UMB/DFHCC Comprehensive Cancer Partnership Program

描述 超重和肥胖对少数族裔和低收入人群，特别是妇女的影响不成比例。越来越多的科学证据表明，肥胖、久坐不动的生活方式和不健康的饮食模式可能会显著增加患几种主要癌症的风险。然而，不幸的是，体重管理计划在不同的社会人口统计学群体中的效果参差不齐。越来越多的科学证据表明，电子健康促进战略(电子健康)可能在帮助个人改变饮食和PA方面有效。虽然近年来关于电子健康技术的文献如雨后春笋般涌现，但相对较少的实证关注指向了利用此类技术在社会人口统计多样化的女性中促进健康体重控制行为的可行性。然而，电子保健工具可以进行调整，以满足这些人口的具体识字、文化和后勤需求。然而，尚不清楚的是，为了在目标人群中最大限度地利用电子健康系统，需要在多大程度上提供人际帮助(例如，辅导)。本研究是一项为期三年的研究，旨在论证在城市社区娱乐中心设计和实施交互式电子饮食和PA监测和反馈系统(ESolutions)的可行性。研究程序将分两个阶段进行。在第一阶段，我们建议进行形成性研究，在迭代的软件开发过程中设计eSolutions系统，并在目标人群中进行系统的可用性测试。在第二阶段，我们建议在城市基督教青年会分支机构的大约60名超重成年女性中测试实施该工具的可行性。参与者将被随机分配到两种实验条件之一：1)使用eSolutions系统的自定进度，或2)由eSolutions和为期12周的指导干预(eSolutions-Plus)组成的组合计划。我们将在12周的初始阶段结束时检查短期结果。在初始阶段之后，两种情况下的参与者将被要求使用eSolutions进行另外12周的自定进度维护阶段。在维护阶段，两种情况下一半的参与者将被随机分配，每月接到电话，提醒他们使用eSolutions并排除任何系统故障。将在基线、基线后12周和24周进行评估(包括自我报告调查、人体测量和检索eSolutions系统数据)。主要结果将包括eSolutions系统持续利用率的衡量标准。次要结果将包括改善饮食习惯、PA和减肥。这项研究将证明eSolutions系统的可行性，并将进一步提供效应大小的估计，用于计划未来在马萨诸塞州基督教青年会中测试这种干预的随机对照试验。这项初步研究还提供了一个基础，证明了DF/HCC和UMB之间成功合作的更多证据，并将促进我们与马萨诸塞州基督教青年会网络的持续伙伴关系。 A.具体目标 这项研究回应了为促进身体活动(PA)和体重管理而开发、测试和实施癌症预防干预措施的迫切需要，特别是在不同种族和低收入人群中。2我们假设电子健康促进(电子健康)战略可以有效地实施在服务不足的人群中进行的体重管理干预措施。然而，一个悬而未决的问题是，是否有必要为低收入和不同族裔群体的成员提供人际支持，以实现电子健康体重管理系统的全部好处。这个问题可能不仅会影响计划的有效性，还会影响可持续性的潜力。因此，拟议研究的主要目的是确定开发和实施交互式电子饮食和PA监测和反馈系统(ESolutions)的可行性，以促进参加城市社区娱乐中心的低收入、不同种族人口在饮食、PA和减肥方面的改善。我们的具体目标是： 1.开发eSolutions，这是一种互动的电子饮食和PA监测和反馈系统，面向社会人口结构多样化、识字率低的受众。 1.1.评估eSolutions在目标人群成员中的可用性。 2.为了确定两个试验组之间的持续系统利用率是否存在差异：1)那些以自定进度的方式使用eSolutions的人，相比之下，2)接受由eSolutions和为期12周的教练减肥干预(eSolutions-Plus)组成的组合计划的人。 2.1.以确定每月电话支持电话(在协议实施12周后)是否促进较长期的eSolutions系统利用率。 3.估计接受e Solutions-Plus的参与者与只接受eSolutions的参与者相比，在饮食、PA和减肥方面有更大的短期和长期改善程度。 3.1评估eSolutions-Plus参与者是否在饮食、PA和减肥/维持方面获得了最大的长期改善(96周)(在协议的第12周后)。

DESCRIPTION Overweight and obesity disproportionately affect racial and ethnic minority and lower income populations, particularly women. An accumulating body of scientific evidence indicates that obesity, sedentary lifestyles, and unhealthy dietary patterns may significantly increase the risk of several major cancer types. Unfortunately however, the efficacy of weight management programs in diverse sociodemographic groups has been mixed. Accumulating scientific evidence demonstrates that electronic health promotion strategies (e-health) may be effective in assisting individuals to make dietary and PA change. While the literature on e-health technologies has blossomed in recent years, comparatively little empirical attention has been directed to the feasibility of utilizing such technologies to promote healthy weight-control behaviors among sociodemographically-diverse women. E-health tools however, can be adapted to meet the specific literacy, cultural, and logistical needs of these populations. What remains unclear however is the extent to which interpersonal assistance (e.g. coaching) is necessary to realize the maximum amount of ehealth system utilization in the target population. This study is a three-year investigation designed to demonstrate the feasibility of designing and implementing an interactive electronic diet and PA monitoring and feedback system (eSolutions) to be implemented in an urban community recreation center. Study procedures will occur in two phases. In Phase 1, we propose to conduct formative research, design the eSolutions system in an iterative software development process, and conduct usability testing of the system among the target population. In Phase 2, we propose to test the feasibility of implementing the tool among approximately 60 overweight adult women in an urban YMCA branch. Participants will be randomly assigned to one of two experimental