Adapting Online Obesity Treatment for Primary Care Patients in Poverty

项目摘要 在美国，贫困影响着3700多万人，使他们受到综合症的影响-成簇的，相互促进的 肥胖症、糖尿病和抑郁症等流行病是由社会经济不平等引起的，并使之永久化。Syndemic 该理论强调了通过干预集群中的单个目标来减轻综合征的途径。肥胖率很高 贫穷的普遍程度;在增加主要死亡原因方面的作用（例如，心血管疾病、癌症、痴呆）;以及 不利的心理社会影响（例如，抑郁症增加）使其成为一个重要的，高优先级的目标。虽然结构和社会 因素导致贫困中的肥胖，研究表明，个人层面的干预措施在改善 健康行为和体重对负担过重人群的需求高度敏感。同时，证据 由于社会经济地位不利的参与者人数不足， 肥胖治疗研究。反映这一现象，Rx减肥，一个完全自动化的在线肥胖治疗， 尽管过去的工作表明它可以通过以下方式有效地提供，但在低收入患者中的使用有限 低成本的初级保健。由于72.8%的贫困成年人有普通的初级保健提供者，83%的人有互联网 普及方面的这一差距代表了通过调整RxWL来影响公共卫生的重要机会， 增加了对传统上得不到充分服务的人口的相关性。此外，这项研究有望填补一个关键的空白， 肥胖治疗文献因此，本申请旨在修订RxWL内容和初级保健 提供者将患者推荐给该计划（统称为“RxWL包”）以最大限度地提高响应性， 对贫困人口的影响和有效性。本项目采用混合方法进行数据采集， 使用社会营销评估和应对工具（SMART）开展活动，并审查实施成果 实施研究综合框架（CFIR）。初级保健提供者（n = 23）和 患者（n = 16）利益相关者将提供对现有RxWL包的反馈（目标1）;见解和科学 知识将被集成以产生低成本RxWL封装原型（即，带有嵌入式链接的PDF 近似预期程序）进行可用性测试（n = 8名提供者，10名患者;目标2）;数据将驱动 开发最终的RxWL包，通过初级保健进行传播，并在开放试验中进行评价（n = 12 供应商，32例患者;目标3）。目标3将检查实施和初步临床结果，包括 对减肥和综合征后遗症的影响;获得进一步改进的见解;并表示准备进行更大的R- 资助的临床试验修订RxWL具有很大的潜力，可以减少来自社会经济领域的人的健康差距 弱势背景。此外，研究结果将对招募和 肥胖症治疗研究中贫困患者的保留;适应肥胖症治疗以满足 传统上得不到充分服务的人群;以及健康的社会决定因素对肥胖治疗过程的影响。

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.