Testing scalable, IVR-supported cancer prevention interventions in the rural Alabama Black Belt

定期的体力活动（PA）与降低几种癌症（乳腺癌，结肠癌，子宫内膜癌）的风险有关 .然而，大多数 美国人不活跃，特别是在南方腹地。癌症发病率/死亡率也普遍较高， 该地区，服务不足（农村，非洲裔美国人）人口报告的PA更少， 癌症负担与文化、与公共行政设施的距离、收入、识字率和互联网连接有关的因素 在南方腹地，可能会限制对PA信息/资源的访问，并导致现有的癌症差异。 电话支持的干预措施在增加PA方面取得了成功，不需要诊所访问，识字， 或昂贵的技术，因此可能代表一种有前途的战略，促进PA的癌症风险降低， 南方腹地，特别是当自动化与交互式语音应答（IVR）系统，以提高成本- 有效性和范围。因此，我们采用了现有的IVR系统，在过去的艾滋病毒研究中使用，为PA宣传 通过广泛的文献综述和形成性研究，在南方腹地进行癌症预防[11焦点 关于PA干预需求/偏好的小组与南方癌症控制网络社区健康 顾问（CHAs）和社区成员。由此产生的深南IVR支持的主动 生活方式（拨号）干预！（R 03 CA 177538）发现第12周时保持率和参与者满意度较高。 此外，与DIAL相比，DIAL从基线到12周的MVPA增加幅度更大（每周增加42.5分钟） 等待名单控制，沿着PA自我调节和社会支持的显著改善。结果 在知情的情况下加强干预措施，为在农村各州推广做准备 （使用IVR发起的呼叫和腕带来促进依从性;进一步针对未改变的社会认知 理论结构;纳入更多的人际、社区/组织和政策层面的战略， 加强鼓励和问责，评估和解决建筑环境问题）。 目前的研究将涉及一项完善的、多水平的12个月完全把握度的随机对照试验。 DIAL干预与候补控制条件（N=240农村，主要是非洲裔美国成年人）。招聘 将由黑带县的南方癌症控制CHAs网络领导（自2009年以来参与该项目）。 初步形成性研究）。主要目的包括检查中等强度或 从基线到6个月和12个月，有氧体力活动增加。探索性目标包括检查 干预对身体表现和心理社会变量的影响;从12岁到20岁的身体活动变化 18个月;干预费用;潜在的调解人（来自家人、朋友、CHA的社会支持）和主持人 治疗效果（邻里/环境特征）;以及广泛传播的潜在障碍/促进因素 由南方腹地癌症控制网络在农村黑带县实施DIAL干预。 !

Regular physical activity (PA) is linked to lower risk for several cancers (breast, colon, endometrial) . Yet, most Americans are inactive, particularly in the Deep South. Cancer incidence/mortality is also generally higher in this region, with underserved (rural, African American) populations reporting even less PA and disproportionate cancer burden. Factors related to culture, distance from PA facilities, income, literacy, and Internet connectivity in the Deep South may limit access to PA information/resources and contribute to existing cancer disparities. Telephone-supported interventions have shown success in increasing PA, do not require clinic visits, literacy, or costly technology, and thus may represent a promising strategy for promoting PA for cancer risk reduction in the Deep South, especially when automated with Interactive Voice Response (IVR) systems for improved cost- effectiveness and reach. Thus, we adapted an existing IVR system, used in past HIV studies, for PA promotion and cancer prevention in the Deep South through extensive literature review and formative research [11 focus groups on PA intervention needs/preferences with Deep South Network For Cancer Control community health advisors (CHAs) and community members]. A pilot trial of the resulting Deep south IVR-supported Active Lifestyle (DIAL) intervention!(R03CA177538) found high retention and participant satisfaction at 12 weeks. Moreover, DIAL produced larger increases in MVPA (42.5 more min/week) from baseline to 12 weeks than a waitlist control, along with significantly greater improvements in PA self-regulation and social support. Results have informed intervention enhancements in preparation for scale up and dissemination in rural counties (using IVR-initiated calls and wristbands to facilitate adherence; further targeting unchanged Social Cognitive Theory constructs; incorporating more interpersonal, community/organizational and policy level strategies for increased encouragement and accountability and to assess and address built environment). The current study will involve a fully powered randomized controlled trial of the refined, multi-level 12 month DIAL intervention with a waitlist control condition (N=240 rural, mostly African American adults). Recruitment will be led by Deep South Network for Cancer Control CHAs in Black Belt counties (involved in project since initial formative research). Primary aims include examining arm differences in changes in moderate intensity or greater aerobic physical activity from baseline to 6 and 12 months. Exploratory aims include examining intervention effects on physical performance and psychosocial variables; changes in physical activity from 12- 18 months; intervention costs; potential mediators (social support from family, friends, CHAs) and moderators of treatment efficacy (neighborhood/ environmental features); and potential barriers/facilitators to widespread implementation of DIAL intervention in rural Black belt counties by Deep South Network for Cancer Control. !