Native American Youth Cardiovascular Disease Prevention: Implementation of Culturally-Tailored Evidence-Based After School and Home Visitation Programs for Healthy Eating and Physical Activity

项目概要-项目3 城市美洲原住民社区在心血管疾病方面存在显著和持续的差异。 疾病、肥胖症和糖尿病，以及它们可预防的行为前兆、饮食和体育活动。这 一项研究实施了两个多层次的循证干预（EBI），明尼苏达NET-Works和斯坦福大学 目标与六个美国印第安人的课后计划和社区服务组织合作， 明尼苏达州明尼阿波利斯、圣保罗和杜卢斯。采用和维护这些程序可以 通过有条理的、基于证据的参与性办法， 定制干预措施，以满足文化，组织背景和更广泛的社会经济背景， 结合当地创新。该提案准备通过以社区为基础的 参与式研究（CBPR）。联盟包括医疗保健提供者明尼阿波利斯美洲土著人 社区诊所（NACC，初级保健系统），明尼阿波利斯和圣保罗和杜卢斯明尼苏达学校 地区的印度教育课后计划（学校系统），社会服务提供者印度分部 工作家庭精神家访方案（社会服务提供者制度），公共卫生部门 和明尼苏达大学的研究人员。该联盟将使用基于证据的10个步骤， 成果（GTO）定制和执行方法，以提高执行的准确性、覆盖面和 接受，和可持续性之间的课后计划和社区服务组织。原生 美国组织领导和项目交付人员将接受量身定制的 EBI课程和有效的实施战略。实施战略的有效性将是 使用阶梯式楔形研究设计进行评估。本研究以社会生态学模型为多层次 干预框架，RE-AIM作为其实施过程评估测量框架。 执行成果包括组织领导支持、工作人员执行能力和 干预保真度（方案覆盖范围、干预内容、交付、接收和剂量）。重要的创新 拟议研究的一个方面是使用基于证据的实施战略， 方案和工作人员实施干预措施的能力，覆盖面广，参与度高， 通过与当地文化和背景保持一致来实现更高的忠诚度。建议的项目将使用经证实有效的 建立项目组织领导和项目交付人员的实施战略 执行能力，成功地使城市美洲原住民家庭参与基于优势的、文化上的、 促进青少年体育活动和健康饮食的基础计划。持续的项目参与 在城市美洲原住民家庭中，将促进健康饮食和体育活动行为， 降低这个负担沉重的社区未来心血管疾病的风险。

PROJECT SUMMARY – Project 3 Urban Native American communities experience significant and persistent disparities in cardiovascular diseases, obesity and diabetes, and their preventable behavioral precursors, diet and physical activity. This study implements two multi-level evidence-based interventions (EBIs) Minnesota NET-Works and Stanford GOALS in partnership with six American Indian after school programs and community-serving organizations in the Minneapolis, St Paul and Duluth Minnesota. Adoption and maintenance of these programs can be enhanced and effectiveness strengthened through a structured, evidence-based participatory approach that tailors the interventions to meet the cultural, organizational contextual, and broader socioeconomic context and incorporates local innovations. This proposal is poised to achieve these goals through a community-based participatory research (CBPR).Coalition including the healthcare provider Minneapolis Native American Community Clinic (NACC, primary care system), Minneapolis and St Paul and Duluth Minnesota School Districts' Indian Education after school programs (school system), the social service provider Division of Indian Work's Family Spirit Home Visitation program (social service provider system), departments of public health and University of Minnesota researchers. The Coalition will use the evidence-based 10-step Getting to Outcomes (GTO) tailoring and implementation approach to enhance implementation fidelity, reach and acceptance, and sustainability among the after school programs and community-serving organizations. Native American organization leadership and program delivery staff will receive mentoring and training in the tailored EBI curricula and in effective implementation strategies. Implementation strategy effectiveness will be assessed using a stepped wedge study design. The study uses the Social Ecological Model as its multilevel intervention framework, and RE-AIM as its implementation process evaluation measurement framework. Implementation outcomes include organizational leadership support, staff implementation capacity, and intervention fidelity (program reach, intervention content, delivery, receipt and dose). An important innovative aspect of the proposed research is its use of evidence-based implementation strategies to strengthen the capacity of the programs and staff to implement the interventions with broad reach, high participation, and strong fidelity by aligning with local culture and context. The proposed project will use proven effective implementation strategies to build program organizational leadership and program delivery staff implementation capacity to successfully engage urban Native American families in strengths-based, culturally- grounded programs to promote youth physical activity and healthy eating. Sustained program engagement among urban Native American families will promote healthy eating and physical activity behaviors that will reduce future cardiovascular disease risk in this highly burdened community.