SIPsmartER Southwest Virginia: A systems-based approach to disseminate andimplement an effective sugar-sweetened beverage reduction intervention

 描述(由申请人提供)：将与健康相关的研究成果缓慢地转化为实践是有充分记录的，这延伸到健康素养干预措施。我们的R21应用程序是为了通过加快SIPSmartER的紧急发现的翻译来减少研究过程中的过度滞后时间，SIPSmartER是一种健康素养干预措施，旨在减少含糖饮料(SSB)的消费。SSB消费是一种高度优先的公共卫生行为，占美国成年人总能量摄入量的7%左右。不幸的是，这项申请的目标是弗吉尼亚州西南部的阿巴拉契亚地区，比全国SSB的平均消费量高出三倍以上。SIPSmartER是一种基于理论、为期6个月、多组分的健康素养干预措施，旨在减少SSB的摄入量，目前正在类型1有效性-实施混合随机对照试验中进行测试。这项严格设计的试验的新发现表明，SIPSmartER是一种减少SSB摄入量的有效干预措施：从0到6个月，干预参与者的SSB摄入量显著减少了236千卡/天(SD=46)，而对照组(P&lt；0.001)每天减少了54千卡(SD=19)。此外，SSB结果和SIPSmartER完成率不受卫生知识普及状况的影响，初步数据表明，SSB在干预一年后仍在持续减少。为了将这些有希望的效果转化为人口层面的SSB削减，需要作出协调一致的努力，以了解在现有系统内在组织一级采用和实施SIPSmartER的可行性，并开发一个执行支助系统，以帮助交付。此外，由于系统提供的SIPSmartER干预将在较不受控制的条件下进行，因此有必要确定个人层面对SSB消费的影响。因此，我们的方法以RE-AIM(REACH，Efficiency，Adption，Implementation，and Maintenance)框架为指导，并整合了互动系统框架和前沿战略，以促进组织级别的健康素养。我们针对四个医疗服务不足的西南部弗吉尼亚州卫生部地区及其客户群体，提出了一种包括形成性、过程和结果评估的混合方法设计。我们的主要目标是开发、确定SIPSmartER实施战略的可行性并确定其潜在效用，该战略将反映特定于SIPSmartER的系统级需求、障碍和资源，并建立与组织健康素养相关的一般能力。次要目标是确定在组织一级的采用和实施过程，并确定现有系统内SIPSmartER的个人覆盖范围和有效性。我们的目标是建立一个SIPSmartER的实施支持系统，该系统可以在随后的全面R01型有效性-实施混合随机对照试验中进行测试，长期目标是在公共卫生保健系统中广泛传播SIPSmartER，以实现SSB中人口水平的减少。

 DESCRIPTION (provided by applicant): The slow translation of health-related research findings into practice is well documented and this extends to health literacy interventions. Our R21 application is driven by the desire to reduce the excessive lag times along the research pipeline by speeding the translation of emergent findings from SIPsmartER, a health literacy intervention to reduce sugar-sweetened beverage (SSB) consumption. SSB consumption is a high priority public health behavior and contributes ~7% of total energy intake for US adults. Unfortunately, the targeted Appalachian region of Southwest Virginia for this application exceeds the national average consumption of SSB by more than three times. SIPsmartER is a theory-based, 6-month, multi- component health literacy intervention designed to reduce SSB intake and is currently being tested in a type 1 effectiveness-implementation hybrid RCT. Emerging findings from this rigorously designed trial illustrate that SIPsmartER is an efficacious intervention to decrease SSB intake: intervention participants have significantly decreased SSB intake by 236 SSB kcals/day (SD=46) from 0 to 6 months compared to a decrease of 54 SSB kcals/day (SD=19) in the control group (p<0.001). Furthermore, SSB outcomes and SIPsmartER completion rates do not vary by health literacy status and preliminary data indicate that SSB reductions are being sustained one year post intervention. To translate these promising effects into population-level SSB reductions, a concerted effort is needed to understand the feasibility of organizational-level adoption and implementation of SIPsmartER within existing systems and to develop an implementation support system to aid in delivery. Additionally, since a system-delivered SIPsmartER intervention would be conducted under less-controlled conditions, ascertaining individual-level effects on SSB consumption is necessary. Thus, our approach is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework and integrates the Interactive Systems Framework and cutting-edge strategies for advancing organizational-level health literacy. We target four medically-underserved Southwest Virginia Department of Health districts and their client population, and propose a mixed-methods design that includes formative, process, and outcome evaluations. Our primary aim is to develop, establish feasibility, and determine the potential utility of an implementation strategy for SIPsmartER, which will reflect system-level needs, barriers, and resources specific to SIPsmartER, as well as build general capacity related to organizational health literacy. Secondary aims are to determine the adoption and implementation process at the organization-level and determine individual-level reach and effectiveness of SIPsmartER within an existing system. The goal is to have an implementation support system for SIPsmartER that can be tested in a subsequent full-scale R01 type 3 effectiveness-implementation hybrid randomized-controlled trial, with a long-term goal of broad scale dissemination of SIPsmartER within public health care systems to achieve population-level reductions in SSB.