Promotora-Led Intervention to Promote Weight Loss in Latinas at-risk for Diabetes

描述（由申请人提供）：本K23提案的总体目标是培训Matthew J.奥布莱恩，医学博士，理学硕士，作为肥胖和糖尿病预防的独立研究者，特别关注拉丁美洲人-这些相关疾病的高风险人口群体。虽然已经尝试将循证糖尿病预防计划（DPP）转化为社区环境，但这些研究中很少包括拉丁美洲人。社区卫生工作者，或promotoras，是受过训练的外行人谁提供健康教育，并可以作为领导者的减肥和糖尿病预防工作在拉丁美洲。以前的研究已经证明，promotoras是一个有效的非专业卫生工作者，但没有发表的研究已经将这种干预模式应用于拉丁美洲的糖尿病预防。奥布莱恩博士计划通过开发一种由民进党告知的以促进者为主导的生活方式干预（PLI）来解决这一知识差距，以促进拉丁美洲人的减肥和降低心脏代谢风险。有3个阶段的拟议研究，将解决相应的具体目标：第一阶段使用焦点小组，以探讨周围的社会和文化背景下的体重相关的行为，在拉丁美洲的糖尿病风险，应用研究结果，以制定PLI;第二阶段涉及试点PLI在单臂试验，并评估其可行性和可接受性;第三阶段将在一项随机对照试验中测试PLI对改变高危拉丁美洲人体重和心脏代谢标志物的影响。 为了成功完成拟议的研究计划，奥布莱恩博士将通过正式的课程和结构化的指导在以下3个领域接受额外的培训：1）定性方法; 2）减肥和糖尿病预防的随机对照试验;和3）肥胖，糖尿病和代谢的基础。天普大学是国际公认的研究人员在每个研究领域，谁将担任博士奥布莱恩的导师。拟议研究的地点是由O 'Brien-Puentes de Salud博士（“健康之桥”）创立的社区健康中心-该中心为拉丁裔人口提供服务，自2007年以来一直是涉及目标人群的几项基于促进剂的研究的地点。 公共卫生相关性：拉丁美洲人患糖尿病的终生风险高于任何其他人口群体，因此，关注这一人群的糖尿病预防是公共卫生的优先事项。一项具有里程碑意义的研究表明，生活方式干预在促进减肥和预防糖尿病方面是有效的，目前正在努力在不同人群中复制这项研究的结果。这项拟议的研究将测试社区卫生工作者或促进者在提供类似的生活方式干预以促进拉丁美洲人减肥和降低心脏代谢风险方面的有效性。

DESCRIPTION (provided by applicant): The overall goal of this K23 proposal is to train Matthew J. O'Brien, MD, MSc for a career as an independent investigator in obesity and diabetes prevention, with a specific focus on Latinas-a demographic group at high risk for these related disorders. While there have been attempts to translate the evidence-based Diabetes Prevention Program (DPP) into community settings, very few of these studies have included Latinas. Community health workers, or promotoras, are trained lay people who provide health education, and could serve as leaders of weight loss and diabetes prevention efforts in Latinas. Previous research has demonstrated that promotoras are an effective lay health workforce, but no published studies have applied this intervention model to diabetes prevention in Latinas. Dr. O'Brien plans to address this gap in knowledge by developing a promotora-led lifestyle intervention (PLI), informed by the DPP, to promote weight loss and reduce cardiometabolic risk in Latinas. There are 3 Phases to the proposed research that will address corresponding specific aims: Phase 1 uses focus groups to explore the social and cultural context surrounding weight-related behaviors in Latinas at-risk for diabetes, applying the findings to develop PLI; Phase 2 involves piloting PLI in a single-arm trial, and assessing its feasibility and acceptabilit; Phase 3 will test the effects of PLI on changing at-risk Latinas' weight and cardiometabolic markers in a randomized controlled trial. In order to successfully complete the proposed research plan, Dr. O'Brien will receive additional training through formal coursework and structured mentorship in the following 3 areas: 1) qualitative methods; 2) randomized controlled trials for weight loss and diabetes prevention; and 3) foundations in obesity, diabetes, and metabolism. Temple University is home to internationally-recognized researchers in each of these areas of study, who will serve as Dr. O'Brien's mentors. The site for the proposed research is a community health center founded by Dr. O'Brien-Puentes de Salud ("Bridges of Health")-which serves a Latino population and has been the site of several promotora-based studies involving the target population since 2007. PUBLIC HEALTH RELEVANCE: Latinas have a higher lifetime risk of developing diabetes than any other demographic group, and therefore, focusing on diabetes prevention in this population is a public health priority. A landmark study showed that lifestyle interventions are effective at promoting weight loss and preventing diabetes, and efforts are underway to replicate this study's findings in diverse populations. The proposed research will test the effectiveness of community health workers, or promotoras, in delivering a similar lifestyle intervention to promote weight loss and lower cardiometabolic risk in Latinas.