Increasing uptake of behavioral weight loss programs among primary care patients

 这项拟议的K23奖项的目的是为Megan McVay博士作为一名独立科学家的职业生涯做好准备，研究以患者为导向的方法，以增加肥胖成年人对循证体重管理治疗的参与。McVay博士将获得定性研究方法，数字健康干预研究以及在初级保健环境中进行实用临床试验等领域的培训。候选人和她的导师制定了一个五年计划，以获得这些领域的培训，其中包括课程作业，讲习班和出席国家会议。McVay博士将与她的主要导师Corrine Voils博士和她的共同导师加里班尼特博士和William Yancy博士密切合作，他们共同拥有国内和国际公认的行为减肥治疗，定性研究，干预开发，基于初级保健的临床试验和数字健康干预的专业知识。拟议的研究和培训将在杜克大学医学中心资源丰富的环境中进行。目前提出的研究通过开发和测试通过初级保健环境提供的干预措施，解决了循证行为减肥治疗效果不佳的问题。具体而言，提出了一种基于网络的干预，由患者远程完成，在临床访问之前。干预内容将根据我们的概念模型进行个性化定制，并将针对治疗启动的决定因素，该模型广泛借鉴了健康信念模型。远程干预的交付可以允许更多的患者接受基于证据的体重咨询，同时最大限度地减少对诊所时间和空间的额外需求。干预开发的第一步是更好地表征健康信念模型结构，因为它们与初级保健人群中的减肥治疗启动有关，这将通过焦点小组完成（目标1）。接下来，目标1的数据将用于制定干预措施内容和干预措施网站（次级目标2.a.）。将通过可用性测试和干预后患者定性访谈对干预的初步版本进行完善（子目标2.b.）通过对小学生的定性访谈， 护理提供者（次级目标2c）。最后，将进行一项试点、务实的群集随机试验 在初级保健诊所，以确定干预的可接受性和拟议的研究方案的可行性（目标3）。在奖项任期结束时，申请人将准备提交NIH R01，以进行足够有力的，务实的临床试验，以测试干预措施在增加治疗开始和体重减轻方面的有效性。

 DESCRIPTION (provided by applicant): The objective of this proposed K23 award is to prepare Dr. Megan McVay for a career as an independent scientist studying patient-oriented approaches to increase engagement in evidence-based weight management treatment among adults with obesity. To this end, Dr. McVay will obtain training in the areas of qualitative research methods, digital health intervention research, and the conduct of pragmatic clinical trials in primary care settings. The candidate and her mentors have developed a five- year plan to obtain training in these areas that includes coursework, workshops, and attendance at national conferences. Dr. McVay will work closely with her primary mentor, Corrine Voils, PhD, and her co-mentors, Gary Bennett, PhD, and William Yancy, MD, who jointly have nationally and internationally recognized expertise in behavioral weight loss treatment, qualitative research, intervention development, primary care-based clinical trials, and digital health interventions. The proposed research and training will be conducted in the resource-rich environment of Duke University Medical Center. The currently proposed research addresses the problem of poor uptake of evidence-based behavioral weight loss treatment through the development and testing of an intervention delivered via the primary care setting. Specifically, a web-based intervention that is completed by patients remotely, prior to a clinical visit is proposed. The intervention content will be individually tailored and will target determinants of treatment initiation based on our conceptual model, which draws extensively on the Health Belief Model. The delivery of the intervention remotely may allow more patients to receive evidence-based weight counseling while minimizing additional demands on clinic time and space. The first step of intervention development is to better characterize Health Belief Model constructs as they relate to weight loss treatment initiation in a primary care population, which will be accomplished through focus groups (Aim 1). Next, data from Aim 1 will be used to develop intervention content and the intervention website (Sub-aim 2.a.). This preliminary version of the intervention will be refined through usability testing and post-intervention qualitative interviews with patients (Sub-aim 2.b.) and through qualitative interviews with primary care providers (Sub-aim 2c). Finally, a pilot, pragmatic cluster randomized trial will be conducted in primary care clinics to determine intervention acceptability and the feasibility of proposed study protocol (Aim 3). At the end of the award tenure, the applicant will be prepared to submit an NIH R01 to conduct an adequately powered, pragmatic clinical trial to test the effectiveness of the intervention in increasing treatment initiation and weight loss.