Dissemination of a Theory-Based Bone Health Program in Online Communities

在在线社区中传播基于理论的骨骼健康计划

• 批准号: 8266894
• 负责人: EUN-SHIM NAHM
• 金额: $ 49.03万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8266894
• 关键词: Academic Medical Centers; Activities of Daily Living; Address; Adoption; Adult; Advisory Committees; Age; Aging; American; Baltimore; Binding Sites; Bone Density; Bone Diseases; Calcium; Caring; Collaborations; Communities; Community Healthcare; Community Practice; Control Groups; Data Collection; Development Plans; Dimensions; Effectiveness; Electronics; Exercise; Exhibits; Fall prevention; Foundations; Fracture; Frequencies; Goals; Grant; Guidelines; Health; Health Promotion; Health Resources; Health Services Research; Health behavior; Health behavior change; Hip region structure; Home environment; Incidence; Individual; Intake; Internet; Intervention; Knowledge; Life; Linear Models; Long-Term Effects; Maintenance; Maryland; Measures; Methodology; Methods; Modeling; Modification; Nature; Osteoporosis; Outcome; Outcome Measure; Pain; Participant; Pharmacotherapy; Physical activity; Prevention strategy; Preventive; Primary Health Care; Provider; Public Health; Randomized Controlled Trials; Research; Resources; Safety; Schools; Screening procedure; Self Efficacy; Site; Smoking; Source; Target Populations; Testing; Time; Trust; United States; United States National Institutes of Health; University Hospitals; Use Effectiveness; Vitamin D; Woman; age related; base; bone health; calcium intake; cost; design; diet and exercise; disorder prevention; dissemination research; evidence base; expectation; experience; falls; follow-up; group intervention; high risk; improved; innovation; interest; literacy; member; men; nutrition; prevent; programs; rapid growth; social cognitive theory; statistics; theories; tool; usability; user-friendly

DESCRIPTION (provided by applicant): Bone health is a significant public health issue in the United States. An estimated 10 million Americans age 50 and older are living with osteoporosis, and approximately 50% of women and 25% of men over age 50 will experience an osteoporosis-related fracture in their remaining lifetime. Recent research advancements have produced effective measures to improve and maintain bone health, including exercise, diet, screening tests, pharmacotherapies, and fall prevention strategies. These findings, however, have not been fully incorporated into the daily lives of adults, and many are unaware of the magnitude of bone-health problems. Only 11-44% of adults at high risk for osteoporosis take calcium and vitamin D supplements, and one third of women over age 55 have not discussed bone health issues with their care providers. Greater efforts must be made to effectively disseminate evidence-based research findings to improve bone health behaviors of the public. The Internet, with its increasing popularity, can be an effective tool in this endeavor. Despite a great deal of available online health resources, there has been a lack of research investigating effective methods to package and deliver these resources to yield positive public health outcomes. Our prior R21 grant project showed some preliminary effectiveness of using a social cognitive theory (SCT)-based online health promotion intervention. Expanding upon our prior findings and using an innovative approach combining two models of the SCT and the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), in this proposal, we propose a large scale online study (N = 768) that will compare the long-term impact of two SCT-based online bone health interventions in adults age 50 and older targeting two large online communities (SeniorNet, MyHealtheVet). The two interventions are (1) an 8-week SCT-based Online Bone Health (TO-BoneHealth) program and (2) a 12-month TO-BoneHealth Plus program, including the TO-BoneHealth program followed by biweekly theory- based eNewsletters with follow-up of each individual's bone health behaviors ("booster" intervention) for 10 months. The interventions' impact will be assessed on the following dimensions of the modified RE-AIM framework: (a) Effectiveness (knowledge, selected bone health behaviors, fall incidence, initiation of a discussion about bone health with a primary care provider, eHealth literacy); (b) Reach (number of participants the program reached); (c) Implementation (program usage); and (d) Maintenance (participants' bone health behavior maintenance). The Effectiveness dimension will be assessed using a randomized controlled trial employing a 3-group design (2 intervention and 1 control groups) with repeated measures (baseline, 8 weeks, 6, 12, and 18 months). The primary analytic approach for the Effectiveness dimension will involve mixed linear models analyses. Other impact dimensions will be assessed using descriptive statistics. With the rapid growth of online communities, findings from this study will significantly contribute to current eHealth practice and research and serve as a dissemination model for other health promotion projects targeting online communities. PUBLIC HEALTH RELEVANCE: Bone health is a significant public health issue in the United States, with approximately 10 million Americans age 50 and older living with osteoporosis. Several effective measures have been found to improve and maintain bone health. Many individuals, however, are unaware of the significance of bone health problems and do not follow recommended guidelines for bone health behaviors. Maximizing the popularity of the Internet, this innovative study will examine the impact of two online motivational health promotion interventions on improving mature adults' bone health behaviors. With the rapid growth of active online communities, findings from the proposed study will significantly contribute to public health by advancing current face-to-face health promotion efforts to online settings serving as a model approach.

