iSIPsmarter: An RCT to evaluate the efficacy, reach, and engagement of a technology-based behavioral and health literacy intervention to reduce sugary beverages among rural Appalachian adults

项目概述：含糖饮料(SSB，例如苏打水/汽水、甜茶、运动和能量饮料， 水果饮料)是美国饮食中最大的单一卡路里来源，对 约占美国成年人每日总能量摄入量的7%。在阿巴拉契亚成年人中，SSB的摄入量是 高得不成比例，平均约占每日总能量摄入量的14%。有强大和一致的数据 记录高SSB消费与肥胖、糖尿病等众多健康问题之间的关系 一些与肥胖有关的癌症、冠心病、高血压和龋齿。进一步复利 由于SSB问题，阿巴拉契亚地区缺乏获得提供者、医疗服务和循证服务的机会 行为预防计划。关于基于技术的行为干预的数据也有限。 阿巴拉契亚。然而，鉴于最近在缩小数字鸿沟方面取得的进展，现在是进行评估的最佳时机 这一地区的基于技术的行为干预。目前的提案旨在针对这一主要 社会保障局饮食风险因素和公共卫生挑战，以及解决农村电子/移动健康方面的显著差距 文学。重要的是，这项建议建立在我们团队的电子/移动健康干预专业知识和SSB十年经验的基础上 阿巴拉契亚农村地区的行为干预研究。ISIPSmarter是一种基于技术的行为和健康 扫盲干预的目标是减少SSB和减轻/维持体重。它由六个核心组成 互联网提供的模块，一种集成的短消息服务(SMS)战略，可让用户参与跟踪 SSB行为，以及用于家庭体重跟踪的蜂窝天平。ISIPSmarter是一款高度交互、 结构化的、自我指导的计划，使用先前被证明可以促进行为改变的策略。 ISIPSmarter还采用了阶梯式护理方法，以吸引难以完成的用户 干预措施的组成部分。拟议的随机对照研究以RE-AIM框架为指导，目标是244名成年人 来自阿巴拉契亚的乡村。总体目标是在两组中检查iSIPSmarter的有效性[iSIPSmarter与 静态患者教育(PE)网站]由4个评估(前、3个月、6个月和18个月随访)设计。它是 假设iSIPSmarter在减少SSB消耗方面将比PE网站更有效 后评估。二次结局的变化(例如，总体饮食质量、体重、生活质量)和 还将评估干预后6个月和18个月结果的维持情况。额外的辅助设备 目标包括检查覆盖范围和代表性、用户参与度模式和成本。两个第三级 目标包括探索性调解分析和系统级别的参与性进程，以了解上下文 以供将来在组织级别采用iSIPSmarter，特别是探索可促进 或阻碍可持续的SSB筛选和转介过程。这项研究的长期目标是 维持有效、可扩展和高覆盖的行为干预，以改善SSB行为和体重 并减少阿巴拉契亚及其他地区农村地区与SSB相关的健康不平等和慢性病。

Project Summary: Sugar-sweetened beverages (SSB, e.g., soda/pop, sweet tea, sports and energy drinks, fruit drinks) are the largest single food source of calories in the United States (US) diet and contributes approximately 7% of total daily energy intake for US adults. Among Appalachian adults, SSB intake is disproportionately high, averaging about 14% of total daily energy intake. There are strong and consistent data documenting relationships among high SSB consumption and numerous health issues such obesity, diabetes, some obesity-related cancers, coronary heart disease, hypertension, and dental decay. Further compounding the SSB problem, the Appalachian region lacks access to providers, medical services, and evidence-based behavioral prevention programs. There is also limited data on technology-based behavioral interventions in Appalachia. However, given recent progress in shrinking the digital divide, the timing is optimal to evaluate technology-based behavioral interventions in this region. The current proposal is designed to target this major SSB dietary risk factor and public health challenge, as well as address notable gaps in the rural e/m-Health literature. Importantly, this proposal builds on our team’s e/m-Health intervention expertise and decade of SSB behavioral intervention research in rural Appalachia. iSIPsmarter is a technology-based behavioral and health literacy intervention targeting SSB reduction and weight reduction/maintenance. It is comprised of six core Internet-delivered modules, an integrated short message service (SMS) strategy to engage users in tracking SSB behaviors, and a cellular enabled scale for in-home weight tracking. iSIPsmarter is a highly interactive, structured, and self-guided program that uses strategies previously proven to promote behavior change. iSIPsmarter also incorporates a stepped care approach to engage users who struggle to complete components of the intervention. The proposed RCT is guided by the RE-AIM framework and targets 244 adults from rural Appalachia. The overall goal is to examine the efficacy of iSIPsmarter in a 2 group [iSIPsmarter vs. static Patient Education (PE) website] by 4 assessment (Pre, 3-, 6- and 18-month follow-up) design. It is hypothesized that iSIPsmarter will be more efficacious at reducing SSB consumption than a PE website at post assessment. Changes in secondary outcomes (e.g. overall dietary quality, weight, quality of life) and maintenance of outcomes at 6- and 18-months post intervention will also be evaluated. Additional secondary aims include to examine reach and representativeness, patterns of user engagement, and cost. Two tertiary aims include exploratory mediation analyses and a systems-level, participatory process to understand context for future organizational-level adoption of iSIPsmarter, and specifically to explore factors that would promote or inhibit a sustainable SSB screening and referral process. The long-term goal of this line of this research is to sustain an effective, scalable, and high reach behavioral intervention to improve SSB behaviors and weight and to reduce SSB-related health inequities and chronic conditions in rural Appalachia and beyond.