Translating Behavioral Interventions for Health Disparity Populations

在19财年，我们发表了关于两个随机对照试验和两个可行性研究的手稿，这些研究测试了在种族/民族多样化的社区环境中的行为干预。这些出版物和发现将在下面进行描述。 在19财年，我们完成了新阿曼瑟-II(A New Dawn-II)RCT研究的数据收集，在该研究中，我们测试了一种针对农村西班牙语乳腺癌幸存者的压力管理干预措施。在这项研究中，我们应用了一种称为转化框架的社区参与翻译模型来开发改编计划(NA-II)，设计了一项针对社区环境的随机对照试验，确定了招聘者和干预者，并实施了试验。干预者接受的是拉丁裔乳腺癌幸存者的培训。社区倡导者招募并招募了患有非转移性乳腺癌的农村讲西班牙语的拉丁裔人。在接触的231名妇女中，24%的人拒绝，10%的人不合格，153人(66%)被随机分配到干预或等待名单对照组。91%的人是在外国出生的，48%的人报告在过去一年里遇到了经济困难。基线平均得分(SD；可能范围)为：FACT-B总分，73.7(15.1；0-108)；情感幸福感，14.4(4.3；0-20)；功能幸福感，11.0(2.9；0-16)；社会/家庭幸福感，13.6(4.1；0-20)；身体幸福感17.4(5.3；0-24)；乳腺癌关注17.4(4.7；0-28)；焦虑，0.70(0.76；躯体化得分为0.70(0.64；0-4)；抑郁得分为6.7(5.3；0-24)；感知压力得分为15.7(7.3；0-40)。基线结果水平表明，还有改进的空间。正在修订和重新提交一份关于区域合作研究的改编和设计的手稿。另一份报告试验结果的论文正在编写中。我们访问了研究社区网站，以传播结果。我们完成了新安曼赛尔项目的干预手册和实施指南的最终审查。项目网站的最后准备工作正在进行中。方案材料将张贴在项目网站上，供公众查阅，以便更广泛地传播。 我们发表了一篇手稿，报道了一项整群随机对照试验的结果，该试验涉及年龄在60岁及以上的不同成年人(n=390)，他们在12个政府支持的老年中心登记。老年中心被随机分配为立即开始合唱团(干预组)或等待6个月开始合唱团(对照组)。社区之声是一个由专业音乐指挥家在老年中心举办的文化定制合唱团节目，反映了参与的三个组成部分(认知、身体和心理)。与对照组相比，干预组成员在孤独感(p=0.02；标准化效应大小ES=0.34)和生活兴趣(p=0.008，ES=0.39)方面有显著改善。研究结果支持社区合唱团的采用，以减少不同老年人的孤独感，提高他们对生活的兴趣。 在19财年，我们发表了一份手稿，报告了一项研究的结果，该研究测试了一项手机应用程序和电话指导生存护理计划计划(SCPP)的可行性，该计划对23名讲西班牙语的拉丁裔乳腺癌幸存者进行了测试。与基线相比，干预后的疲劳(B=.26；P=.02；Cohen d=0.4)和健康苦恼程度(B=.36；P=.01；Cohen d=0.3)显著降低，对推荐的后续护理和资源的知识(B=.41；P=.03；Cohen d=0.5)和情绪幸福感显著改善(B=1.42；P=0.02；Cohen d=0.3)；管理癌症随访护理的自我效能没有改变。日均步数从6157步增加到7469步(B=1311.8；P=0.02；Cohen d=0.5)。我们发现了计划可行性、可接受性和有效性的初步证据，两个月后疲劳、健康困扰和情绪健康显著改善，对推荐的后续护理和平均每日步数的了解增加。定制的移动电话和健康指导SCPP可以帮助确保公平获得这些服务，并改善讲西班牙语的拉丁裔乳腺癌幸存者的症状和体力活动水平。 在19财年，我们公布了另一项可行性研究的结果，在该研究中，我们测试了一项为期8周的压力管理干预措施，以预防说西班牙语的拉美裔移民中的抑郁症。干预是由社区环境中10名训练有素的推动者(社区卫生工作者)进行的。10名推广者在培训(P&lt；0.001)后显著提高了他们的知识，并提供了表现出极高保真度的程序。接受该计划的参与者(n=50)在移民压力、感觉到的压力和抑郁症状方面的得分有显著改善(p&lt；0.001)。对拉丁裔推销员进行培训是可行的，以便为他们所在社区的低收入拉丁裔移民提供有效的压力管理计划。结果有助于越来越多的文献研究此类干预措施在社区环境中的价值。 NIMHD DIR学士后研究员克里斯蒂安·埃斯卡雷拉发表了一篇手稿，证明有形和深情的支持对讲西班牙语的乳腺癌幸存者的焦虑症状具有保护作用，这些人对自己的疾病经历了侵入性的想法(冥想)。最后，我们在《美国公共卫生杂志》的NIMHD特刊上共同撰写了一篇手稿，提出了建立成功适应和公平实施减少健康差距的循证干预措施的科学所需的研究愿景和战略。

In FY19, we published manuscripts reporting on two RCTs and two feasibility studies testing behavioral interventions in racially/ethnically diverse community settings. These publications and findings are described next. In FY19, we completed data collection for the Nuevo Amancer-II (A New Dawn-II) RCT study in which we tested a stress management intervention for rural Spanish-speaking breast cancer survivors. In this study, we applied a community-engaged translational model called the Transcreation Framework to develop the adapted program (NA-II), design a randomized control trial for community settings, identify recruiters and interventionists, and implement the trial. Interventionists were trained Latina breast cancer survivors. Rural Spanish-speaking Latinas with non-metastatic breast cancer were recruited and enrolled by community advocates. