A Multilevel Physical Activity Intervention for South Asian Women and Girls

项目摘要 亚洲印度和巴基斯坦（南亚）移民有很高的身体不活动的患病率， 心脏代谢危险因素。南亚（SA）妇女和女孩由于融合而面临特别高的风险 移民、文化和性别因素决定了南非妇女和女孩一生中的健康风险。 我们基于社区的参与性研究发现，南非妇女（85%是第一代） 移民）经历：a）社会孤立和社会支持低，减少了身体活动（PA） 动机和自我效能; B）希望维护传统价值观和规范，这与当地PA冲突 环境（例如，（c）语言和环境障碍。在SA 女孩（大多数是第二代）进入青春期，他们描述：a）与文化适应有关的家庭冲突 因为运动被认为是一种“美国行为”; B）性别限制; c）缺乏榜样;以及 d）他们社区的共同疾病信念，即“如果你很瘦，你就不需要锻炼”。重要的是 社区还确定了增强南澳妇女和女孩权能的个人、人际和家庭过程 变得更加活跃，包括PA的整体益处，对儿童健康的期望，以及对儿童健康的感受。 与其他女性和家庭一起锻炼时，保持联系并感到快乐。根据一项试点研究， 的可行性及初步成效，建议的研究旨在测试 南亚人一起行动（SAATH）。为期16周的干预针对个人， 通过四个主要组成部分：1）母女团体锻炼班 二人组; 2）使用动机访谈的二人组母女PA咨询; 3）同伴讨论组， （3）家庭步行组。干预措施还通过与公园区合作， 公共卫生部门和社区组织，以改变当地的环境， 考虑到社会文化因素（例如，性别、家庭重点）和环境（例如，同性类）的期望 的SA。本研究的目的1是确定SAATH干预增加中度-剧烈运动的有效性。 PA在SA母女二人组使用随机等待列表对照研究设计。次要结局为： 二对儿的步行和久坐时间以及母亲的心脏代谢危险因素。目标2将评估 干预对个体（自我效能、自主支持、社会支持、动机）和二元结构的影响 （文化适应冲突、沟通、连通性）假设调解干预效果的因素 在PA。目标3是评价SAATH的执行情况和可持续性，包括环境和 跨部门合作伙伴为促进和维持南澳大利亚州妇女和女孩的公共行政而进行的制度改革。鉴于 SA人口的增长及其心脏代谢疾病风险的增加，确定干预措施， 在亚洲印度和巴基斯坦移民妇女中增加PA具有重要公共卫生意义。

Project Summary Asian Indian and Pakistani (South Asian) immigrants have a high prevalence of physical inactivity and cardiometabolic risk factors. South Asian (SA) women and girls are particularly at high risk due to a confluence of immigration, culture, and gender which shape the health risk of SA women and girls across the life course. Our community-based participatory research found that SA women (85% of whom were 1st generation immigrants) experienced: a) social isolation and low social support, which reduced physical activity (PA) motivation and self-efficacy; b) desire to maintain traditional values and norms, which conflicted with local PA environments (e.g., mixed-gender exercise classes); and c) linguistic and environmental barriers. When SA girls (majority 2nd generation) entered adolescence, they described: a) acculturation-related family conflict because exercise was perceived as an “American behavior”; b) gender constraints; c) lack of role models; and d) their community's shared illness belief that “if you are thin, you don't need to exercise.” Importantly, the community also identified individual, interpersonal, and familial processes that empowered SA women and girls to become more active, including holistic benefits of PA, aspirations for children's health, and feeling connected and happy when exercising with other women and family. Building on a pilot study demonstrating feasibility and preliminary efficacy, the proposed study aims to testing the efficacy and implementation of the South Asians Active Together (SAATH) intervention. The 16-week intervention targets individual, interpersonal, and family levels through four main components: 1) group exercise classes for mother-daughter dyads; 2) dyadic mother-daughter PA counseling using motivational interviewing; 3) peer discussion groups, and 3) family walking groups. The intervention also targets the environment level by working with park districts, a public health department, and community organizations to make changes to the local environment that take into account sociocultural (e.g., gender, family focus) and environmental (e.g., same sex classes) expectations of SA. Aim 1 of the study is to determine the efficacy of the SAATH intervention to increase moderate-vigorous PA in SA mother-daughter dyads using a randomized wait-list control study design. Secondary outcomes are: walking and sedentary time in dyads and cardiometabolic risk factors in mothers. Aim 2 will evaluate the impact of the intervention on individual (self-efficacy, autonomy support, social support, motivation) and dyadic (acculturation conflict, communication, connectedness) factors hypothesized to mediate the intervention effect on PA. Aim 3 is to evaluate implementation and sustainability of SAATH, including the environment and systems changes made by cross-sector partners to promote and sustain PA in SA women and girls. Given the growth of the SA population and their increased risk for cardiometabolic disease, identifying interventions that increase PA among Asian Indian and Pakistani immigrant women is of significant public health import.