Weight management in rural health clinics

 描述（由申请人提供）：对于超重或肥胖的个人来说，体重减轻和维持仍然是个问题。减肥可以改善代谢综合征的慢性危险因素;然而，已被证明有效的体重管理计划很少被转化为医疗保健社区。特别是，那些生活在农村地区的人可能无法获得城市居民所能获得的资源。我们有一个成功的体重管理计划，称为“堪萨斯大学体重管理计划”（KWMP），自1986年以来一直在进行。KWMP以社会认知理论为基础，并在6个月内持续为各种各样的人提供> 10%的体重减轻。我们最近为KWMP开发了一个基于电话的交付系统，通过取代面对面诊所（GP）的小组会议电话，并直接向参与者提供减肥材料和产品，消除了提供者和参与者的许多障碍。以这种方式，健康教育者和参与者可以居住在任何位置，并接收传统上在诊所提供的相同信息。我们还开发并测试了一种通过电话单独提供的KWMP的强度较低的版本，称为IP，其涉及健康教育者和参与者之间的较少接触，但也导致临床显著的体重减轻（即，> 7%）。我们建议通过培训农村卫生保健提供者来翻译我们的大学计划，为超重和肥胖的个人提供GP，IP和增强版的常规护理（EUC）。这种设计将使我们能够确定梯度护理对体重管理的有效性，包括成本效益和农村医疗保健提供者提供的代谢综合征风险因素的改善。超重和肥胖成人将随机分配至GP、IP或EUC组，持续24个月。6个月的试验体重减轻，12个月体重维持）和6个月。没有后续联系。具体而言，我们预计GP提供的体重减轻显著大于IP，IP提供的体重减轻显著大于 6个月时的EUC。次要目的包括12个月、18个月和24个月时的体重变化、成本效益分析、慢性疾病风险因素的变化（即，代谢综合征），以及采用干预成分与体重减轻和维持幅度之间的关联。广泛的过程分析将记录农村卫生保健提供者提供的干预措施的保真度，有效实施的挑战和障碍，以及计划指定活动的使用。如果电话干预措施成功实施，农村诊所将有一个或多个新的证据和基于成本的选择来改善农村地区居民的体重管理。

 DESCRIPTION (provided by applicant): Weight loss and maintenance continues to be problematic for individuals who are overweight or obese. It is established that weight loss improves chronic risk factors for metabolic syndrome; however, weight management programs that have been proven efficacious are seldom translated into the health care community. In particular, those who live in rural locations may not have access to the resources available to their urban counterparts. We have a successful weight management program termed "University of Kansas Weight Management Program," (KWMP) that has been ongoing since 1986. KWMP is grounded in social cognitive theory and has consistently provided >10 percent weight loss at 6 months in a wide array of individuals. We have recently developed a phone based delivery system for KWMP that eliminates many barriers for providers and participants by substituting group conference calls for face-to-face clinics (GP) and by delivering weight loss materials and products directly to the participant. In this fashion, the health educator and participants can reside in any location and receive the same information that has traditionally been delivered in the clinic. We have also developed and tested a less intensive version of KWMP delivered individually by phone termed IP that involves less contact between health educator and participant but also results in clinically significant weight loss (i.e.,>7 percent). e propose to translate our university based program by training rural health care providers to deliver GP, IP, and an enhanced version of usual care (EUC) for individuals that are overweight and obese. This design will allow us to determine the effectiveness of gradients of care for weight management, including cost effectiveness and improvement in risk factors for metabolic syndrome when delivered by rural health care providers. Overweight and obese adults will be randomly assigned to GP, IP, or EUC for a 24 mo. trial of 6 mos. weight loss, 12 mos. weight maintenance) and 6 mos. no contact follow-up. Specifically, we expect GP to provide significantly greater weight loss than IP, and IP to provide significantly greater weight loss than EUC at 6 months. Secondary aims include weight change at 12, 18 and 24 months, cost effectiveness analysis, changes in chronic disease risk factors (i.e., metabolic syndrome), and associations between adoption of intervention components and magnitude of weight loss and maintenance. Extensive process analysis will document the fidelity of the interventions delivered by rural health care providers, challenges and barriers to effective implementation, and use of program specified activities. Should the phone interventions translate successfully; rural clinics will have one or more new evidence and cost based options to improve weight management for residents of rural areas.