WOOP VA: Mental Contrasting With Implementation Intentions to Promote Weight Management in Primary Care

背景：大约40%的退伍军人患有肥胖症。集约化体重管理 节目如MOVE！促进临床显著减肥，但只有3%-7%的符合条件 退伍军人参加。注册人数低和人员流失率高是由于差旅、成本和 动力。经过20多年的研究，形成了与 实施意向(MCII)是一种新颖的、以证据为基础的干预措施，旨在提高动机 和行为的改变。MCII已被证明可以增加体力活动和消耗 水果和蔬菜，并促进减肥，我们最近证明了MCII是 对于退伍军人来说，体重管理是可行的和可以接受的。然而，还没有经过测试 退伍军人的体重没有在初级保健中得到充分的改善。我们建议 评估MCII在改变行为和减肥方面的有效性和实施情况 退伍军人在初级保健中与退伍军人事务部联合行动！程序。 意义/影响：这项建议符合退伍军人事务部HSRD的初级保健实践和 管理复杂慢性病“的资金重点。初级保健提供者和协议 会员没有提供足够的咨询来增加搬家的参与度！ 程序。MCII可以由业馀教育人员教授，也可以与MOVE一起教授！ 以及其他体重管理疗法。 创新：MCII在图像的使用上是创新的，非专业教育人员易于传达，新颖 行动机制(通过无意识的动机和认知过程)和能力 与其他项目相结合。退伍军人可以在10分钟内自行练习MCII。 MCII使用标准化的四步成像程序，称为Woop，可在30分钟内传授 几分钟。然后，退伍军人可以在Woop的帮助下继续定期使用Woop 包含基于视频、音频和纸质工具的应用程序和网站。这项研究将是第一次 初级保健中MCII的随机对照试验和第一个RCT以测试其疗效和 结合MOVE实现体重管理的MCII！在退伍军人中。 具体目标：1.比较MCII+MOVE的影响！VS.移动！仅按百分比重量计算 6个月和12个月时的变化和腰围。2.比较MCII+Move的影响！ VS.移动！独自行动！6岁和12岁的出勤率、体力活动和健康饮食 月份。3.评估MCII的实施情况。我们将使用覆盖范围、有效性、采用率、 实施、维护(RE-AIM)框架7、8评估实施障碍， 促进者和多边气候变化倡议的成果。 方法：我们将初级保健中的366名退伍军人随机分配到MCII+电话- 出手了！(干预)VS电话传递的举措！独自(控制)在曼哈顿 弗吉尼亚州在6个月和12个月时，参与者将返回诊所进行研究访问，在那里体重，饮食， 并对两组的体力活动进行评估。我们将使用意向治疗分析。 实施/后续步骤：MCII设计为可在各种环境中轻松实施 以及各种不同的行为。免费提供的在线培训材料将有助于 实施。为了指导未来的实施和政策变化，我们将从以下方面提供数据 我们的目标3实施分析并从经验丰富的利益攸关方以及当地获得意见 退伍军人和全国大会党领袖。如果被发现有效，我们将进行杂交 多点研究中的MCII有效性/实施研究。

Background: Approximately 40% of Veterans have obesity. Intensive weight management programs such as MOVE! promote clinically significant weight loss, but only 3-7% of eligible Veterans attend. Low enrollment and high attrition are due to obstacles such as travel, cost, and motivation. Developed through over 20 years of research, Mental Contrasting with Implementation Intentions (MCII) is a novel, evidence-based intervention to increase motivation and behavior change. MCII has been shown to increase physical activity and consumption of fruits and vegetables and promote weight loss, and we recently demonstrated that MCII is feasible and acceptable to Veterans for weight management. However, has not been tested adequately within primary care nor demonstrated weight loss in Veterans. We propose to evaluate the efficacy and implementation of MCII for behavior change and weight loss in Veterans within primary care when combined with the VA MOVE! Program. Significance/Impact: This proposal aligns with the VA HSRD “primary care practice and management of complex chronic diseases” funding priority. Primary care providers and PACT members do not provide sufficient counseling to increase engagement with the MOVE! Program. MCII can be taught by lay educators and can be delivered in conjunction with MOVE! and other weight management treatments. Innovation: MCII is innovative in its use of imagery, ease of delivery by lay educators, novel mechanisms of action (via non-conscious motivational and cognitive processes), and ability to be combined with other programs. Veterans can practice MCII on their own in under 10 minutes. MCII uses a standardized, 4-step imagery procedure called WOOP that can be taught in 30 minutes. Veterans can then continue to use WOOP regularly, with the assistance of a WOOP App and website containing video-, audio-, and paper-based tools. This study will be the first randomized controlled trial of MCII within primary care and the first RCT to test the efficacy and implementation of MCII for weight management when combined with MOVE! in Veterans. Specific Aims: 1. Compare the impact of MCII + MOVE! vs. MOVE! alone on percent weight change and waist circumference at 6 and 12 months. 2. Compare the impact of MCII + MOVE! vs. MOVE! alone on MOVE! attendance, physical activity, and healthy eating at 6 and 12 months. 3. Evaluate implementation of MCII. We will use the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework7,8 to evaluate implementation barriers, facilitators, and outcomes of MCII. Methodology: We will randomize 366 Veterans within primary care to either MCII + telephone- delivered MOVE! (intervention) vs. telephone-delivered MOVE! alone (control) at the Manhattan VA. At 6 and 12 months, participants will return to the clinic for a study visit where weight, diet, and physical activity will be assessed in both groups. We will use intention-to-treat analyses. Implementation/Next Steps: MCII is designed to be easily implemented in a variety of settings and for a variety of behaviors. Freely available online training materials will facilitate implementation. To guide future implementation and policy change, we will present data from our Aim 3 implementation analyses and obtain input from Veteran stakeholders as well as local VA and NCP leaders. If found to be efficacious, we will conduct hybrid effectiveness/implementation studies of MCII in a multi-site study.