Novel Intervention Linking Public Housing with Primary Care to Prevent Diabetes

描述(由申请人提供)：非裔美国人(AA)女性，她们肥胖的可能性比非西班牙裔白人女性高80%。再生障碍性贫血妇女还面临着与肥胖相关的负面健康结局的不成比例的风险，包括2型糖尿病、高血压、血脂异常、心脏病和癌症。此外，生活在种族隔离的贫困市中心社区的再生障碍性贫血妇女患肥胖症和相关后遗症的风险更高，这一系列问题因她们无法获得初级保健和社区相关资源而加剧。为了解决这些高危人群获得初级保健的障碍，成立了联邦合格卫生中心(FQHC)初级保健网络，现在为原本不需要护理的低SES患者提供服务。然而，民进党对这种环境的适应(即向公共住房输出民进党干预措施)尚未得到彻底评估。因此，有一个绝佳的机会来检验将FQHC网络与公共住房基础设施连接起来的新型合作伙伴关系是否在降低肥胖和糖尿病风险方面有效，该R34两年规划项目的目标是开发、实施和评估试点的多层次DPP干预。在这项先导研究中，我们将使用随机等候名单对照设计来分配60名参与者，以试行基于转化型社区的DPP干预或FHCN/FQHC常规护理。具体目标是：1)使用RE-AIM过程和结果指标，在FHCN/FQHC基础设施的背景下评估公共住房环境中SHAPE UP干预措施的可行性、可接受性和实施情况。2)对干预措施的有效性进行初步评估，包括干预后24周的体重减轻(主要结果)、二次影响生理指标(例如血糖、糖化血红蛋白、血压、血脂)和干预与对照组中的行为指标(例如体力活动(PA)、营养)，以估计用于后续样本量计算的指标的可变性。这项由具有广泛合作历史的经验丰富的团队进行的高度重要和新颖的研究将提供初步数据，为动力充足的更大规模的随机对照试验提供信息。

DESCRIPTION (provided by applicant): African American (AA) women, who are 80% more likely to be obese than their non-Hispanic white counterparts. AA women are also at disproportionate risk for negative obesity related health outcomes, including type 2 diabetes, hypertension, dyslipidemia, heart disease, and cancer. Further, AA women living in racially segregated, impoverished inner city neighborhoods are at even higher risk for obesity and associated sequalae, a set of problems exacerbated by the fact that they lack access to primary care and community related resources. To address barriers to primary care among these high-risk groups, Federally Qualified Health Center (FQHC) Primary Care Networks were formed, and now offer services to low SES patients who would otherwise go without care. However, DPP adaptation to this type of setting (that is, exporting DPP interventions to public housing) has not been thoroughly evaluated. Thus, there is a prime opportunity to examine whether novel partnerships linking FQHC networks with Public Housing infrastructure to deliver modified DPP programs directly into high risk communities are effective in reducing obesity and diabetes risk The goal of this R34 two-year planning project is to develop, implement, and evaluate a pilot multi-level DPP intervention. In this pilot study, we will use a randomized wait list control desig to allocate 60 participants to pilot test a translational community based DPP intervention or FHCN/FQHC usual care. The specific aims are to: 1) Evaluate the feasibility, acceptability and implementation of the SHAPE UP intervention in Public Housing settings in the context of FHCN/FQHC infrastructure, using RE-AIM process and outcome indicators. 2) Conduct a preliminary evaluation of this intervention's effectiveness including weight loss at 24 weeks (primary outcome), secondary impact physiological measures (e.g., glucose, A1C, BP, lipids) and behavioral measures (e.g., physical activity (PA), nutrition) in intervention vs. control arms to estimate variability of measures for subsequent sample size calculation. This highly significant and novel study by an experienced team with an extensive partnership history will provide preliminary data to inform an adequately powered, larger randomized controlled trial.