Enhancing Quality and Access to Lifestyle Counseling and Health Behavior Change

说明(申请人提供)：尽管不断努力，种族和族裔少数群体在卫生保健和结果方面仍然存在显著差异。持续的差异是由许多因素造成的，但质量不平等以及获得预防性护理和慢性病管理的机会减少是迫切需要注意的措施之一，以减少差异。卫生保健提供者(HCP)在帮助患者采取和维持健康的生活方式方面发挥着重要作用。但是，在提供关于改变生活方式和健康行为改变的建议和咨询的机会和质量方面存在差异。有许多基于证据的策略来促进健康行为的改变和在初级保健中提供生活方式咨询，但提供者可能不知道这些策略，对其在种族和少数民族中的有效性以及如何调整现有策略以满足患者的需求和偏好的了解有限。增加生活方式改变和健康行为改变咨询循证策略的转化的一种方法是在利益相关者中确定这些努力的优先事项和偏好，并制定基于实践的实施和评估计划，与这些优先事项和偏好以及实践中可用的资源保持一致。基于社区的参与性研究(CBPR)是一种方法，可以用来确定提供者和患者的优先事项和偏好是否以及在哪里趋同和分歧，就不同的问题达成共识，并制定基于实践的实施和评估计划，将现有的循证战略转化为护理。为了响应RFA-HS-13-010，通过传播和实施以患者为中心的结果研究(U18)来缩小医疗保健差距，我们建议开展一个示范项目，通过与初级保健项目和患者合作，使用CBPR来减少初级保健在质量和获得生活方式改变和健康行为改变咨询方面的差距。这项研究将分两个阶段实施。在第一阶段，我们将使用多层次战略来识别和合成基于证据的策略，以改变生活方式和健康行为，这些策略是通过系统的证据综合审查在种族和少数民族中有针对性地、制定或评估的，并确定和优先考虑在来自国家PBRN的不同初级保健实践的HCP和患者中提供和使用生活方式改变和健康行为咨询的关切和偏好。在第二阶段，我们将制定实施和评估计划，具体说明必要的程序、结果和资源，以将基于证据的生活方式改变和健康行为改变战略转化为初级保健，通过参与性规划和干预地图，与初级保健计划和PPRNet实践中的患者合作。我们还将评估在确定优先次序的过程中从PPRNet实践中吸收提供者和患者的过程，以及制定和传播执行和评估计划的过程。

DESCRIPTION (provided by applicant): Despite ongoing efforts, racial and ethnic minorities continue to experience significant disparities in health care and outcomes. Persistent disparities are due to many factors, but unequal quality and reduced access to preventive care and chronic disease management are among the measures that are in need of urgent attention to reduce disparities. Health care providers (HCP) play an important role in helping patients to adopt and maintain healthy lifestyle behaviors. But, there are disparities in access and quality of provider advice and counseling about lifestyle modification and health behavior change. There are many evidence-based strategies to promote health behavior change and provide lifestyle counseling in primary care, but providers may not be aware of these strategies, have limited understanding about their effectiveness in racial and ethnic minorities, and how to adapt existing strategies to meet the needs and preferences of patients. One way to increase the translation of evidence-based strategies for lifestyle modification and health behavior change counseling is to identify the priorities and preferences for these efforts among stakeholders and develop practice-based implementation and evaluation plans that are consistent with these priorities and preferences and the resources that are available in the practice. Community-based participatory research (CBPR) is an approach that can be used to determine if and where the priorities and preferences of providers and patients converge and diverge, reach consensus on divergent issues, and develop practice-based implementation and evaluation plans to translate existing evidence-based strategies into care. In response to RFA-HS-13-010, Closing the Gap in Healthcare Disparities through Dissemination and Implementation of Patient Centered Outcomes Research (U18), we propose to conduct a demonstration project that uses CBPR to reduce disparities in quality and access to lifestyle modification and health behavior change counseling in primary care by working collaboratively with HCPs and patients. This research will be implemented in two phases. During Phase I, we will use a multilevel strategy to identify and synthesize evidence-based strategies for lifestyle modification and health behavior change that were targeted, developed, or evaluated in racial and ethnic minorities through a systematic evidence synthesis review and identify and prioritize the concerns and preferences about the delivery and use of lifestyle modification and health behavior counseling among HCPs and patients from diverse primary care practices that are part of a national PBRN. In Phase II, we will develop implementation and evaluation plans that specify the procedures, outcomes, and resources that are necessary to translate evidence-based strategies for lifestyle modification and health behavior change into primary care collaboratively with HCPs and patients from PPRNet practices using participatory planning and intervention mapping. We will also evaluate the process of engaging provider and patient from PPRNet practices in the prioritization process and the development and dissemination of implementation and evaluation plans.