Peer-Led Healthy Lifestyle Program in Supportive Housing

描述（由申请人提供）：此申请响应RFA-MH-14-060。本研究的目的是检验同伴主导的健康生活方式干预（Peer GLB）在不同类型的超重或肥胖严重精神疾病（SMI）患者的支持性住房机构中的实施效果。重度精神障碍患者患肥胖症的风险是普通人群的两倍。少数民族血统会增加风险。与患有重度精神疾病的非拉丁裔白人相比，患有重度精神疾病的非裔美国人和拉丁裔美国人肥胖和心血管疾病的风险更高。来自糖尿病预防计划的群体生活方式平衡（GLB）是一种既定的健康生活方式干预，对一般人群有效，可实现临床显著的体重减轻（体重减轻5%）。在本研究中，我们的目标是通过以下方式提高GLB的覆盖范围：1)通过在支持性住房机构提供这种干预措施，将这种干预措施带到人们的家门口；2)利用同侪专家（有SMI生活经验的前客户）作为调解人，以解决经济和人员需求；3)确定能够促进在社区环境中使用这种干预措施的实施因素。我们建议采用混合1型随机对照试验设计来测试支持性住房机构中同伴GLB与常规护理的有效性，并检查多层次实施因素。同侪GLB课程为期12个月，由房屋中介的同侪专家提供。在基线和随机化后6、12和18个月进行重复评估。为了检验Peer GLB的实施情况，我们将对背景因素进行一项混合方法研究，在我们的试验实施之前和试验招募结束后，从住房中介的主管、项目经理、员工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.