Technology Innovations for Supporting Health in Alaska Native People

描述(由申请人提供)这项拟议的研究将评估两种文化定制的技术中介疾病预防干预措施在支持阿拉斯加原住民(AN)农村地区多种危险行为改变方面的有效性。通过研究团队过去6年在阿拉斯加农村的实地考察、与部落的持续社区伙伴关系以及人种学研究，干预措施将根据健康需求和价值观而量身定做，以实现美国心脏协会2020年7个战略影响目标中的5个目标。在随机对照的两组设计中，该试验将比较两种有效的治疗条件：第一组针对烟草和体育活动；第二组针对通过药物依从性和营养变化控制高血压和高胆固醇血症(HTN-HCL)。这两种情况都利用跨理论模型--量身定做的计算机化干预措施，由安克雷奇的土著顾问通过远程医疗向农村家乡的人提供服务。计算机化干预接触发生在基线、3个月、6个月和12个月，最终评估在18个月。研究设计提供了同等的接触时间和技术比较；促进了社区内个人层面的随机化，因为所有参与者都接受了高度个性化的咨询和干预材料；并允许比较传统风险因素(HTN-HCL)和风险行为(烟草/体力活动)干预措施。参与者(N=300)将是每天吸烟者，至少有一种额外的心血管疾病危险因素(例如，缺乏运动、超重、HTN、HCL)或已有血管疾病。这项试验的目的是接触到一个人，而不考虑居住地点或改变的意图。主要的假设是，通过18个月的随访，第一组的生物化学确认的烟草戒断程度将显著高于第二组，其次将显著增加他们的体力活动。第二个假设是，通过(I)服药依从性和(Ii)饮食改变，组2将比组1更好地控制HTN和HCL。第三个目标将：(A)比较干预措施对整体行为变化的影响；(B)模拟每项干预措施的成本效益和预算影响；(C)检查治疗结果的调节因素/中介因素，包括反式3‘-羟基可替宁与可替宁的比率，这是尼古丁代谢率的非侵入性衡量标准。该提案结合了技术、药理学、行为科学和卫生经济学，以促进面临显著健康差距的人民的健康，由于他们与世隔绝的地理位置，获得干预的机会有限。

DESCRIPTION (provided by applicant) the proposed research will evaluate the efficacy of two culturally-tailored technology- mediated disease prevention interventions for supporting change in multiple risk behaviors in rural Alaska Native (AN) men and women. Directly informed by the research team's fieldwork over the past 6 years in rural Alaska, continued community partnership with the tribes, and ethnographic research, the interventions will be tailored to AN health needs and values to target 5 of the American Heart Association's 7 Strategic Impact Goals for 2020. In a randomized controlled 2-group design, the trial will compare two active treatment conditions: Group 1 targets tobacco and physical activity; Group 2 targets control of hypertension and hypercholesterolemia (HTN-HCL) through medication adherence and nutritional changes. Both conditions utilize trans theoretical model-tailored, computerized interventions, delivered via telemedicine by Indigenous-focused counselors located in Anchorage reaching AN people in their rural home villages. Computerized intervention contacts occur at baseline, 3-, 6- and 12-months with final assessment at 18-months. Study design provides an equivalent contact time and technology comparison; facilitates individual-level randomization within communities, as all participants receive highly individualized counseling and intervention materials; and allows for comparison of traditional risk factor (HTN-HCL) versus risk behavior (tobacco/ physical activity) interventions. Participants (N=300) will be daily smokers with at least one additional cardiovascular disease risk factor (e.g., inactivity, overweight, HTN, HCL) or established vascular disease. The trial aims to reach AN people regardless of residential location or intention to change. The primary hypothesis is that Group 1 will achieve significantly greater biochemically- confirmed tobacco abstinence than Group 2 through 18-months follow-up and secondarily will significantly increase their physical activity. Secondary hypotheses are that Group 2 will achieve significantly greater control of HTN and HCL than Group 1 through (i) medication compliance and (ii) dietary change. Tertiary aims will: (a) compare the interventions on overall behavior change; (b) model cost-effectiveness and budgetary impact of each intervention; and (c) examine moderators/mediators of treatment outcome, including the trans-3'-hydroxycotinine to cotinine ratio, a noninvasive measure of nicotine metabolism rate. The proposal combines technology, pharmacology, behavioral science, and health economics for advancing the health of AN people who face significant health disparities with limited access to interventions given their isolated geographics.