Using grassroots wellness coaching to enhance reach and sustainability of behavioral weight management

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ABSTRACT African American adults and adults from economically disadvantaged environments are at disproportionate risk for obesity yet are markedly underrepresented in traditional weight management trials and experience lower weight losses relative to their white and socioeconomically advantaged counterparts. Developing sustainable, community-based behavioral interventions to address the national obesity crisis is critical in order to mitigate the alarmingly poor health outcomes faced by underserved populations. Indeed, initiation and maintenance of healthy lifestyle behaviors presents unique challenges in underserved, economically disadvantaged communities, but traditional behavioral weight management delivery models largely disregard the social and cultural assets which exist within these community settings. Moreover, previously tested community-based interventions have not fully harnessed the potential of community members as agents of change within their social networks. Thus, the overall objective of this proposal is to test the feasibility, acceptability and preliminary effectiveness of a grassroots intervention delivery model which includes training community members to recruit and retain members of their social network and to deliver an evidence-based lifestyle intervention to reduce adiposity and improve cardiometabolic risk. The specific aims are: 1) to test the feasibility and acceptability of using house chats (home-based, peer-led focused discussions) as a model for intervention implementation in a real-world, community-based setting; and 2) to assess the preliminary effectiveness of the house chat intervention model for promoting change in behavioral (physical activity, diet) and physical (adiposity, fasting glucose, blood pressure) markers of cardiometabolic risk at post-treatment (12 weeks) and follow up (24 weeks); and 3) to systematically evaluate—using a mixed methods approach—the facilitators and barriers to sustainability of this model. The proposed pilot trial will utilize a group randomized controlled design wherein participants are assigned by ward to either intervention or delayed intervention control. A total of 10 house chat leaders (HCL) will be recruited and trained (5 HCL in each condition). HCL will recruit members of their social network (N=80, 18- 70 years of age) to participate in an 12-week lifestyle intervention delivered via weekly group meetings in the house chat leaders’ homes. In-person assessment visits will be conducted by masked research staff at 0, 12 weeks (post-treatment) and 24 weeks (follow-up). Satisfaction will be assessed in-person at 12 weeks (post- treatment) only via surveys and an exit interview. Facilitators and barriers to sustainability will be assessed via a mix of in-depth interviews (with house chat leaders), focus groups (with participants) and surveys (with both) at 24 weeks. The proposed intervention delivery model, which draws on community assets and builds capacity, could offer a viable approach to improve health outcomes for an underserved population. This pilot trial will provide the first evidence of feasibility and preliminary effectiveness, which will make a meaningful contribution to the field and inform a larger trial.