New Media Obesity Treatment in Community Health Centers

描述（由申请人提供）：我们对如何在初级保健环境中为社会经济条件差的患者提供有效的行为肥胖治疗知之甚少。这是一项重大的公共卫生挑战。社会经济上处于不利地位的人口受致肥风险因素的影响最大，肥胖和相关慢性疾病的发病率最高。然而，在这一人群中，在促进临床显著的减肥结果方面几乎没有成功。有新的证据支持电子健康减肥方法的有效性，特别是当它们包括护理提供者的人际支持时。我们小组在社区健康中心进行了eHealth肥胖治疗干预的初步研究。社区卫生中心是特别重要的初级保健机构，因为它们主要服务于社会经济上处于不利地位的病人，从而针对那些最需要的人，同时具有很大的传播潜力。这些环境中的初级保健提供者可能在刺激患者行为改变方面发挥重要作用。然而，考虑到他们的临床需求和有限的辅助资源，目前尚不清楚如何最佳地让社区卫生中心提供者参与肥胖治疗干预。我们提出了一种新颖的，基于系统的干预方法，整合并告知初级保健提供者，而不会造成负担。与最佳证据保持一致，它包括辅助护理提供者作为干预者。使用电子健康技术提供量身定制的技能培训、自我监测和反馈。该研究将与北卡罗莱纳州农村的社区卫生中心系统皮埃蒙特卫生服务公司（PHS）合作进行。小灵通患者群体具有很大的种族/民族和地理多样性，但由于严重的社会经济劣势和高肥胖率和相关慢性疾病（如糖尿病和心血管疾病）而统一。我们建议进行一项聚类随机试验，将六个小灵通社区卫生中心随机分为两个治疗组：1)标准初级保健；2)初级保健加上12个月的电子健康行为减肥干预（iOTA），其中包括交互式自我监测和反馈、量身定制的技能培训材料、18个电话咨询电话和提供者咨询。主要结果是12个月时的体重变化。参与者将是患有肥胖症和心脏代谢合并症的PHS患者。参与者将被随访超过12个月，在基线和基线后6和12个月进行评估。

DESCRIPTION (provided by applicant): We know little about how to deliver efficacious behavioral obesity treatments to socioeconomically disadvantaged patients in the primary care setting. This is a major public health challenge. Socioeconomically disadvantaged populations have the greatest exposure to obesogenic risk factors and the highest rates of obesity and related chronic diseases. However, there has been little success in promoting clinically significant weight loss outcomes in this population. There is emerging evidence supporting the efficacy of eHealth weight loss approaches, particularly when they include interpersonal support from care providers. Our group has conducted preliminary studies of eHealth obesity treatment interventions in community health centers. Community health centers are particularly important primary care settings because they mainly serve socioeconomically disadvantaged patients - thus targeting those with greatest need - while offering great dissemination potential. Primary care providers in these settings may play an important role in stimulating patient behavior change. However, it is unclear how to optimally involve community health center providers in obesity treatment interventions, given their clinical demands and limited ancillary resources. We propose a novel, systems-based intervention approach that integrates and informs primary care providers without being burdensome. In keeping with the best evidence, it includes ancillary care providers as interventionists. Tailored skills training, self-monitoring and feedback are offered using eHealth technologies. The study will be conducted in collaboration with Piedmont Health Services, Inc. (PHS), a community health center system in rural North Carolina. The PHS patient population has great racial/ethnic and geographic diversity, but is unified by profound socioeconomic disadvantage and high rates of obesity and related chronic diseases (e.g. diabetes and CVD). We propose a cluster randomized trial in which the six PHS community health centers will be randomized into one of two treatment arms: 1) standard primary care; or 2) primary care plus a 12-month eHealth behavioral weight loss intervention (iOTA), which includes interactive self-monitoring and feedback, tailored skills training materials 18 telephone counseling calls, and provider counseling. The primary outcome is weight change at 12 months. Participants will be PHS patients with obesity and a cardiometabolic comorbidity. Participants will be followed over 12 months with assessments at baseline and 6 and 12 months post baseline.