MOVE!+UP: Improving MOVE! for Veterans with PTSD Using Peer Support

描述（由申请人提供）： 背景资料：凯瑟琳赫斯特，博士，公共卫生硕士是一个工作人员心理学家与弗吉尼亚州普吉特湾西雅图（VAPS）和代理助理教授与华盛顿大学（UW）精神病学和行为科学系。Hoerster博士已证明致力于进行VA研究，重点是改善患有PTSD的退伍军人的健康和福祉。拟议的职业发展奖（CDA-2）将确保Hoerster博士将发展必要的技能和专业知识，成为一名独立的卫生服务研究人员，致力于改善对患有精神疾病的退伍军人的护理。职业发展计划：拟议的CDA-2的重点是研究一个同伴主导的行为体重管理干预，增强VA的现有体重管理计划（移动!）对于患有PTSD的退伍军人：MOVE!+ UP（改进移动!为退伍军人与创伤后应激障碍使用同侪支持）。移动!+ UP将在MOVE!的第一个月由付费的同伴支持顾问在4个小组会议中提供，并将涉及学习基本的焦虑管理技能和从事以社区为基础的体育活动，以解决障碍（例如，高度警惕）。四个双周简短的电话咨询会议将在移动后举行!+ UP的小组结束，并将专注于保持收益和解决问题的障碍。提出这种干预措施是因为患有创伤后应激障碍的退伍军人经历1）由于不活动和不健康的饮食，肥胖和相关疾病的发生率很高; 2） 降低MOVE!和3）身体活动和健康饮食的独特障碍。社会支持缓冲了这些障碍，以体力活动和健康的饮食为退伍军人与创伤后应激障碍，和退伍军人与创伤后应激障碍赞同与同龄人在这些问题上的强烈偏好。除了潜在的健康行为和减肥益处外，MOVE!+ UP也有望解决PTSD症状。拟议的CDA-2涉及两项研究，将评估MOVE!+ UP的可接受性和可行性，并指导其完善：1）一个不受控制的试点试验和后续定性访谈28肥胖退伍军人与创伤后应激障碍;和2）定性访谈的目的性样本的12 - 16 VA供应商和关键利益相关者。精致的MOVE!+ UP干预将在随机对照试验（RCT）中进行测试，以确定MOVE! UP导致更好的减肥比平时护理移动!在336名患有创伤后应激障碍的肥胖退伍军人中Hoerster博士将在同伴支持和行为减肥干预方面的导师和顾问专家的指导下进行研究和培训（Karin纳尔逊，医学博士，MSHS），健康行为干预RCT（盖勒雷伯，博士，公共卫生硕士），特别是那些退伍军人与创伤后应激障碍（迈尔斯麦克福尔，博士），综合护理和实施科学（J <$rgen Un <$tzer，MD，MPH，MA）、体力活动和饮食评估和干预（Brian Saelens，PhD）、定性（Helene Starks，PhD，MPH）和统计（David Atkins，PhD）方法。导师和顾问位于VAPS或UW。Hoerster博士还将参加UW课程，地方和国家培训，国家合作以及其他学术和专业活动，以支持培训目标。CDA-2研究和培训计划将为推进Hoerster博士在以下领域的独立研究生涯提供必要的准备：1）促进体力活动和饮食的同伴支持方法; 2）解决患有精神疾病的退伍军人慢性疾病的干预措施; 3）行为干预的RCT;和4）行为干预的传播和实施。影响：该CDA-2将加速Hoerster博士作为VA卫生服务调查员的独立性。Hoerster博士将专注于研究如何减少患有精神疾病的退伍军人的不公平疾病负担，并利用这项研究来塑造VA心理健康服务的提供。

DESCRIPTION (provided by applicant): Background: Katherine Hoerster, PhD, MPH is a staff psychologist with VA Puget Sound-Seattle (VAPS) and Acting Assistant Professor with the University of Washington (UW) Department of Psychiatry and Behavioral Sciences. Dr. Hoerster has demonstrated a commitment to conducting VA research focused on improving the health and well-being of Veterans with PTSD. The proposed career development award (CDA-2) will ensure that Dr. Hoerster will develop the skills and expertise necessary to become an independent health services researcher dedicated to improving care for Veterans with psychiatric illness. Career Development Plan: The proposed CDA-2 is focused on studying a peer-led behavioral weight management intervention that augments VA's existing weight management program (MOVE!) for Veterans with PTSD: MOVE!+UP (Improving MOVE! for Veterans with PTSD Using Peer Support). MOVE!+UP will be delivered by a paid peer support counselor in 4 group sessions in the first month of MOVE!, and will involve learning basic anxiety management skills and engaging in community-based physical activity to address barriers (e.g., hypervigilance). Four biweekly brief telephone counseling sessions will take place after MOVE!+UP's group ends and will focus on maintaining gains and problem-solving barriers. This intervention is proposed because Veterans with PTSD experience 1) high rates of obesity and related conditions due to inactivity and unhealthy diet; 2) reduced effectiveness of MOVE!; and 3) unique barriers to physical activity and healthy diet. Social support buffers these barriers to physical activity and healthy diet for Veterans with PTSD, and Veterans with PTSD endorse a strong preference for working with peers on these issues. In addition to the potential health behavior and weight loss benefits, MOVE!+UP is also expected to address PTSD symptoms. The proposed CDA-2 involves two studies that will assess MOVE!+UP's acceptability and feasibility and guide its refinement: 1) an uncontrolled pilot trial and follow-up qualitative interviews among 28 obese Veterans with PTSD; and 2) qualitative interviews with a purposive sample of 12-16 VA providers and key stakeholders. The refined MOVE!+UP intervention will be tested in a randomized controlled trial (RCT) to determine whether MOVE!+UP leads to better weight loss than usual care MOVE! among 336 obese Veterans with PTSD. Dr. Hoerster will conduct the research and training under mentors and consultants expert in peer support and behavioral weight loss interventions (Karin Nelson, MD, MSHS), health behavior intervention RCTs (Gayle Reiber, PhD, MPH) and specifically those for Veterans with PTSD (Miles McFall, PhD), integrated care and implementation science (J¿rgen Un¿tzer, MD, MPH, MA), physical activity and dietary assessment and intervention (Brian Saelens, PhD), and qualitative (Helene Starks, PhD, MPH) and statistical (Dr. David Atkins, PhD) methods. Mentors and consultants are located at VAPS or UW. Dr. Hoerster will also participate in UW coursework, local and national trainings, national collaborations, and other academic and professional activities to support training goals. The CDA-2 research and training plan will provide essential preparation to advance Dr. Hoerster's independent research career in the following areas: 1) peer support approaches to promoting physical activity and diet; 2) interventions to address chronic disease in Veterans with psychiatric conditions; 3) RCTs for behavioral interventions; and 4) dissemination and implementation of behavioral interventions. Impact: This CDA-2 will accelerate Dr. Hoerster's independence as a VA health services investigator. Dr. Hoerster will focus on studying ways to reduce inequitable disease burden for Veterans with psychiatric conditions and use this research to shape VA mental health services delivery.