Adapting Online Obesity Treatment for Primary Care Patients in Poverty

项目摘要 贫困影响着美国3700多万人，使他们受到群聚、相互促进的共同特征的影响 由社会经济不平等引起并使之永久化的流行病，如肥胖、糖尿病和抑郁症。集合体 理论强调了一种通过干预集群内的单个目标来缓解综合征的途径。肥胖率高 贫困患病率；在增加主要死亡原因(如心血管疾病、癌症、痴呆症)方面的作用；以及 不利的心理社会影响(例如，抑郁症加重)使其成为关键的、高度优先的目标。虽然结构性和社会性 贫困人口肥胖的因素，研究表明个人层面的干预在改善肥胖方面的有效性 对超负荷人群的需求做出高度反应时的健康行为和体重。同时，有证据表明 指导改进干预措施的工作很少，因为处于社会经济劣势的参与者在 肥胖症治疗研究。为了反映这一现象，全自动在线肥胖症治疗软件Rx Weight Lighting已经 在低收入患者中使用有限，尽管过去的研究表明，它可以通过 低成本的初级保健。由于72.8%的贫困成年人通常有初级保健提供者，83%的人有互联网 获取，这一采用差距代表着通过调整RxWL来影响公共卫生的重大机会 增加了与传统上服务不足的人群的相关性。此外，这项研究有望填补以下方面的关键空白 肥胖症治疗文献。因此，本申请旨在修改RxWL的内容和初级保健的流程 提供者向患者推荐该计划(统称为“RxWL包”)以最大化响应性， 为贫困人口提供可及和有效的服务。本项目采用混合方法进行数据收集，构建研究结构 使用社交营销评估和响应工具(SMART)的活动，并检查实施结果 由实施研究综合框架(CFIR)确定。初级保健提供者(n=23)和 患者(n=16)利益相关者将提供对现有RxWL包的反馈(目标1)；洞察力和科学 将整合知识以产生低成本的RxWL包原型(即，带有嵌入链接的PDF 接近预期计划)用于可用性测试(n=8个提供商，10个患者；目标2)；数据将驱动 制定最终的RxWL包，通过初级保健传播并在公开试验中进行评估(n=12 提供者，32名患者；目标3)。AIM 3将检查实施情况和初步临床结果，包括 对体重减轻和综合征后遗症的影响；获得进一步完善的见解；并表明已准备好接受更大的R- 资助的临床试验。修订RxWL有很大潜力缩小来自社会经济领域的人的健康差距 弱势群体背景。此外，调查结果将对关于招聘和培训的文献作出重大贡献 留住贫困患者的肥胖治疗研究；适应肥胖治疗的独特需求 传统上服务不足的人群；以及健康的社会决定因素对肥胖治疗过程的影响。

Project Summary Poverty affects over 37 million individuals in the U.S., subjecting them to syndemics – clustered, mutually enhancing epidemics such as obesity, diabetes, and depression that arise from and perpetuate socioeconomic inequality. Syndemic theory underscores a pathway to mitigate syndemics by intervening on a single target within the cluster. Obesity’s high prevalence in poverty; role in increasing leading causes of death (e.g., cardiovascular disease, cancer, dementia); and adverse psychosocial effects (e.g., increased depression) make it a crucial, high priority target. While structural and social factors contribute to obesity in poverty, research shows the effectiveness of individual-level interventions in improving health behaviors and weight when highly responsive to overburdened populations’ needs. At the same time, evidence guiding refinement of interventions is sparse as participants with socioeconomic disadvantage are underrepresented in obesity treatment research. Reflecting this phenomenon, Rx Weight Loss, a fully automated online obesity treatment, has seen limited use among patients with low income despite past work showing it can be delivered effectively through primary care at low cost. Since 72.8% of adults in poverty have a usual primary care provider, and 83% have Internet access, this gap in adoption represents a significant opportunity for public health impact through adaptation of RxWL that increases relevance for traditionally underserved populations. Further, this research is poised to fill a critical gap in obesity treatment literature. Thus, this application aims to revise RxWL content and the process by which primary care providers refer patients to the program (referenced collectively as the “RxWL package”) to maximize responsiveness, reach, and effectiveness for those in poverty. Using mixed methods data collection, this project structures research activities using the Social Marketing Assessment and Response Tool (SMART) and examines implementation outcomes identified by the Consolidated Framework for Implementation Research (CFIR). Primary care provider (n = 23) and patient (n = 16) stakeholders will provide feedback on the existing RxWL package (Aim 1); insights and scientific knowledge will be integrated to produce a low-cost RxWL package prototype (i.e., a PDF with embedded links approximating the intended program) for usability testing (n = 8 providers, 10 patients; Aim 2); and data will drive development of a finalized RxWL package to disseminate through primary care and evaluate in an open trial (n = 12 providers, 32 patients; Aim 3). Aim 3 will examine both implementation and preliminary clinical outcomes, including effects on weight loss and syndemic sequelae; obtain insights for further refinement; and indicate readiness for a larger R- funded clinical trial. Revising RxWL holds high potential to reduce health disparities for those from socioeconomically disadvantaged backgrounds. Moreover, findings will make significant contributions to the literature on recruitment and retention of patients in poverty in obesity treatment research; adaptation of obesity treatment to fit the unique needs of traditionally underserved populations; and impact of social determinants of health on the course of obesity treatment.