Improving Health Habits in Impoverished Populations

描述（由申请人提供）：低收入少数群体中的不良饮食、缺乏运动和久坐行为与慢性健康状况（如超重/肥胖、心血管疾病和2型糖尿病）的风险更大有关。为这些人群提供服务的低收入诊所往往是促进贫困人群健康的一个尚未利用的机会。很少有研究探讨了使用简短的医生建议和多层次的，基于诊所的干预措施，以改变不良的饮食习惯，缺乏身体活动，久坐不动的生活方式行为之间的这些文化多样性的人群，包括诊所人口的可行性。该探索性项目建议通过引入和试点自我护理刺激疾病预防计划（SCSDPP）来解决这一科学差距，以解决低收入、无保险患者人群（主要是拉丁裔）中不良饮食习惯、缺乏身体活动和久坐不动的生活方式行为，这些患者人群由洛杉矶县威尼斯家庭诊所（VFC）健康中心的社区诊所提供服务。该计划将包括开发1）简单易用的患者健康优先评估（HPA）工具，旨在评估患者对行为改变的偏好; 2）医生使用动机访谈（每次访问< 2分钟）提供简短健康建议的标准协议; 3）分发自助辅助工具供患者使用的协议（例如，步数计，运动视频）;和4）由非专业健康教育者（例如，推动者），以帮助患者解决他们的生活方式改变超时的优先事项。我们将在VFC卫生中心系统内的两个社区卫生诊所的大约100例患者中进行SCSDPP的随机对照试验。试点将利用精确的结果指标，包括普遍接受的生物标志物（例如，HbA 1c，空腹血糖）和心理测量学验证的过程和健康状况的措施，以准确评估患者在12个月的观察期内饮食和体力活动的变化幅度。将评估将SCSDPP纳入社区卫生诊所环境的可行性，这是该项目的主要目标。研究结果将为计划更大规模的后续研究提供信息。与公共卫生的相关性：这项研究评估了一项基于诊所的预防超重/肥胖的简短干预方案，超重/肥胖是一个与心脏病和糖尿病等慢性健康状况风险增加有关的公共卫生问题。

DESCRIPTION (provided by applicant): Poor diet, physical inactivity, and sedentary behaviors among low-income, minority populations have been linked to greater risk of chronic health conditions such as overweight/obesity, cardiovascular disease, and type 2 diabetes. Low-income clinics that serve these populations often represent an untapped opportunity for health promotion in impoverished individuals. Few studies have examined the feasibility of using brief physician advice and multi-level, clinic-based interventions to change poor dietary habits, physical inactivity, and sedentary lifestyle behaviors among these culturally diverse populations that comprise the clinic population. This exploratory project proposes to address this scientific gap by introducing and piloting a Self- Care Stimulating Disease Prevention Program (SCSDPP) to address poor dietary habits, physical inactivity, and sedentary lifestyle behaviors among low income, uninsured patient populations (primarily Latinos) served by the community clinics of the Venice Family Clinic (VFC) health center in Los Angeles County. The program will include the development of 1) a simple-to-use patient Health Priority Assessment (HPA) tool designed to assess patient preferences for behavior change; 2) a standard protocol for physicians to provide brief health advice using motivation 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 monthly follow-up counseling sessions by lay health educators (e.g., promoters) to help patients address their lifestyle change priorities overtime. We will conduct a randomized controlled pilot of the SCSDPP in approximately 100 patient cases at two community health clinics within the VFC health center system. The pilot will utilize precise outcome measures, including commonly-accepted biomarkers (e.g., HbA1c, fasting blood glucose) and psychometrically-validated measures of process and health status, to accurately assess the magnitude of changes in diet and physical activity among patients over a 12-month observation period. The feasibility of integrating the SCSDPP into the community health clinic setting will be evaluated, and is the primary aim of this project. The results will inform efforts to plan a larger, successor study. Relevance to Public Health: this study evaluates a clinic-based brief intervention protocol for preventing overweight/obesity, a public health problem that has been linked to greater risk of chronic health conditions such as heart disease and diabetes.