Testing scalable, IVR-supported cancer prevention interventions in the rural Alabama Black Belt

有规律的体力活动(PA)可以降低患多种癌症(乳腺癌、结肠癌、子宫内膜癌)的风险。 。然而，大多数 美国人不活跃，特别是在南方腹地。癌症发病率/死亡率也普遍较高 这一地区，服务不足的(农村、非裔美国人)人口报告的PA更少，比例不成比例 癌症负担。与文化、离PA设施的距离、收入、识字率和互联网连接有关的因素 在南方腹地，可能会限制对PA信息/资源的获取，并导致现有的癌症差异。 电话支持的干预措施在增加PA方面取得了成功，不需要去诊所就诊，识字， 或昂贵的技术，因此可能代表着一个有希望的战略，以促进PA降低癌症风险 南方腹地，尤其是在使用交互式语音应答(IVR)系统实现自动化以降低成本时- 有效性和可及性。因此，我们调整了现有的IVR系统，用于过去的艾滋病毒研究，以推广PA 以及通过广泛的文献回顾和形成性研究在南方腹地预防癌症[11焦点 与深南癌症控制社区健康网络合作的PA干预需求/偏好小组 顾问(乍得)和社区成员]。由此产生的深南IVR支持的Active的试点试验 生活方式(拨号)干预！(R03CA177538)在12周时发现高保留率和参与者满意度。 此外，从基线到12周，Dial的MVPA增加幅度更大(每周增加42.5分钟)。 等待名单控制，以及PA自律和社会支持方面的显著改善。结果 加强知情干预，为扩大规模并在农村县推广做准备 (使用IVR发起的呼叫和腕带以促进遵守；进一步瞄准未改变的社会认知 理论构建；纳入更多人际、社区/组织和政策层面的战略 加强鼓励和问责，评估和解决建筑环境问题)。 目前的研究将包括一项经过改进的、多水平的12个月的完全有效的随机对照试验 等待名单控制条件下的拨号干预(N=240名农村人，主要是非洲裔美国成年人)。招聘 将由深南癌症控制网络在黑带县领导(参与项目自 初步形成性研究)。主要目标包括检查手臂在中等强度或强度变化中的差异 从基线到6个月和12个月有更多的有氧体力活动。探索性目标包括检查 干预对体能和心理社会变量的影响；12-12岁以后体力活动的变化 18个月；干预费用；潜在调解人(来自家人、朋友、乍得人的社会支持)和主持人 治疗效果(社区/环境特征)；以及广泛传播的潜在障碍/促进者 深南癌症防治网络在农村黑带县实施拨号干预。 好了！

Regular physical activity (PA) is linked to lower risk for several cancers (breast, colon, endometrial) . Yet, most Americans are inactive, particularly in the Deep South. Cancer incidence/mortality is also generally higher in this region, with underserved (rural, African American) populations reporting even less PA and disproportionate cancer burden. Factors related to culture, distance from PA facilities, income, literacy, and Internet connectivity in the Deep South may limit access to PA information/resources and contribute to existing cancer disparities. Telephone-supported interventions have shown success in increasing PA, do not require clinic visits, literacy, or costly technology, and thus may represent a promising strategy for promoting PA for cancer risk reduction in the Deep South, especially when automated with Interactive Voice Response (IVR) systems for improved cost- effectiveness and reach. Thus, we adapted an existing IVR system, used in past HIV studies, for PA promotion and cancer prevention in the Deep South through extensive literature review and formative research [11 focus groups on PA intervention needs/preferences with Deep South Network For Cancer Control community health advisors (CHAs) and community members]. A pilot trial of the resulting Deep south IVR-supported Active Lifestyle (DIAL) intervention!(R03CA177538) found high retention and participant satisfaction at 12 weeks. Moreover, DIAL produced larger increases in MVPA (42.5 more min/week) from baseline to 12 weeks than a waitlist control, along with significantly greater improvements in PA self-regulation and social support. Results have informed intervention enhancements in preparation for scale up and dissemination in rural counties (using IVR-initiated calls and wristbands to facilitate adherence; further targeting unchanged Social Cognitive Theory constructs; incorporating more interpersonal, community/organizational and policy level strategies for increased encouragement and accountability and to assess and address built environment). The current study will involve a fully powered randomized controlled trial of the refined, multi-level 12 month DIAL intervention with a waitlist control condition (N=240 rural, mostly African American adults). Recruitment will be led by Deep South Network for Cancer Control CHAs in Black Belt counties (involved in project since initial formative research). Primary aims include examining arm differences in changes in moderate intensity or greater aerobic physical activity from baseline to 6 and 12 months. Exploratory aims include examining intervention effects on physical performance and psychosocial variables; changes in physical activity from 12- 18 months; intervention costs; potential mediators (social support from family, friends, CHAs) and moderators of treatment efficacy (neighborhood/ environmental features); and potential barriers/facilitators to widespread implementation of DIAL intervention in rural Black belt counties by Deep South Network for Cancer Control. !