MICCO - Mobile Integrated Care for Childhood Obesity: A technology-enhanced comprehensive approach to integrating obesity care in rural communities

项目概要 在美国，近五分之一的儿童受到肥胖的影响，其中种族儿童的比例更高 社会经济地位低下、生活在农村社区的少数民族群体。肥胖是一个重要的 公共健康问题，因为它增加了儿童每个器官系统健康状况的风险，包括 糖尿病、心血管疾病和心理健康问题。传统的生活方式行为干预 在有色人种社区、低收入社区和农村实施时效果不佳 社区。以临床和社区整合框架为指导，强调整合 社区和医疗保健系统，以推动家庭参与和赋权治疗肥胖，我们的 工作证明了解决社会心理需求和利用技术来改善的重要性 关爱肥胖儿童的家庭。我们组建了一个研究团队，具有互补性和相关性 专业领域，完善和测试多成分干预措施，儿童移动综合护理 肥胖（MICCO）。 MICCO 结合了我们之前开发和测试的基于证据的方法 研究团队的每个项目都通过与电子健康记录集成的移动应用程序平台进行交付。 组成部分包括：(1) 协调社区的社会服务，以满足家庭的社会心理需求， (2) 利用远程医疗整合肥胖专家的护理，以及 (3) 提供基于媒体的心理教育 促进生活方式行为改变的自我管理工具。社区参与的定性研究 将采用方法将 MICCO 完善为以社区为中心和家庭友好型（目标 1）。精致的 干预措施将在一项随机对照试验中进行测试，该试验涉及 184 个 4-12 岁儿童家庭 肥胖，从农村初级保健实践中招募，以确定干预措施对儿童肥胖的影响 以及家庭在六个月内参与治疗的情况（目标 2），以及这些结果因种族、族裔、 和社会经济地位（目标 3）。这项研究将为第二年的 R01 申请提供信息，将概念扩展到 多地点 RCT 来测试 MICCO 综合的、以社区为中心的、技术状态的有效性 提高儿童肥胖治疗对家庭的影响力和相关性的最先进方法 服务不足的农村社区，增加对肥胖结果和不平等产生积极影响的可能性 在儿童健康方面。

PROJECT SUMMARY Nearly 1 in 5 children in the United States are affected by obesity, with even higher rates among children of racial and ethnic minority groups, of low socioeconomic status, and living in rural communities. Obesity is a significant public health concern because it increases a child’s risk for health conditions within every organ system, including diabetes, cardiovascular disease, and mental health problems. Traditional lifestyle behavior interventions have not been as effective when implemented in communities of color, low-income communities, and rural communities. Guided by the Clinical and Community Integration Framework, which emphasizes the integration of community and healthcare systems to drive family engagement and empowerment in treating obesity, our work has demonstrated the importance of addressing psychosocial needs and leveraging technology to improve care for families of children with obesity. We have assembled a research team, with complimentary and relevant areas of expertise, to refine and test a multi-component intervention, Mobile Integrated Care for Childhood Obesity (MICCO). MICCO combines evidence-based approaches previously developed and tested by our research team, each delivered through a mobile app platform integrated with the electronic health record. Components will include: (1) coordinating social services in the community to meet families’ psychosocial needs, (2) integrating care from obesity specialists using telehealth, and (3) providing media-based psychoeducational tools to promote self-management of lifestyle behavior change. Community-engaged and qualitative research methods will be employed to refine MICCO to be community-centered and family-friendly (Aim 1). The refined intervention will be tested in a randomized controlled trial with 184 families of children 4-12 years of age with obesity, recruited from rural primary care practices, to determine the impact of the intervention on child adiposity and family engagement in treatment over six months (Aim 2) and disparities in these outcomes by race, ethnicity, and socioeconomic status (Aim 3). This study will inform a R01 application in Year 2 to expand the concept to a multi-site RCT to test the effectiveness of MICCO’s integrated, community-centered, and technologically state- of-the-art approach in improving the reach and relevance of childhood obesity treatments to families in underserved rural communities, increasing the likelihood of a positive impact on obesity outcomes and inequities in child health.