UMB/DFHCC Comprehensive Cancer Partnership Program

描述 超重和肥胖对少数民族和低收入人群，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几种主要癌症的风险。然而，不幸的是，体重管理计划在不同社会人口群体中的疗效好坏参半。越来越多的科学证据表明，电子健康促进战略（电子健康）可能有效地帮助个人改变饮食和PA。虽然电子健康技术的文献近年来蓬勃发展，相对较少的经验注意力已经针对利用这些技术，以促进健康的体重控制行为的社会人口统计学不同的妇女之间的可行性。然而，电子保健工具可以进行调整，以满足这些人群的具体识字、文化和后勤需求。然而，目前尚不清楚的是，在多大程度上需要人际协助（如辅导），以实现目标人群对电子保健系统的最大利用。本研究是一项为期三年的调查，旨在证明设计和实施一个互动的电子饮食和PA监测和反馈系统（eSolutions）将在城市社区娱乐中心实施的可行性。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电子解决方案系统，并在目标人群中进行系统的可用性测试。在第二阶段，我们建议测试的可行性，实施该工具约60超重的成年妇女在城市基督教青年会分支。参与者将被随机分配到两个实验条件之一：1）自定进度使用eSolutions系统，或; 2）由eSolutions加上12周辅导干预（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，将要求这两种情况下的参与者使用电子解决方案进行额外的12周自定进度的维护阶段。在维护阶段，两种情况下的一半参与者将被随机分配每月接受电话，提醒他们使用电子解决方案并解决任何系统问题。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eSolutions系统数据检索）。主要成果将包括衡量电子解决方案系统的持续利用情况。次要结果将包括饮食习惯、PA和体重减轻的改善。本研究将证明电子解决方案系统的可行性，并将进一步提供效应量的估计，用于计划未来的随机对照试验，以测试马萨诸塞州基督教青年会的这种干预。这项试点研究还为展示DF/HCC和UMB之间成功合作的额外证据提供了基础，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 这项研究回应了迫切需要开发，测试和实施癌症预防干预措施，以促进身体活动（PA）和体重管理，特别是在种族多样性和低收入人群中。我们假设，电子健康促进（电子健康）策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，提供人际支持是否是必要的低收入和种族多样化的人口实现电子健康体重管理系统的全部好处。这个问题不仅会影响项目的效率，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，以促进低收入，种族多样化的人群参加城市社区娱乐中心的饮食，PA和减肥的改善。我们的具体目标是： 1.开发电子解决方案，一个互动的电子饮食和PA监测和反馈系统，为社会人口多样化，识字率低的观众。 1.1. 评估电子解决方案在目标人群中的可用性。 2.确定两个实验组之间是否存在持续系统利用率的差异：1）以自定进度方式使用eSolutions的人，与2）接受由eSolutions加上12周指导减肥干预（eSolutions-Plus）组成的组合计划的人相比。 2.1.确定每月电话支持呼叫（方案第12周后）是否促进长期eSolutions系统利用率。 3.估计与仅接受eSolutions的受试者相比，接受eSolutions-Plus的受试者在饮食、PA和体重减轻方面的短期和长期改善程度。 3.1估计在接受每月电话支持呼叫（方案第12周后）的eSolutions-Plus参与者中是否发现饮食、PA和体重减轻/维持方面的最大长期改善（第96周）。

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).