A Randomized Trial Testing Lay Health Coaches for Obesity Treatment

描述（由申请人提供）：外行健康教练提供支持和问责之间的卫生保健访问，以促进行为改变。有两种类型的外行教练，同伴（两个开始行为改变的人互相指导）和导师（以前成功地改变了他们的行为的人指导刚刚开始改变他们的行为的人）。非专业教练还没有接受过肥胖治疗的测试。唯一有客观结果的试验是在糖尿病管理领域，结果表明同伴可能比导师更有效。同样，社会比较理论的研究结果表明，与“相似”目标（例如，同伴）的横向比较比与“更成功”目标（例如，导师）的向上比较可能促进更大的动机和健康行为改变，因为与成功目标的比较可能引起挫折并阻碍表现。虽然社会比较理论是一种自然契合，但它还没有被用来理解同伴和导师健康教练对健康结果的影响。此外，这两种类型的非专业教练还没有在任何领域进行直接比较。我们进行了一项为期6个月的试点研究，测试同伴和导师健康教练的减肥效果。参与者接受了一个团体行为减肥计划（BWL），并被随机分配到同伴或导师健康教练组。BWL治疗包括减少接触时间；疗程为每周6周，每两周6周，之后为每月。在小组没有见面的几周，参与者通过电子邮件将他们一周的体重、卡路里和活动信息发送给他们的教练，并收到反馈。结果令人印象深刻。教练协议的遵守情况非常好。与导师组相比，同伴组的减肥效果更好（-8.7kg vs -5.3kg）。此外，同伴参与者与他们的教练进行横向比较，而导师参与者进行向上比较，横向比较与更大的减肥结果相关。这些初步研究结果提供了强有力的证据：1)非专业健康教练对肥胖治疗是可行的；2)同伴健康教练可能产生特别令人印象深刻的体重减轻；3)社会比较过程可能在同伴和导师健康教练治疗结果中起重要作用。我们建议对非专业健康教练进行肥胖治疗测试。参与者将被随机分配到BWL+同伴，BWL+导师或单独BWL。BWL将减少接触时间；6周为每周一次，6周为两周一次，剩下的9个月为每月一次。在小组不开会的几周内，Peer和Mentor的参与者将通过电子邮件向他们的教练发送他们的进展，并获得反馈。我们假设BWL+同伴教练在12个月时的减重效果优于BWL+导师和单独使用BWL，并且同伴组和导师组在社会比较方向上存在差异。如果这些假设得到支持，我们将探讨社会比较方向是否在同伴和导师研究组之间介导12个月的减肥结果。这个项目测试了一种新颖的、有理论基础的、可推广的肥胖治疗方法。如果成功的话，这种方法可以为目前的肥胖治疗工作提供大量信息。

DESCRIPTION (provided by applicant): Lay health coaches provide support and accountability between health care visits to promote behavior change. There are 2 types of lay coaches, Peers (2 individuals initiating behavior change coach one another) and Mentors (individuals who previously and successfully modified their behavior coach patients just starting to change their behavior). Lay coaches have not been tested for obesity treatment. The only trials with objective outcomes are in the area of diabetes management, and results suggest that Peers may be more effective than Mentors. Similarly, findings from Social Comparison Theory show that lateral comparisons with "similar" targets (e.g., Peers) may promote greater motivation and health behavior change than upward comparisons with "more successful" targets (e.g., Mentors), as comparisons with successful targets can induce frustration and hinder performance. Although a natural fit, Social Comparison Theory has not been used to understand the effects of Peer and Mentor Health Coaches on health outcomes. Moreover, the2types of lay coaches have not been directly compared in any area. We conducted a 6-month pilot study testing Peer and Mentor Health Coaches for weight loss. Participants received a group behavioral weight loss program (BWL) and were randomized to a Peer or Mentor Health Coach. BWL treatment involved a reduced contact schedule; sessions were weekly for 6-weeks, biweekly for 6-weeks, and monthly thereafter. On weeks that group did not meet, participants emailed their week's weight, calorie, and activity information to their coach and received feedback. Results were impressive. Compliance with the coaching protocol was excellent. The Peer condition yielded superior weight loss outcomes compared to the Mentor condition (-8.7kg v. -5.3kg). Moreover, Peer participants engaged in lateral comparisons with their coach whereas Mentor participants engaged in upward comparisons, and lateral comparisons were associated with greater weight loss outcomes. These preliminary findings provide strong evidence that 1) lay health coaches are feasible for obesity treatment, 2) Peer Health Coaches may yield particularly impressive weight losses, and 3) social comparison processes may play an important role in Peer and Mentor Health Coach Treatment outcomes. We propose to test lay health coaches for obesity treatment. Participants will be randomized to BWL+Peer, BWL+Mentor, or BWL alone. BWL will involve a reduced contact schedule; sessions will be weekly for 6-weeks, biweekly for 6-weeks, and monthly for the remaining 9-months. During weeks that group does not meet, Peer and Mentor participants will email their progress to their coach and receive feedback. We hypothesize that BWL+Peer Coach will yield superior weight losses at 12-months compared to BWL+Mentor and BWL alone and that Peer and Mentor arms will differ on social comparison direction. If these hypotheses are supported, we will explore whether social comparison direction mediates 12-month weight loss outcomes between the Peer and Mentor study arms. This project tests a novel, theoretically-grounded, disseminable approach to obesity treatment. If successful, this approach could substantially inform current obesity treatment efforts.