Improving Health Habits: Self-Care Priorities

描述(申请人提供)：在低收入的少数群体中，糟糕的饮食和缺乏体力活动与超重/肥胖和癌症等慢性病的风险更高有关。为这些低收入人口提供服务的安全网诊所是让贫困人口参与健康促进的一个尚未开发的机会。很少有研究探讨使用简短的医生建议和基于临床的多层次干预措施来改善不良饮食习惯、增加体力活动或减少低收入人群中久坐不动的生活方式的可行性，这些低收入人群通常构成洛杉矶市区这些社区卫生中心的患者群体。这一探索性项目建议通过引入和试点多层次的、以患者为导向的、改变生活方式的健康促进计划(MPLC-HPP)来解决这一科学差距，以解决由洛杉矶县威尼斯家庭诊所(VFC)健康中心系统的公共部门诊所提供服务的低收入、未参保患者群体(主要是拉丁裔)的不良饮食习惯和缺乏体育活动的问题。该计划将包括开发1)简单易用的患者健康行为优先评估(PHBPA)工具，旨在评估患者对行为改变的优先顺序；2)医生通过激励性访谈(每次访问2分钟)提供简短健康建议的标准协议；3)分发患者使用的自助辅助工具的协议(例如计步器、运动视频)；以及4)由健康教育人员举办的一系列八次后续电话咨询会议，以帮助患者解决随着时间的推移他们改变生活方式的优先顺序。我们将在两个VFC诊所对100例患者进行MPLC-HPP的单盲、假对照试验(MPLC-HPP中50例，假对照中50例)。我们将使用量化结果指标，包括氧化应激和全身炎症的常见生物标记物(即血浆胡萝卜素和高敏感性C反应蛋白水平)，以及经过心理测量的营养和身体健康自我报告指标，以准确评估研究参与者在12个月的观察期内饮食和体力活动的变化幅度。将评估将MPLC-HPP整合到公共部门卫生诊所环境中的可行性，这是本项目的主要目标。这一结果将为计划一项更大、更雄心勃勃的后续研究提供参考，该研究涉及多个诊所。

DESCRIPTION (provided by applicant): Poor diet and physical inactivity among low-income, minority populations have been linked to greater risk of chronic disease conditions such as overweight/obesity and cancer. Safety net clinics that serve these low- income populations represent an untapped opportunity to involve impoverished individuals in health promotion. Few studies have examined the feasibility of using brief physician advice and multi-level, clinic- based interventions to improve poor dietary habits, increase physical activity, or reduce sedentary lifestyles among culturally diverse, low-income populations that typically comprise the patient population of these community health centers in Los Angeles urban areas. This exploratory project proposes to address this scientific gap by introducing and piloting a Multi-level, Patient-directed, Lifestyle Change, Health Promotion Program (MPLC-HPP) to address poor dietary habits and physical inactivity among low income, uninsured patient populations (primarily Latinos) served by the public sector clinics of the Venice Family Clinic (VFC) health center system in Los Angeles County. The program will include the development of 1) a simple-to- use Patient Health Behavior Priority Assessment (PHBPA) tool designed to assess patient priorities for behavior change; 2) a standard protocol for physicians to provide brief health advice using motivational interviewing (< 2 minutes per visit); 3) a protocol for distributing self-help aids for patient use (e.g., pedometer, exercise videos); and 4) a series of eight follow-up telephone counseling sessions by health educators to help patients address their lifestyle change priorities over time. We will conduct a single- blinded, sham-controlled pilot of the MPLC-HPP in 100 patient cases at two VFC clinics (n=50 in MPLC- HPP; n=50 in sham control). We will use quantitative outcome measures, including common biomarkers of oxidative stress and systemic inflammation (i.e., plasma carotenoids and high-sensitivity C-reactive protein levels) and psychometrically-tested self-report measures of nutrition and physical fitness, to accurately assess the magnitude of changes in diet and physical activity among study participants over a 12-month observation period. The feasibility of integrating the MPLC-HPP into the public sector health clinic setting will be evaluated, and is the primary aim of this project. The results will inform efforts to plan a larger, more ambitious successor study involving multiple clinics.