iSIPsmarter: An RCT to evaluate the efficacy, reach, and engagement of a technology-based behavioral and health literacy intervention to reduce sugary beverages among rural Appalachian adults

iSIPsmarter：一项随机对照试验，旨在评估基于技术的行为和健康素养干预措施的功效、范围和参与度，以减少阿巴拉契亚农村成年人的含糖饮料

• 批准号: 10311110
• 负责人: Lee M Ritterband
• 金额: $ 68.53万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-22 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311110
• 关键词: Address; Adherence; Adoption; Adult; Appalachian Region; Behavior; Behavior Therapy; Behavioral; Beverages; Biological Markers; Body Weight decreased; Calories; Caring; Chronic; Community Services; Consumption; Coronary heart disease; Data; Dental caries; Development; Diabetes Mellitus; Diet; Effectiveness; Energy Intake; Evidence based intervention; Food; Fruit; Future; Geography; Goals; Health; Heart Diseases; Home; Hypertension; Intake; Internet; Intervention; Intervention Studies; Literature; Maintenance; Mediation; Mediator of activation protein; Medical; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Obesity associated cancer; Outcome; Participant; Patient Education; Pattern; Persons; Phase; Prevention program; Process; Provider; Public Health; Quality of life; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; Risk Factors; Rural; Rural Appalachia; Services; Source; Sports; Structure; System; Tea; Technology; Text Messaging; Time; Transportation; United States; Virginia; Voice; Weight; base; behavior change; behavioral health; cancer type; cost; design; diaries; dietary; digital; efficacy evaluation; efficacy outcomes; efficacy trial; evidence base; follow-up; health inequalities; health literacy; improved; mHealth; medically underserved; nutrition; post intervention; primary outcome; programs; response; rural area; screening; secondary outcome; soft drink; sugar; sweetened beverage; theories; web site; web-based intervention

Project Summary: Sugar-sweetened beverages (SSB, e.g., soda/pop, sweet tea, sports and energy drinks, fruit drinks) are the largest single food source of calories in the United States (US) diet and contributes approximately 7% of total daily energy intake for US adults. Among Appalachian adults, SSB intake is disproportionately high, averaging about 14% of total daily energy intake. There are strong and consistent data documenting relationships among high SSB consumption and numerous health issues such obesity, diabetes, some obesity-related cancers, coronary heart disease, hypertension, and dental decay. Further compounding the SSB problem, the Appalachian region lacks access to providers, medical services, and evidence-based behavioral prevention programs. There is also limited data on technology-based behavioral interventions in Appalachia. However, given recent progress in shrinking the digital divide, the timing is optimal to evaluate technology-based behavioral interventions in this region. The current proposal is designed to target this major SSB dietary risk factor and public health challenge, as well as address notable gaps in the rural e/m-Health literature. Importantly, this proposal builds on our team’s e/m-Health intervention expertise and decade of SSB behavioral intervention research in rural Appalachia. iSIPsmarter is a technology-based behavioral and health literacy intervention targeting SSB reduction and weight reduction/maintenance. It is comprised of six core Internet-delivered modules, an integrated short message service (SMS) strategy to engage users in tracking SSB behaviors, and a cellular enabled scale for in-home weight tracking. iSIPsmarter is a highly interactive, structured, and self-guided program that uses strategies previously proven to promote behavior change. iSIPsmarter also incorporates a stepped care approach to engage users who struggle to complete components of the intervention. The proposed RCT is guided by the RE-AIM framework and targets 244 adults from rural Appalachia. The overall goal is to examine the efficacy of iSIPsmarter in a 2 group [iSIPsmarter vs. static Patient Education (PE) website] by 4 assessment (Pre, 3-, 6- and 18-month follow-up) design. It is hypothesized that iSIPsmarter will be more efficacious at reducing SSB consumption than a PE website at post assessment. Changes in secondary outcomes (e.g. overall dietary quality, weight, quality of life) and maintenance of outcomes at 6- and 18-months post intervention will also be evaluated. Additional secondary aims include to examine reach and representativeness, patterns of user engagement, and cost. Two tertiary aims include exploratory mediation analyses and a systems-level, participatory process to understand context for future organizational-level adoption of iSIPsmarter, and specifically to explore factors that would promote or inhibit a sustainable SSB screening and referral process. The long-term goal of this line of this research is to sustain an effective, scalable, and high reach behavioral intervention to improve SSB behaviors and weight and to reduce SSB-related health inequities and chronic conditions in rural Appalachia and beyond.

项目概要：含糖饮料（SSB，例如，汽水/汽水、甜茶、运动和能量饮料， 水果饮料）是美国（US）饮食中最大的单一食物卡路里来源， 约占美国成年人每日总能量摄入的7%。在阿巴拉契亚成年人中，SSB摄入量是 不成比例地高，平均约占每日总能量摄入量的14%。有强有力和一致的数据 记录了高SSB消费与众多健康问题（如肥胖，糖尿病， 一些与肥胖有关的癌症、冠心病、高血压和蛀牙。进一步加剧 SSB的问题，阿巴拉契亚地区缺乏获得供应商，医疗服务，并以证据为基础 行为预防计划。关于基于技术的行为干预的数据也很有限， 阿巴拉契亚。然而，鉴于最近在缩小数字鸿沟方面取得的进展， 在这个地区进行基于技术的行为干预。目前的建议旨在针对这一主要 SSB饮食风险因素和公共卫生挑战，以及解决农村电子/移动卫生方面的显著差距 文学重要的是，这项提案建立在我们团队的电子/移动健康干预专业知识和十年的SSB基础上。 阿巴拉契亚农村的行为干预研究。iSIPsmarter是一个基于技术的行为和健康 针对减少SSB和减轻/维持体重的扫盲干预。它由六个核心组成 通过互联网提供的模块，一项使用户参与跟踪的综合短信服务战略 SSB行为，以及用于家庭体重跟踪的蜂窝功能秤。iSIPsmarter是一个高度互动， 一个结构化的、自我指导的计划，使用以前被证明可以促进行为改变的策略。 iSIPsmarter还采用了分步护理方法，以吸引那些难以完成 干预的组成部分。拟议的RCT以RE-AIM框架为指导，针对244名成年人 来自阿巴拉契亚的乡村总体目标是检查iSIPsmarter在2组中的疗效[iSIPsmarter vs. 静态患者教育（PE）网站]通过4项评估（术前、3个月、6个月和18个月随访）设计。是 假设iSIPsmarter在减少SSB消耗方面比PE网站更有效， 后评估。次要结局的变化（例如，总体饮食质量、体重、生活质量），以及 还将评估干预后6个月和18个月的结局维持情况。其他次要 目的包括检查覆盖范围和代表性、用户参与模式和成本。两个叔 目标包括探索性调解分析和系统层面的参与性过程，以了解背景 为未来组织级采用iSIPsmarter，特别是探索可以促进 或抑制可持续的SSB筛选和转介过程。这项研究的长期目标是 持续有效、可扩展和高范围的行为干预，以改善SSB行为和体重 并减少阿巴拉契亚及其他地区与SSB相关的健康不平等和慢性病。