Peer-Led Healthy Lifestyle Program in Supportive Housing

描述(申请人提供)：本申请符合RFA-MH-14-060。这项研究的总体目标是测试同伴主导的健康生活方式干预(Peer GLB)在支持性住房机构中的实施情况，这些机构为超重或肥胖的严重精神疾病(SMI)患者提供服务。与普通人群相比，SMI患者患肥胖症的风险是普通人的两倍。少数民族血统增加了额外的风险。与患有SMI的非拉丁裔白人相比，患有SMI的非洲裔美国人和拉丁裔SMI患肥胖症和心血管疾病的风险更高。源自糖尿病预防计划的团体生活方式平衡(GLB)是一种公认的健康生活方式干预措施，在普通人群中有效地实现了临床上显著的体重减轻(e5%体重减轻)。在这项研究中，我们旨在通过：1)通过在支持性住房机构中提供这种干预措施，将这种干预措施带到人们的家门口；2)使用同行专家(具有SMI经验的前客户)作为促进者来解决经济和人员需求；以及3)确定能够促进这种干预措施在社区环境中使用的实施因素。我们建议使用一种混合类型1随机对照试验设计来测试在支持性住房机构中同伴GLB与普通护理的有效性，并检查多水平的实施因素。Peer GLB为期12个月，将由住房机构的同行专家提供。重复评估将在基线以及随机化后6、12和18个月进行。为了检验Peer GLB的实施情况，我们将对背景因素进行混合方法研究，在我们的试验实施之前和试验招募结束后从住房机构的董事、项目经理、工作人员和同行专家那里收集数据。

DESCRIPTION (provided by applicant): This application responds to RFA-MH-14-060. The overall goals of this study are to test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention (Peer GLB) in supportive housing agencies serving diverse clients with serious mental illness (SMI) who are overweight or obese. The risk for obesity is twice as high in people with SMI compared to the general population. Minority origin contributes additional risk. Compared to non-Latino Whites with SMI, African Americans and Latinos with SMI are at higher risk of obesity and cardiovascular disease. The Group Lifestyle Balance (GLB) derived from the Diabetes Prevention Program is an established healthy lifestyle intervention that is efficacious in the general population for achieving clinically significant weiht loss (e5% weight loss). We aim to improve the reach of GLB in this study by: 1) bringing this intervention to people's doorsteps through its delivery in supportive housing agencies; 2) using peer specialists (former clients with lived experience of SMI) as facilitators to address economic and staffing demands; and 3) identifying implementation factors that can foster the use of this intervention in community settings. We propose to use a Hybrid Type 1 randomized controlled trial design to test the effectiveness of Peer GLB vs. Usual Care in supportive housing agencies and examine multi-level implementation factors. Peer GLB lasts 12 months and will be delivered by peer specialists in the housing agencies. Repeated assessments will be at baseline and at 6, 12, and 18 months post-randomization. To examine Peer GLB's implementation, we will conduct a mixed-methods study of contextual factors, collecting data from housing agencies' directors, program managers, staff, and peer specialists before the implementation of our trial and after recruitment for the trial has ended.