Increasing Physical Activity in Rural Pennsylvanians: The PA Moves Trial

增加宾夕法尼亚州农村地区的体育活动：宾夕法尼亚州移动审判

• 批准号: 10733578
• 负责人: MACK T. RUFFIN
• 金额: $ 97.56万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733578
• 关键词: Address; Adult; Appointment; Behavioral; Breast; Chronic Disease; Clinic; Cohort Effect; Collaborations; Colon; Colorectal Cancer; Communities; Computerized Medical Record; Counseling; Diabetes Mellitus; Disparity; Education; Ensure; Environment; Exposure to; Faculty; Goals; Health; Health Benefit; Health Professional; Health system; Healthcare Systems; Incidence; Individual; Intervention; Learning; Location; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Malignant neoplasm of prostate; Methodology; Methods; Modeling; Obesity; Outcome; Overweight; Participant; Patients; Pennsylvania; Physical activity; Physical assessment; Physicians; Population; Positioning Attribute; Primary Care; Primary Health Care; Provider; Qualifying; RALA gene; Randomized; Recommendation; Reporting; Research; Resources; Risk; Risk Factors; Rural; Social Environment; Source; Specialist; Techniques; Technology; Telephone; Training; Trust; Work; built environment; cancer health disparity; cancer risk; digital intervention; fitness intervention; health communication; implementation evaluation; instrument; intervention cost; malignant breast neoplasm; moderate-to-vigorous physical activity; mortality; mortality disparity; physical inactivity; primary care clinic; primary care practice; primary care provider; programs; quitline; randomized trial; rural America; rural dwellers; rural setting; smoking cessation; social; success; urban disparity

Project Summary / Abstract A rural/urban disparity in mortality of 8% has been observed for lung, colorectal, prostate, breast, and cervical cancers. Physical inactivity is a modifiable cancer risk factor; physical activity (PA) is associated with risk reductions between 10-20% for breast, colon, and 6 other cancers. Further, rural residents report approximately 24% lower PA compared to urban residents. Primary care providers are a trusted source of health advice and they are in an ideal position to assess PA and advise patients regarding becoming and staying physically active. It is estimated that 84.3% of adults had an appointment with a primary health care professional in 2018. Thus, primary care encounters provide an opportunity to promote PA among the majority of rural adults, particularly among those with chronic disease profiles placing them at elevated cancer risk (e.g., overweight, obesity, diabetes). There is substantial evidence demonstrating the success of primary care providers promoting PA. Advice from providers is most effective in creating sustainable increases in PA when followed by phone or community-based support. The first challenge to implementing this type of approach in rural settings is the need for a methodology to train rural primary care providers to promote PA. We propose to apply the well validated ECHO Model to train providers toward the goal of communicating the health benefits of PA to patients, making clear recommendations, and connecting them to PA resources. Additional challenges to promoting PA in rural residents are provision of behavioral support and ensuring adequate opportunities for PA. These activities are beyond the scope of practice for primary care providers. We propose to partner with the Harrisburg YMCA to create a ‘MoveLine’ – logistically, the PA equivalent to the highly successful smoking cessation ‘QuitLine’. Providers will refer patients to the MoveLine, who will then counsel and connect patients to PA options available in their communities. Study staff and a community advisory board (CAB), in collaboration with the YMCA, Penn State Extension, and Penn State (PSU) faculty will work to identify existing PA options and to expand them as well. While intervening on the built environment is beyond the scope of this application, we acknowledge the import of environment on PA by rigorously evaluating its impact on outcomes. We propose a multi-level group randomized trial, including provider advice (patient), coaching and MoveLine (patient, social), and educating and promoting community PA opportunities and programs (community). We also evaluate the impact of the built environment on PA outcomes. We propose this work in collaboration with the Primary Health Network (8 Federally Qualified Health Clinics serving rural Pennsylvania), Penn State Health (8 clinics serving rural Pennsylvania), the Harrisburg YMCA, and Penn State Extension to increase PA levels in rural Pennsylvanians, toward the goal of reducing cancer risk. A total of 16 clinics will be randomized to the immediate or delayed treatment condition (2-3 providers nested within each clinic and 20 patients nested within each provider; 800 patients in total).

项目摘要/摘要 在肺癌、结直肠癌、前列腺癌、乳腺癌和宫颈癌的死亡率方面，城乡之间存在着8%的差异。 癌症。缺乏体力活动是一个可改变的癌症风险因素；体力活动(PA)与风险相关 乳腺癌、结肠癌和其他6种癌症的降幅在10-20%之间。此外，农村居民报告说 与城市居民相比，PA大约低24%。初级保健提供者是值得信赖的 健康建议，他们处于评估PA的理想位置，并建议患者有关成为和 保持身体活动。据估计，84.3%的成年人预约了初级卫生保健 2018年职业选手。因此，初级保健接触提供了在大多数人中推广PA的机会 农村成年人，特别是那些有慢性病史的人，他们患癌症的风险较高(例如， 超重、肥胖、糖尿病)。有大量证据表明初级保健是成功的 推广PA的供应商。在以下情况下，来自提供商的建议在创造PA的可持续增长方面是最有效的 然后是电话或基于社区的支持。实施这类方法的第一个挑战是 农村背景下需要一种方法来培训农村初级保健提供者，以促进PA。我们建议 将经过充分验证的ECHO模型应用于培训提供者，以实现以下目标： 向患者提供PA，提出明确的建议，并将他们与PA资源联系起来。面临的其他挑战 在农村居民中推广PA是提供行为支持和确保足够的机会 爸。这些活动超出了初级保健提供者的实践范围。我们建议与以下公司合作 哈里斯堡基督教青年会将打造一条‘Moveline’--在逻辑上，PA等同于非常成功的吸烟 停止‘Quitline’。提供者会将患者转介给Moveline，然后Moveline会为患者提供咨询并将其联系起来 到他们社区中可用的PA选项。研究人员和社区咨询委员会(CAB)，在 与基督教青年会、宾夕法尼亚州立大学分校和宾夕法尼亚州立大学(PSU)教职员工的合作将努力确定现有的 PA选项，并将其扩展。虽然对建筑环境的干预超出了这一范围 通过严格评估环境对结果的影响，我们承认环境对PA的影响。 我们提出了一项多水平的随机分组试验，包括提供者建议(患者)、指导和移动 (患者、社会)，以及教育和促进社区PA机会和计划(社区)。我们 还要评估建筑环境对PA结果的影响。我们建议这项工作是与 宾夕法尼亚州初级卫生网络(8家获得联邦资格的卫生诊所，服务于宾夕法尼亚州农村) Health(8家为宾夕法尼亚州农村提供服务的诊所)、哈里斯堡基督教青年会和宾夕法尼亚州立大学扩建项目，以增加PA 在宾夕法尼亚州农村的水平，朝着降低癌症风险的目标前进。共有16家诊所将被随机分配 立即或延迟治疗(每个诊所内嵌套2-3个提供者，嵌套20名患者 在每个提供者内；总共有800名患者)。