Reducing Health Disparity in AA Women: Physical Activity Adherence

摘要 尽管已知有这些好处，但大多数人并没有达到推荐的体力活动(PA)水平。 总体而言，非裔美国女性的PA水平最低，这导致在 心血管健康、糖尿病和抑郁症状。迫切需要研究如何 在非裔美国女性中推广有吸引力的、适用于临床实践和具有成本效益的PA。 这项临床试验的目的是测试我们重新设计的妇女步行计划(WWP)的疗效， 由生活方式PA处方和团体访问交付模式组成，带或不带定制电话 小组访问之间的联系，以增加对PA的遵守和改善健康结果。两部电话 联系策略将与无电话控制条件进行比较：个人管理的联系 使用简短的激励性面试的策略和使用电话计算机的自动联系策略- 链接系统。小组访问和电话联系旨在通过以下方式增加对生活方式PA的遵守 强调每天在基线上积累3000步。本研究的目的是(1)比较 WWP PLUS的初步(采用24周)和较长期(维护第二个24周)有效性 个人管理的电话联系人，WWP加上自动电话联系人，以及不带WWP的WWP 电话联系(A)增加对生活方式PA的坚持，(B)改善健康结果(有氧健身， 身体成分，抑郁症状)，(C)提高自我效能和结果预期；和(2) 比较三种电话治疗条件与坚持生活方式PA的成本效益 和健康结果。这项研究是一项随机整群拉丁方临床试验，随机分配 向6个社区卫生保健中心实施三种治疗条件的顺序。这六个人 中心在种族、社会经济地位和居住流动性方面都是相似的。非裔美国人 288名年龄在40岁至65岁之间的女性，她们久坐不动，没有主要的心血管症状或体征 疾病和无心肌梗死、中风或胰岛素依赖型糖尿病病史将在 社区保健中心方圆3英里。数据将在基线、24周和48周收集 每周使用多项PA测量；有氧健身测试；BMI；腰围；抑郁症状； 克服障碍的自我效能感；以及结果预期。我们预计(A)坚持生活方式 PA，因此健康结果将改善，自我效能感和结果预期将在 与没有电话联系的WWP相比，WWP有电话联系的补充；和(B) WWP加自动电话联系将比WWP加人工管理更具成本效益 电话联系人。这项研究将有助于确定一种可报销、实用的方式来交付 临床环境中的行为改变干预，将增加对PA的依从性，并具有吸引力和 吸引非裔美国女性。

Abstract Despite the known benefits, most individuals do not achieve the recommended levels of physical activity (PA). Overall, African American women have the lowest PA levels, which contributes to substantial disparities in cardiovascular health, diabetes, and depressive symptoms. There is a pressing need to examine ways to promote PA in African American women that are appealing, applicable to clinical practice, and cost-effective. The purpose of this clinical trial is to test the efficacy of our reframed Women's Walking Program (WWP), consisting of a lifestyle PA prescription and "group visit" delivery model, with or without tailored telephone contacts between group visits for increasing adherence to PA and improving health outcomes. Two telephone contact strategies will be compared against a no-telephone control condition: a person-administered contact strategy using brief motivational interviewing and an automated contact strategy using a telephone computer- linked system. Group visits and telephone contacts are designed to increase adherence to lifestyle PA with an emphasis on accumulation of 3,000 steps daily over baseline. The aims of this study are (1) to compare the initial (adoption 24 weeks) and longer-term (maintenance 2nd 24 weeks) effectiveness of the WWP plus person-administered telephone contacts, WWP plus automated telephone contacts, and the WWP without telephone contacts on (a) increasing adherence to lifestyle PA, (b) improving health outcomes (aerobic fitness, body composition, depressive symptoms), (c) improving self-efficacy and outcome expectations; and (2) to compare cost-effectiveness of the three telephone treatment conditions in relation to adherence to lifestyle PA and health outcomes. The study is a randomized cluster Latin Squares clinical trial with random assignment of the order of administering the three treatment conditions to six community health care centers. These six centers are similar with respect to race, socioeconomic status, and residential mobility. African American women (n = 288) aged 40 to 65 years, who are sedentary with no major signs or symptoms of cardiovascular disease and no history of myocardial infarction, stroke, or insulin-dependent diabetes will be recruited within a 3-mile radius of the community health care centers. Data will be collected at baseline, and at 24 weeks and 48 weeks using multiple measures of PA; aerobic fitness testing; BMI; waist circumference; depressive symptoms; self-efficacy for overcoming barriers; and outcome expectations. We anticipate that (a) adherence to lifestyle PA and therefore health outcomes will improve and self-efficacy and outcome expectations will be higher in the WWP complemented with telephone contacts compared to the WWP without telephone contacts and (b) the WWP plus automated telephone contact will be more cost-effective than WWP plus person-administered telephone contacts. This study will contribute to identifying a reimbursable, practical way of delivering a behavioral change intervention in clinical settings that will increase adherence to PA and be attractive and appealing to African American women.