Peer-support motivational interviewing PA intervention for African American women

描述（由申请人提供）：PA的健康益处被广泛接受，有助于降低心血管疾病、糖尿病、中风、肥胖和某些癌症的风险。建议在一周的大部分时间里每天运动30分钟，然而，有一半的成年人不运动，少数种族和少数民族妇女的不运动率更高。《社区预防服务指南》发现，社会支持干预措施在增加PA方面是有效的。因此，本研究旨在检验一种新颖的“文化适当的同伴动机访谈”（CAPMI）干预的可行性和有效性，该干预以行为技能、沟通和社会支持为目标，提高久坐不动的非裔美国人（AA）女性的PA。CAPMI的主要理论基础是社会影响在行为改变过程中的作用。家人、朋友和支持他人的人会对一个人的动机、偏好、行为和结果产生影响。因此，在行为改变研究中明确需要以自然网络为目标。动机性访谈（MI）是一种可以帮助个人提高从支持他们的人那里得到的支持质量的方法。MI的重点是通过使用移情、鼓励和非对抗性的方法，减少改变的障碍，解决对特定行为的矛盾心理，从而帮助个人增加动机。这种方法已广泛用于成瘾研究，但在改善其他健康行为（如饮食和PA）以及少数群体中也显示出希望。提出的干预措施的主要目标是检查使用动机访谈技术促进更好的互惠社会支持的功效。具体目的是：(1)采用半结构化的深度访谈和焦点小组对久坐不动的AA女性进行形成性研究，探讨社会支持对PA的作用和重要性；(2)确定在久坐不动的AA女性中招募和实施CAPMI的可行性；(3)与注意控制组比较，对CAPMI在干预后提高自我感受、社会支持、自我效能感和减少自我感受障碍方面的效果进行试点测试和评估。在自然非亲密组（即家庭成员或朋友）中招募的女性（N=80； 40对）将被随机分配到CAPMI中：(1)基于同伴的MI和行为技能（如设定目标和解决问题）培训；(2)自助材料（如练习册、培训DVD和PA通讯）；(3)计步器;或注意力控制（AC）：(1)自助材料（仅限PA通讯）；(2)计步器。在干预开始之前，焦点小组和配对的半结构化深度访谈将与AA妇女进行，以检查PA的社会支持来源。干预组和对照组的参与者将在基线和基线后第4、8和12周四个时间点比较中等强度PA、社会支持和PA障碍的自我报告分钟数。我们还提出了使用RE-AIM框架进行过程评估的简要计划，以确定干预措施的范围、有效性和实施情况。公共卫生相关性：非亲密的自然网络，即家庭成员/朋友，可以在增加非裔美国妇女的身体活动（PA）中发挥重要作用。所提出的文化上合适的同伴提供的心理干预（CAPMI）旨在通过增强同伴为心理干预提供的动机和支持类型来解决这一问题。本研究的目标是通过开发针对AA女性社会资源的预防干预措施，最终减少癌症的种族/民族差异，并提高我们对如何使女性从久坐不动到达到PA建议的癌症预防的知识。

DESCRIPTION (provided by applicant): The health benefits of PA are widely accepted, aiding in reducing the risk of cardiovascular disease, diabetes, stroke, obesity, and some cancers. Recommendations are to engage in 30 minutes a day on most days of the week, however, < of adults are inactive with higher rates of inactivity among racial and ethnic minority women. The Guide to Community Preventive Service found social support interventions to be effective in increasing PA. Therefore, the proposed study seeks to examine the feasibility and efficacy of a novel "Culturally-Appropriate Peer-based Motivational Interviewing" (CAPMI) intervention that targets behavioral skills, communication and social support for increasing PA in sedentary African American (AA) women. The overarching theoretical rationale for CAPMI centers on the role of social influence in the behavior change process. Family, friends and supportive others exert influence on one's motives, preferences, behaviors, and outcomes. As such, there is a clear need to target natural networks in behavior change studies. Motivational Interviewing (MI) is an approach that may help individuals enhance the quality of support given and received from their supportive others. MI focuses on helping individuals increase motivation by reducing barriers to change and resolving ambivalence for a given behavior by using empathy, encouragement, and non- confrontational methods. This method has been used extensively in addiction studies, but is showing promise for improving other health behaviors such as diet and PA, and among minority populations. The primary goal of the proposed intervention is to examine the efficacy of using motivational interviewing techniques to foster better reciprocal social support. Specific aims are: (1) to conduct formative research using semi-structured in- depth interviews and focus groups with sedentary AA women to investigate the role and importance of social support for PA; (2) to determine the feasibility of recruiting and implementing CAPMI in sedentary AA women; and (3) to pilot test and evaluate the efficacy of the CAPMI in increasing PA, social support, self-efficacy and reducing barriers to PA at post-intervention compared to an attention control group. Women (N=80; 40 dyads) recruited in natural non-intimate dyads (i.e., family members or friends) will be randomly assigned to either the CAPMI: (1) peer-based MI and behavioral skills (e.g., goal setting and problem solving) training; (2) self-help materials (e.g., workbook, training DVD and PA newsletters); (3) pedometer; or Attention Control (AC): (1) self- help materials (PA newsletter only); (2) pedometer. Prior to the start of the intervention, focus groups and paired semi-structured in-depth interviews will be conducted with AA women to examine sources of social support for PA. Intervention and control participants will be compared on minutes of self-report moderate- intensity PA, social support, and PA barriers at four time-points: baseline and Weeks 4, 8, and 12 post-baseline. We also propose a brief plan of process evaluation using the RE-AIM framework to determine reach, efficacy, and implementation of the intervention. Public Health Relevance: Non-intimate natural networks, i.e., family members/friends, can play a major role in increasing physical activity (PA) in African American women. The proposed culturally- appropriate peer-delivered MI intervention (CAPMI) is designed to address this issue by enhancing the type of motivation and support that peers provide for PA. The goal of this study is to ultimately reduce racial/ethnic disparities in cancer by developing prevention interventions that address AA women's' social resources, and to enhance our knowledge of how to move women from being sedentary to meeting PA recommendations for cancer prevention.