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

描述（由申请人提供）：美国大约有130万名儿童保育工作者，其中大多数是小时工，属于低收入者。在北卡罗来纳州，这些工人中有一半是非裔美国人或西班牙裔。许多人没有医疗保险，这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，有规律的身体活动（PA）可以降低许多慢性病的风险；不幸的是，大多数美国人，尤其是低收入个人和少数民族，没有达到PA的建议。在儿童保育中提供多层次的基于工作场所的PA干预是一种创新的策略，可以覆盖这些低工资工人，并解决这一高危人群之间的健康差距。而我们干预的主要目标是

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.