Increasing Implementation of Evidence-Based Interventions at Low-Wage Worksites

描述（由申请人提供）：癌症和其他慢性疾病是美国的主要杀手和残疾人，低收入美国人患这些疾病的风险很高。存在多种循证干预措施（EBI）来改善慢性病风险行为，如癌症筛查，健康饮食，体育活动和戒烟，但EBI对社区环境的影响很小。在接触低收入成年人的社区环境中，工作场所脱颖而出，因为大多数低收入成年人都有工作，但促进健康的EBI的工作场所实施率很低。一半的美国工人在小型或低工资的工作场所工作，这些EBI的实施和实施准备程度特别低。尽管这些工作场所的决策者往往有促进工人健康的动机，但他们通常没有专门的健康工作人员，在实施EBI时面临三个主要障碍：1）缺乏对EBI潜在好处的认识，2）缺乏选择EBI的知识，3）缺乏实施EBI的财务和人力资源。非营利组织和其他帮助这些工作场所的人也面临着自己的障碍。组织实施EBI的准备程度还没有得到很好的理解，并且很少有有效的措施，特别是对于工作场所。如果没有可靠和有效的措施来衡量工作场所的准备情况，那些愿意帮助他们的人就很难：（a）确定准备就绪的工作场所，以及（B）帮助决策者做好准备，以增加实施成功的可能性。拟议的研究将解决这两组障碍，并有助于传播和实施研究，通过测试的工作场所EBI传播计划，健康链接，与美国癌症协会，一个非营利组织在全国范围内运作的合作伙伴关系开发的有效性。“健康链接”以创新传播框架和创新传播理论为基础，通过为EBI提供免费的现场信息和建议，并通过提供免费的现场方案和临时工作人员协助实施，解决了小型和低工资工作场所的障碍。我们将通过3组随机对照试验测试HealthLinks。工作场所将接收1）HealthLinks，或2）HealthLinks的增强版，通过增加工人健康委员会来解决小型工作场所人员缺乏的问题，或3）在研究结束时接收HealthLinks的延迟对照组中服务。我们将在基线、12个月（干预期结束时）和24个月（评估干预结束后一年的维护情况）时测量工作场所的EBI实施情况。这项设计将测试健康链接和工人健康委员会的有效性。我们还将在基线、12个月和24个月时测量两者对工人健康行为的影响。最后，我们将开发，试点测试，并验证工作现场准备实施EBI的措施。

DESCRIPTION (provided by applicant): Cancer and other chronic diseases are leading killers and disablers in the United States, and low-income Americans are at high risk for these diseases. Multiple evidence-based interventions (EBIs) exist to improve chronic disease risk behaviors, such as cancer screening, healthy eating, physical activity, and tobacco cessation, yet EBI reach to community settings is poor. Among community settings for reaching low-income adults, worksites stand out because most low-income adults are employed, but worksite implementation of health-promoting EBIs is low. Half of American workers work in small or low-wage worksites, where implementation of these EBIs and readiness to implement are especially low. Even though decision-makers at these worksites are often motivated to promote worker health, they usually have no dedicated wellness staff and face three major barriers in implementing EBIs: 1) lack of awareness of the potential benefits of EBIs, 2) lack of knowledge to choose EBIs, and 3) lack of financial and personnel resources to implement EBIs. Non- profit organizations and others who would assist these worksites face their own barriers. Organizational readiness to implement EBIs is not well understood, and few validated measures are available, especially for worksites. Without reliable and valid measures of worksite readiness, those who would assist them have difficulty: a) identifying worksites that are ready, and b) helping decision-makers get ready to increase their odds of implementation success. The proposed research will address both sets of barriers and contribute to dissemination and implementation research by testing the efficacy of a worksite EBI dissemination program, HealthLinks, developed in partnership with the American Cancer Society, a non-profit organization operating nationwide. HealthLinks is based on diffusion of innovations framework and diffusion of innovations theory and addresses small and low-wage worksites' barriers by providing free on-site information and recommendations for EBIs and by providing free on-site programs and temporary staffing to assist implementation. We will test HealthLinks via a 3-arm randomized controlled trial. Worksites will receive either 1) HealthLinks, or 2) an enhanced version of HealthLinks that addresses small worksites' lack of personnel by adding worker wellness committees, or will 3) serve in a delayed control group that receives HealthLinks at study end. We will measure worksites' EBI implementation at baseline, 12 months (at the end of the intervention period), and 24 months (to assess maintenance one year after the intervention ends). This design will test the effectiveness of both HealthLinks and of worker wellness committees. We will also measure the effect of both on workers' health behaviors at baseline, 12 months, and 24 months. Finally, we will develop, pilot-test, and validate a measure of worksite readiness to implement EBIs.