Improving Health Habits: Self-Care Priorities

描述（由申请人提供）：低收入少数群体的不良饮食和缺乏体育活动与超重/肥胖和癌症等慢性疾病的风险增加有关。为这些低收入人群服务的安全网诊所代表了一个尚未利用的机会，让贫困个人参与健康促进。很少有研究探讨了使用简短的医生建议和多层次的、基于诊所的干预措施来改善不良饮食习惯、增加体育活动或减少文化多样性低收入人群中久坐不动的生活方式的可行性，这些人群通常包括洛杉矶城市地区社区卫生中心的患者人群。该探索性项目建议通过引入和试行多层次、患者导向、生活方式改变、健康促进计划（MPLC-HPP）来解决这一科学差距，以解决洛杉矶县威尼斯家庭诊所（VFC）健康中心系统公共部门诊所服务的低收入、无保险患者人群（主要是拉丁裔）中不良饮食习惯和缺乏身体活动的问题。该计划将包括开发1）一个简单易用的患者健康行为优先评估（PHBPA）工具，旨在评估患者行为改变的优先级; 2）一个标准协议，供医生使用动机访谈提供简短的健康建议（每次访问< 2分钟）; 3）一个协议，用于分发自助援助患者使用（例如，计步器、运动视频）;以及4）由健康教育工作者进行的一系列八次后续电话咨询会议，以帮助患者解决他们随着时间的推移而改变生活方式的优先事项。我们将在两个VFC诊所的100例患者病例中进行MPLC-HPP的单盲、假对照试验（MPLC-HPP组n=50;假对照组n=50）。我们将使用定量结果测量，包括氧化应激和全身炎症的常见生物标志物（即，血浆类胡萝卜素和高敏感性C反应蛋白水平）和心理测量学测试的自我报告的营养和身体健康的措施，以准确地评估研究参与者在12个月的观察期内饮食和身体活动的变化幅度。将评估将MPLC-HPP纳入公共部门卫生诊所环境的可行性，这是该项目的主要目标。这些结果将为计划一项涉及多个诊所的更大，更雄心勃勃的后续研究提供信息。

DESCRIPTION (provided by applicant): Poor diet and physical inactivity among low-income, minority populations have been linked to greater risk of chronic disease conditions such as overweight/obesity and cancer. Safety net clinics that serve these low- income populations represent an untapped opportunity to involve impoverished individuals in health promotion. Few studies have examined the feasibility of using brief physician advice and multi-level, clinic- based interventions to improve poor dietary habits, increase physical activity, or reduce sedentary lifestyles among culturally diverse, low-income populations that typically comprise the patient population of these community health centers in Los Angeles urban areas. This exploratory project proposes to address this scientific gap by introducing and piloting a Multi-level, Patient-directed, Lifestyle Change, Health Promotion Program (MPLC-HPP) to address poor dietary habits and physical inactivity among low income, uninsured patient populations (primarily Latinos) served by the public sector clinics of the Venice Family Clinic (VFC) health center system in Los Angeles County. The program will include the development of 1) a simple-to- use Patient Health Behavior Priority Assessment (PHBPA) tool designed to assess patient priorities for behavior change; 2) a standard protocol for physicians to provide brief health advice using motivational interviewing (< 2 minutes per visit); 3) a protocol for distributing self-help aids for patient use (e.g., pedometer, exercise videos); and 4) a series of eight follow-up telephone counseling sessions by health educators to help patients address their lifestyle change priorities over time. We will conduct a single- blinded, sham-controlled pilot of the MPLC-HPP in 100 patient cases at two VFC clinics (n=50 in MPLC- HPP; n=50 in sham control). We will use quantitative outcome measures, including common biomarkers of oxidative stress and systemic inflammation (i.e., plasma carotenoids and high-sensitivity C-reactive protein levels) and psychometrically-tested self-report measures of nutrition and physical fitness, to accurately assess the magnitude of changes in diet and physical activity among study participants over a 12-month observation period. The feasibility of integrating the MPLC-HPP into the public sector health clinic setting will be evaluated, and is the primary aim of this project. The results will inform efforts to plan a larger, more ambitious successor study involving multiple clinics.