Reducing Health Disparity in AA Women: Physical Activity Adherence

描述（由申请人提供）：尽管已知的好处，大多数人没有达到推荐的体力活动水平（PA）。总体而言，非洲裔美国妇女的PA水平最低，这导致了心血管健康，糖尿病和抑郁症状的巨大差异。有一个迫切需要研究的方法，以促进PA在非洲裔美国妇女的吸引力，适用于临床实践，并具有成本效益。这项临床试验的目的是测试我们重新设计的女性步行计划（WWP）的有效性，该计划由生活方式PA处方和“团体访问”交付模式组成，在团体访问之间有或没有定制的电话联系，以增加对PA的依从性并改善健康结果。两种电话联系策略将与无电话控制条件进行比较：使用简短动机访谈的个人管理联系策略和使用电话计算机连接系统的自动联系策略。小组访问和电话联系旨在增加对PA生活方式的坚持，重点是每天超过基线3,000步。本研究的目的是（1）比较初始（收养24周）和更长期（维持第2周和第24周）WWP加个人管理的电话联系、WWP加自动电话联系和WWP无电话联系对（a）增加对PA生活方式的依从性，（B）改善健康结局的有效性（有氧健身，身体成分，抑郁症状），（c）提高自我效能和结果预期;（2）比较三种电话治疗条件与坚持生活方式PA和健康结果相关的成本效益。该研究是一项随机分组拉丁广场临床试验，随机分配了6个社区卫生保健中心的三种治疗条件的给药顺序。这六个中心在种族、社会经济地位和居住流动性方面是相似的。在社区卫生保健中心3英里半径范围内招募40至65岁的非裔美国女性（n = 288），这些女性久坐不动，没有心血管疾病的主要体征或症状，也没有心肌梗死、中风或胰岛素依赖型糖尿病病史。将在基线、第24周和第48周使用PA、有氧体能测试、BMI、腰围、抑郁症状、克服障碍的自我效能和结局预期的多项指标收集数据。我们预计，（a）与没有电话联系的WWP相比，在WWP中补充电话联系的WWP中，对生活方式PA的依从性将得到改善，因此健康结局将得到改善，自我效能和结局预期将更高，（B）WWP+自动电话联系将比WWP+个人管理的电话联系更具成本效益。这项研究将有助于确定一种可偿还的，实用的方式提供行为改变干预在临床环境中，将增加坚持PA和有吸引力和吸引力的非洲裔美国妇女。公共卫生相关性：一些非洲裔美国妇女缺乏身体活动是一个主要的公共卫生问题。这项研究将确定具有成本效益的干预策略，以增加生活方式的身体活动，可以纳入临床实践，以改善中年非洲裔美国妇女的健康。团体访问模式将用于提供社会支持和增强信心，并将测试访问之间两种电话策略（人员管理和自动联系）的好处。

DESCRIPTION (provided by applicant): Despite the known benefits, most individuals do not achieve the recommended levels of physical activity (PA). Overall, African American women have the lowest PA levels, which contributes to substantial disparities in cardiovascular health, diabetes, and depressive symptoms. There is a pressing need to examine ways to promote PA in African American women that are appealing, applicable to clinical practice, and cost-effective. The purpose of this clinical trial is to test the efficacy of our reframed Women's Walking Program (WWP), consisting of a lifestyle PA prescription and "group visit" delivery model, with or without tailored telephone contacts between group visits for increasing adherence to PA and improving health outcomes. Two telephone contact strategies will be compared against a no-telephone control condition: a person-administered contact strategy using brief motivational interviewing and an automated contact strategy using a telephone computer- linked system. Group visits and telephone contacts are designed to increase adherence to lifestyle PA with an emphasis on accumulation of 3,000 steps daily over baseline. The aims of this study are (1) to compare the initial (adoption 24 weeks) and longer-term (maintenance 2nd 24 weeks) effectiveness of the WWP plus person-administered telephone contacts, WWP plus automated telephone contacts, and the WWP without telephone contacts on (a) increasing adherence to lifestyle PA, (b) improving health outcomes (aerobic fitness, body composition, depressive symptoms), (c) improving self-efficacy and outcome expectations; and (2) to compare cost-effectiveness of the three telephone treatment conditions in relation to adherence to lifestyle PA and health outcomes. The study is a randomized cluster Latin Squares clinical trial with random assignment of the order of administering the three treatment conditions to six community health care centers. These six centers are similar with respect to race, socioeconomic status, and residential mobility. African American women (n = 288) aged 40 to 65 years, who are sedentary with no major signs or symptoms of cardiovascular disease and no history of myocardial infarction, stroke, or insulin-dependent diabetes will be recruited within a 3-mile radius of the community health care centers. Data will be collected at baseline, and at 24 weeks and 48 weeks using multiple measures of PA; aerobic fitness testing; BMI; waist circumference; depressive symptoms; self-efficacy for overcoming barriers; and outcome expectations. We anticipate that (a) adherence to lifestyle PA and therefore health outcomes will improve and self-efficacy and outcome expectations will be higher in the WWP complemented with telephone contacts compared to the WWP without telephone contacts and (b) the WWP plus automated telephone contact will be more cost-effective than WWP plus person-administered telephone contacts. This study will contribute to identifying a reimbursable, practical way of delivering a behavioral change intervention in clinical settings that will increase adherence to PA and be attractive and appealing to African American women. PUBLIC HEALTH RELEVANCE: Physical inactivity in some African American women is a major public health concern. This research will identify cost-effective intervention strategies to increase lifestyle physical activity that can be incorporated into clinical practice to improve the health of midlife African American women. The group visit model will be used to deliver social support and promote confidence, and the benefits of two telephone strategies (person administered and automated contacts) between visits will be tested.