描述（由申请人提供）：骨骼健康是美国的一个重要公共卫生问题。据估计，50 岁及以上的美国人有 1000 万患有骨质疏松症，大约 50% 的 50 岁以上女性和 25% 的男性将在余生中经历与骨质疏松症相关的骨折。最近的研究进展产生了改善和维持骨骼健康的有效措施，包括运动、饮食、筛查测试、药物治疗和跌倒预防策略。然而，这些发现尚未完全融入成年人的日常生活中，许多人并没有意识到骨骼健康问题的严重性。只有 11-44% 的骨质疏松症高风险成年人服用钙和维生素 D 补充剂，而 55 岁以上的女性中有三分之一没有与护理人员讨论骨骼健康问题。必须做出更大努力，有效传播循证研究成果，以改善公众的骨骼健康行为。随着互联网的日益普及，它可以成为这一努力的有效工具。尽管有大量可用的在线卫生资源，但仍缺乏研究来调查打包和提供这些资源以产生积极的公共卫生成果的有效方法。我们之前的 R21 资助项目显示了使用基于社会认知理论 (SCT) 的在线健康促进干预的一些初步效果。在本提案中，扩展了我们之前的研究结果，并使用结合了 SCT 和 RE-AIM 框架（覆盖范围、有效性、采用、实施、维护）两种模型的创新方法，我们提出了一项大规模在线研究 (N = 768)，该研究将比较针对两个大型在线社区（SeniorNet、MyHealtheVet）的 50 岁及以上成年人的两种基于 SCT 的在线骨骼健康干预措施的长期影响。这两种干预措施是 (1) 为期 8 周的基于 SCT 的在线骨骼健康 (TO-BoneHealth) 计划和 (2) 为期 12 个月的 TO-BoneHealth Plus 计划，包括 TO-BoneHealth 计划，随后是每两周一次的基于理论的电子通讯，跟踪每个人的骨骼健康行为（“加强”干预），为期 10 个月。将根据修改后的 RE-AIM 框架的以下维度评估干预措施的影响： (a) 有效性（知识、选定的骨骼健康行为、跌倒发生率、与初级保健提供者发起关于骨骼健康的讨论、电子健康素养）； (b) 覆盖范围（方案覆盖的参与者人数）； (c) 实施（方案使用）； (d) 维持（参与者的骨骼健康行为维持）。有效性维度将使用随机对照试验进行评估，该试验采用 3 组设计（2 个干预组和 1 个对照组）并重复测量（基线、8 周、6、12 和 18 个月）。有效性维度的主要分析方法将涉及混合线性模型分析。其他影响维度将使用描述性统计进行评估。随着在线社区的快速发展，这项研究的结果将对当前的电子卫生实践和研究做出重大贡献，并作为其他针对在线社区的健康促进项目的传播模型。公共卫生相关性：骨骼健康是美国的一个重要公共卫生问题，大约有 1000 万 50 岁及以上的美国人患有骨质疏松症。已经发现了几种有效的措施来改善和维持骨骼健康。然而，许多人没有意识到骨骼健康问题的重要性，并且不遵循骨骼健康行为的推荐指南。这项创新研究将最大限度地利用互联网的普及，研究两种在线动机健康促进干预措施对改善成熟成年人骨骼健康行为的影响。随着活跃的在线社区的快速增长，拟议研究的结果将通过将当前面对面的健康促进工作推进到在线环境作为模型方法，从而对公共卫生做出重大贡献。

项目成果

Osteoporosis Preventive Practice Between Veteran and Nonveteran Older Adults: Findings From Patient-Reported Data.

• DOI: 10.1097/nor.0000000000000297
• 发表时间: 2016
• 期刊: Orthopedic nursing
• 作者: Nahm ES;Charters K;Yoo E;Keldsen LM;Zhu S
• 通讯作者: Zhu S

Testing reliability and validity of the eHealth Literacy Scale (eHEALS) for older adults recruited online.

• DOI: 10.1097/cin.0000000000000146
• 发表时间: 2015-04
• 期刊: Computers, informatics, nursing : CIN
• 作者: Chung SY;Nahm ES
• 通讯作者: Nahm ES

Reliability and validity of the revised Osteoporosis Knowledge Test.

修订后的骨质疏松症知识测试的可靠性和有效性。

• DOI: 10.1891/1061-3749.22.2.342
• 发表时间: 2014
• 期刊: Journal of nursing measurement
• 影响因子: 0.7
• 作者: Qi,Bing-Bing;Resnick,Barbara;Nahm,Eun-Shim
• 通讯作者: Nahm,Eun-Shim

Dissemination of a theory-based online bone health program: Two intervention approaches.

基于理论的在线骨骼健康计划的传播：两种干预方法。

• DOI: 10.1177/1460458213505573
• 发表时间: 2015
• 期刊: Health informatics journal
• 影响因子: 3
• 作者: Nahm,Eun-Shim;Resnick,Barbara;Bellantoni,Michele;Zhu,Shijun;Brown,Clayton;Brennan,PatriciaF;Charters,Kathleen;Brown,Jeanine;Rietschel,Matthew;Pinna,Joanne;An,Minjeong;Park,BuKyung;Plummer,Lisa
• 通讯作者: Plummer,Lisa