Virtual Advisors for Physical Activity Promotion in Underserved Communities

背景：拉美裔老年人不成比例地患有多种慢性疾病（如糖尿病、肥胖症），通过增加体育活动（如步行）得到改善。由于语言、教育、计算机和健康素养方面的障碍，拉丁裔老年人通常不能很容易地参加美国社区提供的面对面或在线的典型健康促进计划。非专业健康顾问（在西班牙语中称为“促进者”）为拉丁裔社区提供了一种全国公认的、符合文化特点的、具有成本效益的健康行为改变模式。然而，与所有“人类”提供的健康项目一样，它们对参与者的时间表施加了限制，而且，即使有仔细的干预忠实程序，顾问之间的项目交付也不可避免地存在一些差异。基于计算机的文化量身定制的体育活动顾问程序可以潜在地减少人与人之间的日程安排和保真限制，并扩大程序的覆盖范围。在最近完成的一项为期4个月的实验中，一个基于计算机的双语虚拟顾问，带有触摸屏交互（不需要键盘或鼠标），被安置在一个社区中心，并被编程为根据低收入、老年拉丁裔成年人的需求和偏好量身定制私人助理建议。与健康教育控制相比，虚拟顾问项目成功地提高了参与者的常规步行水平。目的：本研究的主要目的是开展一项比较有效性的试验，在更广泛的拉丁裔老年人中，评估基于社区的Virtual Advisor PA项目相对于已证实的Lay Advisor项目12个月的影响。第二个目标是确定虚拟与非专业顾问程序的比较成本效益。设计：这项为期12个月的随机试验将招募居住在16个社区中心附近的55岁及以上的非活动拉丁裔成年人（n=265/组；总计530）。主要指标是每周步行的分钟数，其他指标包括身体质量指数、久坐行为、功能表现和与健康相关的生活质量。其他研究领域是评估干预成功的理论基础和经验支持的调节因子和中介因子，并确定干预的潜在可推广性。影响：该研究旨在证明，为拉丁裔老年人量身定制的基于计算机的虚拟顾问可以在该人群经常光顾的社区环境中提供有效且具有潜在成本效益的替代方案。这些项目在一系列社区环境（如诊所、药房、图书馆）中使用的潜在扩展范围，为积极影响当前的健康差距提供了巨大的希望。

DESCRIPTION (provided by applicant): Virtual Advisors for Physical Activity Promotion in Aging Latino Communities BACKGROUND: Aging Latino adults suffer disproportionately from a number of chronic conditions (e.g., diabetes, obesity) improved by increased physical activities (PA) such as walking. Due to language, education, computer, and health literacy barriers, older Latino adults often cannot readily access typical health promotion programs offered in-person or online in U.S. communities. Lay health advisors ("promoters" in Spanish) offer a nationally recognized, culturally tailored and cost-efficient health behavior change model for Latino communities. However, as with all "human" delivered health programs, they impose constraints on participant schedules, and, even with careful intervention fidelity procedures in place, some variability in program delivery across advisors is inevitable. Computer-based culturally tailored physical activity advisor programs can potentially reduce human- to-human scheduling and fidelity constraints and extend program reach. In a recently completed 4- month experiment, a computer-based bilingual Virtual Advisor with touch-screen interactivity (no keyboard or mouse needed) was housed in a community center and programmed to tailor PA advice to the needs and preferences of low-income, aging Latino adults. The Virtual Advisor program successfully increased regular walking levels in participants compared to a health education control. OBJECTIVE: The primary study aim is to conduct a comparative effectiveness trial evaluating the 12- month impacts of the community-based Virtual Advisor PA program relative to a proven Lay Advisor program in a broader population of aging Latino adults. The secondary aim is to determine the comparative cost effectiveness of the Virtual vs. Lay Advisor programs. DESIGN: The 12-month randomized trial will enroll inactive Latino adults ages 55 years and older living near 16 neighborhood community centers (n=265/arm; 530 total). The primary outcome is minutes of walking per week, and additional outcomes of interest include BMI, sedentary behavior, functional performance, and health- related quality of life. Additional areas of investigation are to evaluate theoretically based and empirically supported moderators and mediators of intervention success and determine the potential generalizability of the interventions. IMPACT: The study seeks to demonstrate that a computer-based Virtual Advisor tailored to the needs of aging Latino adults can provide an effective and potentially cost-efficien alternative to Lay Advisors in community settings frequented by this population. The potential extended reach of such programs for use in a range of community settings (e.g., clinics, pharmacies, libraries) provides substantial promise for positively impacting the current health disparities gap.