MOVE!+UP: Improving MOVE! for Veterans with PTSD Using Peer Support

描述(由申请人提供)： 背景：凯瑟琳·霍尔斯特博士，公共卫生硕士，弗吉尼亚州普吉特湾-西雅图分校(VAPS)心理学家，华盛顿大学(UW)精神病学和行为科学系代理助理教授。霍尔斯特博士致力于开展退伍军人研究，重点是改善患有创伤后应激障碍的退伍军人的健康和福祉。拟议的职业发展奖(CDA-2)将确保Hoerster博士发展必要的技能和专业知识，成为一名独立的卫生服务研究员，致力于改善对患有精神疾病的退伍军人的护理。职业发展计划：拟议的CDA-2专注于研究同伴主导的行为体重管理干预，以加强退伍军人管理局现有的体重管理计划(Move！)对于患有创伤后应激障碍的退伍军人：移动！+向上(提高移动！对于使用同伴支持的患有创伤后应激障碍的退伍军人)。Move！+Up将由付费同伴支持顾问在Move！的第一个月的4个小组会议中讲授，内容包括学习基本的焦虑管理技能和参与基于社区的体力活动以解决障碍(例如，高度警惕)。Move！+的小组结束后，将举行四次每两周一次的简短电话咨询会议，重点是保持成果和解决问题的障碍。之所以提出这种干预措施，是因为患有创伤后应激障碍的退伍军人经历了1)由于缺乏运动和不健康饮食而导致的高肥胖率和相关情况；2) 降低Move的有效性；以及3)身体活动和健康饮食的独特障碍。社会支持缓冲了患有创伤后应激障碍的退伍军人在身体活动和健康饮食方面的这些障碍，患有创伤后应激障碍的退伍军人强烈倾向于在这些问题上与同龄人合作。除了潜在的健康行为和减肥益处外，Move！+Up还有望解决创伤后应激障碍症状。拟议的CDA-2涉及两项研究，将评估Move！+Up的可接受性和可行性，并指导其改进：1)对28名患有创伤后应激障碍的肥胖退伍军人进行非受控试点试验和后续定性访谈；以及2)对12-16名退伍军人管理局提供者和关键利益相关者进行有目的的样本定性访谈。精细化的Move！+Up干预措施将在随机对照试验(RCT)中进行测试，以确定Move！+Up是否比通常护理的Move！+Up带来更好的减肥效果！在336名患有创伤后应激障碍的肥胖退伍军人中。Hoerster博士将在导师和顾问的指导下进行研究和培训，专家包括同伴支持和行为减肥干预(Karin Nelson，MD，MSHS)，健康行为干预RCT(Gayle Reiber，PhD，MPH)，特别是那些患有创伤后应激障碍的退伍军人(Miles McFall，PhD)，综合护理和实施科学(J？rgen un？tzer，MD，MPH，MA)，身体活动和饮食评估和干预(Brian Saelens，PhD)和定性(Helene Starks，PhD，MPH)和统计学(David Atkins博士，PhD)方法。导师和顾问位于VAPS或UW。Hoerster博士还将参与威斯康星大学的课程工作、地方和国家培训、国家合作以及其他学术和专业活动，以支持培训目标。CDA-2研究和培训计划将为推进Hoerster博士在以下领域的独立研究生涯提供必要的准备：1)促进身体活动和饮食的同行支持方法；2)针对有精神疾病的退伍军人的慢性病干预；3)行为干预的随机对照试验；以及4)行为干预的传播和实施。影响：CDA-2将加速Hoerster博士作为退伍军人健康服务调查员的独立性。霍尔斯特博士将专注于研究如何减轻患有精神疾病的退伍军人的不公平疾病负担，并利用这项研究来塑造退伍军人精神健康服务的提供。

DESCRIPTION (provided by applicant): Background: Katherine Hoerster, PhD, MPH is a staff psychologist with VA Puget Sound-Seattle (VAPS) and Acting Assistant Professor with the University of Washington (UW) Department of Psychiatry and Behavioral Sciences. Dr. Hoerster has demonstrated a commitment to conducting VA research focused on improving the health and well-being of Veterans with PTSD. The proposed career development award (CDA-2) will ensure that Dr. Hoerster will develop the skills and expertise necessary to become an independent health services researcher dedicated to improving care for Veterans with psychiatric illness. Career Development Plan: The proposed CDA-2 is focused on studying a peer-led behavioral weight management intervention that augments VA's existing weight management program (MOVE!) for Veterans with PTSD: MOVE!+UP (Improving MOVE! for Veterans with PTSD Using Peer Support). MOVE!+UP will be delivered by a paid peer support counselor in 4 group sessions in the first month of MOVE!, and will involve learning basic anxiety management skills and engaging in community-based physical activity to address barriers (e.g., hypervigilance). Four biweekly brief telephone counseling sessions will take place after MOVE!+UP's group ends and will focus on maintaining gains and problem-solving barriers. This intervention is proposed because Veterans with PTSD experience 1) high rates of obesity and related conditions due to inactivity and unhealthy diet; 2) reduced effectiveness of MOVE!; and 3) unique barriers to physical activity and healthy diet. Social support buffers these barriers to physical activity and healthy diet for Veterans with PTSD, and Veterans with PTSD endorse a strong preference for working with peers on these issues. In addition to the potential health behavior and weight loss benefits, MOVE!+UP is also expected to address PTSD symptoms. The proposed CDA-2 involves two studies that will assess MOVE!+UP's acceptability and feasibility and guide its refinement: 1) an uncontrolled pilot trial and follow-up qualitative interviews among 28 obese Veterans with PTSD; and 2) qualitative interviews with a purposive sample of 12-16 VA providers and key stakeholders. The refined MOVE!+UP intervention will be tested in a randomized controlled trial (RCT) to determine whether MOVE!+UP leads to better weight loss than usual care MOVE! among 336 obese Veterans with PTSD. Dr. Hoerster will conduct the research and training under mentors and consultants expert in peer support and behavioral weight loss interventions (Karin Nelson, MD, MSHS), health behavior intervention RCTs (Gayle Reiber, PhD, MPH) and specifically those for Veterans with PTSD (Miles McFall, PhD), integrated care and implementation science (J¿rgen Un¿tzer, MD, MPH, MA), physical activity and dietary assessment and intervention (Brian Saelens, PhD), and qualitative (Helene Starks, PhD, MPH) and statistical (Dr. David Atkins, PhD) methods. Mentors and consultants are located at VAPS or UW. Dr. Hoerster will also participate in UW coursework, local and national trainings, national collaborations, and other academic and professional activities to support training goals. The CDA-2 research and training plan will provide essential preparation to advance Dr. Hoerster's independent research career in the following areas: 1) peer support approaches to promoting physical activity and diet; 2) interventions to address chronic disease in Veterans with psychiatric conditions; 3) RCTs for behavioral interventions; and 4) dissemination and implementation of behavioral interventions. Impact: This CDA-2 will accelerate Dr. Hoerster's independence as a VA health services investigator. Dr. Hoerster will focus on studying ways to reduce inequitable disease burden for Veterans with psychiatric conditions and use this research to shape VA mental health services delivery.