Family obesity intervention: Motivational Interviewing and community support

描述(申请人提供)：低收入儿童和肥胖父母的儿童肥胖的风险很高。需要有效的干预措施来针对这些家庭，以改善 保护父母的健康，预防儿童肥胖。这个假设是，结合社区组织的参与、激励性访谈(MI，一种被证明可以帮助人们设定对个人有意义的目标的技术)和资源动员的干预措施，将改变弱势家庭的饮食和体育活动习惯。这一建议源于研究团队和社区组织之间建立的基于社区的参与性研究(CBPR)伙伴关系，这些组织服务于高少数民族(45%-55%)、低收入人口。合作伙伴包括一个社区健康中心、一个食品储藏室网络、一个劳动力培训计划和其他机构。这些伙伴设计并实施了一项成功的试点项目，这项提案就是以此为基础的。这项建议的具体目标是1) 评价以MI和资源动员为基础的家庭定向肥胖干预的效果。假设：与对照家庭相比，参与干预的家庭将证明：a)成年人的BMI减少，b)成年人和儿童适度体育活动的分钟数增加，坐着的时间减少(加速计)，c)肥胖危险行为的数量减少，儿童的肥胖预防行为增加。2)考察影响干预效果的中介因素。3)确定干预家庭最常需要的支持生活方式改变的资源类型。这项随机对照试验包括260个低收入家庭，其中至少有一个肥胖成年人和一个6至12岁的正常或超重儿童。为期12个月的干预包括两个因素。1)健康教练将使用MI来帮助家庭探索对变化的矛盾心理和动机，并为改善饮食和体力活动设定目标。2)为了支持目标，家庭将与社区机构建立联系，这些机构可以在一般资源(如财政资源)和具体目标资源(如食物、体育活动机会)方面提供援助。组织之间的协作将简化推荐、最大限度地利用资源并促进访问。控制家庭将获得有关可用社区资源的需求和信息的基本屏幕。在基线、6个月、12个月和18个月时测量结果。这一干预措施的创新之处在于：1)关注整个家庭的生活方式变化，并衡量成人和儿童的结果；2)结合以整个家庭为重点的MI和针对家庭需求和变化目标的社区资源转介；3)合作伙伴社区组织协调家庭资源；4)通过CBPR方法让合作伙伴参与所有研究阶段。这一贡献将是巨大的，因为拟议的干预措施如果成功，可以在其他地方复制，并适应当地的资源环境，以解决成人肥胖问题，并在高危人群中预防儿童肥胖。该研究还将确定低收入家庭改变饮食和体力活动所需的资源类型。

DESCRIPTION (provided by applicant): Low-income children and children of obese parents are at high risk of obesity. Effective interventions are needed to target these families to improve the health of the parents and prevent obesity in the children. The hypothesis is that an intervention that combines engagement of community organizations, motivational interviewing (MI, a technique proven to help people set goals that are personally meaningful), and resource mobilization will change diet and physical activity habits among disadvantaged families. This proposal grew from an established community-based participatory research (CBPR) partnership between the research team and community organizations that serve high minority (45-55%), low-income populations. Partners include a community health center, a food pantry network, a work-force training program, and other agencies. These partners designed and implemented a successful pilot project on which this proposal is based. The specific aims of this proposal are 1) to evaluate the efficacy of a family-targeted obesity intervention based on MI and resource-mobilization. Hypotheses: In comparison to control families, families participating in the intervention will demonstrate a) a reduction in BMI for adults, b) an increase in minutes of moderate physical activity and decreased sedentary time for both adults and children (accelerometer), and c) a reduction in the number of obesity risk behaviors and an increase in obesity prevention behaviors among children. 2) To examine the mediators of intervention effects. 3) identify the types of resources needed most often by intervention families to support lifestyle change. This randomized controlled trial includes 260 low-income families that contain at least one obese adult and one normal or overweight child between 6 and 12. The 12-month intervention has two elements. 1) A health coach will use MI to help families explore ambivalence toward and motivations for change and set goals for improving diet and physical activity. 2) To support goals, families will be connected with community agencies that can assist with general (e.g., financial) and goal specific resources (e.g., food, physical activity opportunities). Collaboration between organizations will streamline referrals, maximize resources, and facilitate access. Control families will get a basic screen for needs and information about available community resources. Outcomes are measured at baseline, 6, 12, and 18 months. This intervention is innovative in that it 1) focuses on lifestyle changes for the entire family and measures outcomes in adults and children, 2) combines MI focused on the entire family and community resource referrals specific to family needs and goals for change, 3) partners community organizations to coordinate resources for families, and 4) involves partners in all research phases via a CBPR approach. This contribution will be significant because the proposed intervention, if successful, can be replicated elsewhere and adapted to the local resource environment to address adult obesity and prevent childhood obesity in a high-risk population. The study will also identify the types of resources low-income families need to change diet and physical activity.