Care2bWell: A Worksite Physical Activity & Wellness Program for Child Care Staff

描述（由申请人提供）：美国约有130万名儿童保育工作者，其中大多数是小时工，被归类为低工资者。在北卡罗来纳州，这些工人中有一半是非洲裔美国人或西班牙裔。许多人没有医疗保险，使他们面临许多严重和慢性健康状况的风险增加，如肥胖，糖尿病和高血压。众所周知，定期的体育活动（PA）可以降低许多慢性疾病的风险;不幸的是，大多数美国人，特别是低收入人群和少数民族，未能达到PA的建议。一个多层次的工作场所为基础的PA在儿童保育提供的干预措施是一个创新的战略，以达到这些低工资的工人，并解决这个高风险人群的健康差距。虽然我们干预的主要目标是 我们希望，更健康、更积极的工作人员将成为他们所照顾的儿童健康生活方式的更好榜样和促进者。这个双臂、集束RCT（n=104个中心，4名工人/中心）将测试为期6个月的Care 2bWell（CARE）干预与财务授权（FE）对照组相比在增加工人PA方面的功效。CARE干预将包括启动研讨会，参与者在研讨会上获得有关其健康风险的定制反馈并设定行为目标，然后进行三次为期2个月的健康活动，在此期间，工作人员监控PA，接收定制的反馈，并在团队中竞争奖品。中心主任将参加每月的网络研讨会，重点是改善工作环境，以支持PA和健康。在一个社会生态学的框架内，知觉控制、社会支持和创新扩散理论指导了个人内部、人际和中心层面的干预成分。FE部门的参与者将接受平行干预，以增强个人和中心层面的财务健康。主要结局将是加速度计测量的中度至剧烈PA的分钟数。将在基线、随访（6个月）和维持（18个月）时评估主要和次要结局（饮食、人体测量学、心理社会变量和中心健康环境）。详细的过程评估，成本效益和冥想分析将用于评估个人和中心层面的行为改变机制。

DESCRIPTION (provided by applicant): There are approximately 1.3 million US child care workers, most of who are hourly employees and classified as low-wage earners. In North Carolina, half of these workers are African American or Hispanic. Many have no health insurance, putting them at increased risk for many serious and chronic health conditions such as obesity, diabetes, and hypertension. Regular physical activity (PA) is known to decrease risk of many chronic diseases; unfortunately, most Americans, especially low-income individuals and minorities, fail to meet PA recommendations. A multi-level worksite-based PA intervention offered in child care is an innovative strategy to reach these low wage workers and address health disparities among this high-risk population. While the primary target of our intervention is worker PA, we expect that healthier and more physically active workers will be better role models and promoters of healthy lifestyles for children in their care. This two-arm, cluster RCT (n=104 centers, with 4 workers/center) will test the efficacy of a 6-month Care2bWell (CARE) intervention in increasing workers' PA compared to a Financial Empowerment (FE) control arm. The CARE intervention will include a kick-off workshop, where participants get tailored feedback about their health risks and set behavioral goals, followed by three 2-month long wellness campaigns, during which workers monitor PA, receive tailored feedback, and compete in teams for prizes. Center directors will take part in monthly webinars focused on improving the work environment to support PA and wellness. Within a social ecological framework, Perceptual Control, Social Support, and Diffusion of Innovation theories guide intrapersonal, interpersonal, and center- level intervention components. Participants in the FE arm will receive a parallel intervention to enhance financial health at the individual and center levels. The primary outcome will be accelerometer-measured minutes of moderate to vigorous PA. Primary and secondary outcomes (diet, anthropometrics, psychosocial variables, & center wellness environments) will be assessed at baseline, follow-up (6 mo), and maintenance (18 mo). Detailed process evaluation, cost-effectiveness, and meditational analysis will be used to assess mechanisms of behavior change at the individual and center levels.