Family obesity intervention: Motivational Interviewing and community support

描述（由申请人提供）：低收入儿童和肥胖父母的儿童肥胖的风险很高。需要采取有效的干预措施，以改善这些家庭的状况。 父母的健康和预防儿童肥胖。假设是，结合社区组织的参与，动机访谈（MI，一种被证明可以帮助人们设定对个人有意义的目标的技术）和资源动员的干预措施将改变弱势家庭的饮食和体育活动习惯。该提案源于研究团队与社区组织之间建立的基于社区的参与性研究（CBPR）伙伴关系，该伙伴关系为高少数民族（45-55%），低收入人群提供服务。合作伙伴包括一个社区卫生中心，一个食品储藏室网络，一个劳动力培训计划和其他机构。这些合作伙伴设计并实施了一个成功的试点项目，本建议就是以该项目为基础的。本建议的具体目标是：1） 评估基于MI和资源动员的以家庭为目标的肥胖干预的有效性。假设：与对照家庭相比，参与干预的家庭将证明：a）成人BMI降低，B）成人和儿童中等体力活动分钟数增加，久坐时间减少（加速度计），以及c）儿童肥胖风险行为数量减少，肥胖预防行为增加。2)探讨干预效应的中介物。3)确定采取干预措施的家庭为支持改变生活方式最经常需要的资源类型。这项随机对照试验包括260个低收入家庭，其中至少有一个肥胖的成年人和一个正常或超重的6至12岁的儿童。为期12个月的干预措施有两个要素。1)健康教练将使用MI来帮助家庭探索改变的矛盾心理和动机，并设定改善饮食和体育活动的目标。2)为了支持这些目标，家庭将与社区机构建立联系，这些机构可以帮助实现一般目标（例如，财务）和目标特定资源（例如，食物、体力活动机会）。各组织之间的合作将简化转介程序，最大限度地利用资源，并便利获得服务。对照家庭将获得一个基本的屏幕，了解有关可用社区资源的需求和信息。在基线、6、12和18个月时测量结局。这种干预措施是创新的，因为它1）侧重于整个家庭的生活方式的改变，并衡量成人和儿童的结果，2）结合MI侧重于整个家庭和社区资源转介特定的家庭需求和目标的变化，3）合作伙伴社区组织协调家庭的资源，以及4）通过CBPR方法在所有研究阶段涉及合作伙伴。这一贡献将是重大的，因为拟议的干预措施如果成功，可以在其他地方推广，并适应当地的资源环境，以解决成人肥胖问题，并预防高危人群中的儿童肥胖。该研究还将确定低收入家庭需要改变饮食和体育活动的资源类型。

DESCRIPTION (provided by applicant): Low-income children and children of obese parents are at high risk of obesity. Effective interventions are needed to target these families to improve the health of the parents and prevent obesity in the children. The hypothesis is that an intervention that combines engagement of community organizations, motivational interviewing (MI, a technique proven to help people set goals that are personally meaningful), and resource mobilization will change diet and physical activity habits among disadvantaged families. This proposal grew from an established community-based participatory research (CBPR) partnership between the research team and community organizations that serve high minority (45-55%), low-income populations. Partners include a community health center, a food pantry network, a work-force training program, and other agencies. These partners designed and implemented a successful pilot project on which this proposal is based. The specific aims of this proposal are 1) to evaluate the efficacy of a family-targeted obesity intervention based on MI and resource-mobilization. Hypotheses: In comparison to control families, families participating in the intervention will demonstrate a) a reduction in BMI for adults, b) an increase in minutes of moderate physical activity and decreased sedentary time for both adults and children (accelerometer), and c) a reduction in the number of obesity risk behaviors and an increase in obesity prevention behaviors among children. 2) To examine the mediators of intervention effects. 3) identify the types of resources needed most often by intervention families to support lifestyle change. This randomized controlled trial includes 260 low-income families that contain at least one obese adult and one normal or overweight child between 6 and 12. The 12-month intervention has two elements. 1) A health coach will use MI to help families explore ambivalence toward and motivations for change and set goals for improving diet and physical activity. 2) To support goals, families will be connected with community agencies that can assist with general (e.g., financial) and goal specific resources (e.g., food, physical activity opportunities). Collaboration between organizations will streamline referrals, maximize resources, and facilitate access. Control families will get a basic screen for needs and information about available community resources. Outcomes are measured at baseline, 6, 12, and 18 months. This intervention is innovative in that it 1) focuses on lifestyle changes for the entire family and measures outcomes in adults and children, 2) combines MI focused on the entire family and community resource referrals specific to family needs and goals for change, 3) partners community organizations to coordinate resources for families, and 4) involves partners in all research phases via a CBPR approach. This contribution will be significant because the proposed intervention, if successful, can be replicated elsewhere and adapted to the local resource environment to address adult obesity and prevent childhood obesity in a high-risk population. The study will also identify the types of resources low-income families need to change diet and physical activity.