Translating Behavioral Interventions for Health Disparity Populations

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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.