机会影响公共卫生的重要机会 增加了与传统服务不足的人群的相关性。此外，这项研究被中毒以填补关键的空白 肥胖治疗文献。这是该应用程序旨在修改RXWL内容和初级保健的过程 提供者将患者推荐给该计划（共同引用为“ RXWL软件包”），以最大化响应能力， 贫困者的覆盖范围和有效性。使用混合方法数据收集，该项目结构研究 使用社会营销评估和响应工具（SMART）的活动并检查实施成果 由实施研究的合并框架（CFIR）确定。初级保健提供者（n = 23）和 患者（n = 16）利益相关者将对现有的RXWL软件包（AIM 1）提供反馈；见解和科学 知识将集成以产生低成本的RXWL软件包原型（即具有嵌入式链接的PDF 近似预期计划）进行可用性测试（n = 8个提供者，10名患者； AIM 2）；数据将驱动 开发最终确定的RXWL软件包，以通过初级保健传播并在开放试验中进行评估（n = 12 提供者，32例患者；目标3）。 AIM 3将检查实施和初步临床结果，包括 对体重减轻和联合后遗症的影响；获得进一步完善的见解；并指示较大的R-准备就绪 资助的临床试验。修订RXWL具有降低社会经济患者健康差异的巨大潜力 不利的背景。此外，调查结果将为招聘文献做出重大贡献 保留肥胖治疗研究中贫困患者的患者；适应肥胖治疗以满足独特需求 传统上服务不足的人群；社会决定者的健康对肥胖治疗过程的影响。