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. Ninety-one percent were foreign born and 48% reported financial hardship in the past year. Baseline mean scores (SD; possible range) were: FACT-B total score, 73.7 (15.1; 0-108); emotional well-being, 14.4 (4.3; 0-20); functional well-being, 11.0 (2.9;0-16); social/family well-being, 13.6 (4.1; 0-20); physical well-being 17.4 (5.3; 0-24); breast cancer concerns 17.4 (4.7; 0-28); anxiety, 0.70 (0.76; 0-4); somatization, 0.70 (0.64; 0-4); depression, 6.7 (5.3;0-24); and perceived stress, 15.7 (7.3; 0-40). Baseline outcome levels suggest there is room for improvement. A manuscript reporting on the adaptation and design of the RCT is in revise and resubmit status. Another paper reporting on the results of the trial is in process. We visited the study community sites to disseminate the results. We completed the final review of the intervention manuals and implementation guide for the Nuevo Amancer program. Final preparation of a project website is in process. Program materials will be posted on the project website so that it is accessible to the public for wider dissemination. We published a manuscript reporting on findings from a cluster randomized controlled trial with diverse adults age 60 and older (n=390) who were enrolled at 12 Administration on Aging-supported senior centers. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size ES = 0.34 and interest in life (p = .008, ES = 0.39). Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. During FY19, we published a manuscript reporting on the results of a study testing the feasibility of a mobile phone app and telephone coaching survivorship care planning program (SCPP) among 23 Spanish-speaking Latina breast cancer survivors. Compared with baseline, postintervention fatigue (B=.26; P=.02; Cohen d=0.4) and health distress levels (B=.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. During FY19, we published the results of another feasibility study in which we tested an 8-week stress management intervention to prevent depression among Spanish-speaking Latino immigrants. The intervention was delivered by 10 trained promotores (community health workers) in community settings. Promotores (n=10) improved their knowledge significantly after the training (p<0.001) and delivered the program demonstrating excellent fidelity. Participants who received the program (n=50) had significantly improved scores on immigration stress, perceived stress, and depressive symptoms (p<0.001). It is feasible to train Latino promotores to deliver an effective stress management program to low-income Latino immigrants in their communities. Results contribute to a growing literature on the value of such interventions in community settings. Cristian Escalera, a NIMHD DIR post-baccalaureate fellow, published a manuscript that demonstrated that tangible and affectionate support have protective effects on anxiety symptoms among Spanish-speaking breast cancer survivors experiencing intrusive thoughts about their illness (rumination). Finally, we co-authored a manuscript in a NIMHD special issue of the American Journal of Public Health that presented a research vision and strategies needed to build the science of successful adaptation and equitable implementation of evidence-based interventions that reduce health disparities.