conditions: 1) self-paced use of the eSolutions system, or; 2) a combined program consisting of eSolutions plus a 12-week coached intervention (eSolutions-Plus). We will examine short term outcomes at the end of this 12 week initial phase. Following the initial phase, participants in both conditions will be asked to utilize the eSolutions for an additional 12-week self-paced maintenance phase. During the maintenance phase, half of the participants in both conditions will be randomly assigned to receive monthly telephone calls to remind them to utilize eSolutions and troubleshoot any system difficulties. Assessments (including self-report survey, anthropometric measurements, and the retrieval of eSolutions system data) will be conducted at baseline, 12-, and 24-weeks post-baseline. Primary outcomes will include measures of sustained eSolutions system utilization. Secondary outcomes will include improvement in dietary practices, PA and weight-loss. This study will demonstrate the feasibility of the eSolutions system and will further provide estimates of effect size that will be used to plan a future randomized controlled trial to test this intervention among YMCAs in Massachusetts. This pilot study also provides a basis for demonstrating additional evidence of successful collaboration between the DF/HCC and UMB and will facilitate our ongoing partnership with the network of Massachusetts YMCAs. A. SPECIFIC AIMS This study responds to an urgent need to develop, test, and implement cancer prevention interventions for physical activity (PA) promotion and weight management, particularly among ethnically diverse and low-income populations.', 2 We hypothesize that electronic health promotion (e-health) strategies may be effectively implemented in weight management interventions conducted among underserved populations. However, an outstanding question concerns whether the provision of interpersonal support is necessary for members of low income and ethnically diverse populations to realize the full benefits of e-health weight management systems. This issue may impact not only program efficacy, but also the potential for sustainability. Thus, the primary aim of the proposed study is to determine the feasibility of developing and implementing an interactive electronic diet and PA monitoring and feedback system (eSolutions) to promote improvements in diet, PA, and weight loss among a lower income, ethnically-diverse population attending an urban community recreation center. Our specific aims are: 1. To develop eSolutions, an interactive electronic diet and PA monitoring and feedback system for sociodemographically-diverse, low literacy audiences. 1.1. To evaluate the usability of eSolutions among members of the target population. 2. To determine whether there are differential levels of sustained system utilization between two experimental groups: 1) those using eSolutions in a self-paced fashion, compared to 2) those receiving a combined program consisting of eSolutions plus a 12-week coached weight loss intervention (eSolutions-Plus). 2.1. To determine whether monthly telephone support calls (after week 12 of the protocol) promote longer-term eSolutions system utilization. 3. To estimate the extent to which participants receiving e Solutions-Plus have greater shorter and longer-term improvements in diet, PA, and weight loss compared to those receiving eSolutions alone. 3.1 To estimate whether the greatest longer-term improvements (at 96 weeks) in diet, PA, and weight loss/maintenance are found among eSolutions-Plus participants receiving monthly telephone support calls (after week 12 of the protocol).