Translating Behavioral Interventions for Health Disparity Populations

在2019财年，我们发表了关于两项RCT和两项可行性研究的手稿，这些研究在种族/民族多样化的社区环境中测试行为干预措施。这些出版物和研究结果将在下文中介绍。 在2019财年，我们完成了努埃沃Amancer-II（A New Dawn-II）RCT研究的数据收集，在该研究中，我们测试了农村讲西班牙语的乳腺癌幸存者的压力管理干预。 在这项研究中，我们应用了一个社区参与的翻译模型，称为翻译框架，以开发改编的程序（NA-II），设计一个随机对照试验的社区设置，确定招聘人员和干预人员，并实施试验。 干预者是受过训练的拉丁裔乳腺癌幸存者。 社区倡导者招募并登记了患有非转移性乳腺癌的讲西班牙语的拉丁裔农村人。 在231名接近的妇女中，24%拒绝，10%不合格，153名（66%）被随机分配到干预组或等待名单对照组。 91%的人是在外国出生的，48%的人报告说在过去一年中遇到了经济困难。基线平均评分（SD;可能范围）为：FACT-B总分，73.7（15.1; 0-108）;情感健康，14.4（4.3; 0-20）;功能健康，11.0（2.9;0-16）;社会/家庭健康，13.6（4.1; 0-20）;身体健康17.4（5.3; 0-24）;乳腺癌问题17.4（4.7; 0-28）;焦虑，0.70（0.76; 0-4）;躯体化，0.70（0.64; 0-4）;抑郁，6.7（5.3;0-24）;和知觉压力，15.7（7.3; 0-40）。基线结果水平表明有改进的余地。报告RCT改编和设计的手稿处于修订和重新提交状态。另一份报告试验结果的文件正在编写中。 我们访问了研究社区网站以传播结果。 我们完成了对努埃沃Amancer项目干预手册和实施指南的最终审查。 项目网站的最后准备工作正在进行中。方案材料将张贴在项目网站上，以便公众可以查阅，以便更广泛地传播。 我们发表了一篇手稿，报告了一项针对年龄在60岁及以上的不同成年人（n=390）的群集随机对照试验的结果，这些成年人入组了12个老龄化管理支持的老年中心。老年中心被随机分配立即开始合唱团（干预组）或等待6个月才开始（对照组）。声音社区是一个文化定制的合唱团计划，由专业音乐指挥家在老年中心提供，反映了参与的三个组成部分（认知，身体和心理社会）。与对照组相比，干预组成员在孤独感（p = 0.02;标准化效应量ES = 0.34）和生活兴趣（p = 0.008，ES = 0.39）方面有了更大的改善。研究结果支持通过社区合唱团，以减少孤独和增加生活中的各种老年人的兴趣。 在2019财年，我们发表了一份手稿，报告了一项研究的结果，该研究在23名讲西班牙语的拉丁裔乳腺癌幸存者中测试了移动的手机应用程序和电话辅导生存护理计划（SCPP）的可行性。 与基线相比，干预后疲劳（B= 0.26; P= 0.02; Cohen d=0.4）和健康困扰水平（B= 0.36; P= 0.01; Cohen d=0.3）显著较低，（B= 0.41; P= 0.03; Cohen d=0.5）和情绪幸福感显著改善（B=1.42; P= 0.02; Cohen d=0.3）;管理癌症随访护理的自我效能没有改变。平均每日步数从6157显著增加至7469（B=1311.8; P= 0.02; Cohen d=0.5）。 我们发现了项目可行性、可接受性和有效性的初步证据，在疲劳、健康困扰和情绪健康方面有了显著的2个月改善，并增加了对推荐的后续护理和平均每日步数的了解。量身定制的移动的电话和健康指导SCPP可以帮助确保公平获得这些服务，并改善讲西班牙语的拉丁美洲乳腺癌幸存者的症状和身体活动水平。 在2019财年，我们发表了另一项可行性研究的结果，在该研究中，我们测试了一项为期8周的压力管理干预措施，以防止讲西班牙语的拉丁裔移民患上抑郁症。 干预措施由10名经过培训的宣传员（社区卫生工作者）在社区环境中提供。 推广员（n=10）在培训后显著提高了他们的知识（p<0.001），并提供了表现出出色保真度的程序。接受该计划的参与者（n=50）在移民压力，感知压力和抑郁症状方面的得分显着提高（p<0.001）。这是可行的培训拉丁美洲promotores提供一个有效的压力管理计划，以低收入的拉丁美洲移民在他们的社区。这些结果有助于越来越多的文献说明这种干预措施在社区环境中的价值。 Cristian Escalera是NIMHD的一名学士后研究员，他发表了一份手稿，证明有形和深情的支持对讲西班牙语的乳腺癌幸存者的焦虑症状具有保护作用，这些幸存者经历了对疾病的侵入性想法（反刍）。最后，我们在《美国公共卫生杂志》的NIMHD特刊上共同撰写了一篇手稿，提出了建立成功适应科学和公平实施减少健康差异的循证干预措施所需的研究愿景和策略。

In FY19, we published manuscripts reporting on two RCTs and two feasibility studies testing behavioral interventions in racially/ethnically diverse community settings. These publications and findings are described next. In FY19, we completed data collection for the Nuevo Amancer-II (A New Dawn-II) RCT study in which we tested a stress management intervention for rural Spanish-speaking breast cancer survivors. In this study, we applied a community-engaged translational model called the Transcreation Framework to develop the adapted program (NA-II), design a randomized control trial for community settings, identify recruiters and interventionists, and implement the trial. Interventionists were trained Latina breast cancer survivors. Rural Spanish-speaking Latinas with non-metastatic breast cancer were recruited and enrolled by community advocates. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. Ninety-one percent were foreign born and 48% reported financial hardship in the past year. Baseline mean scores (SD; possible range) were: FACT-B total score, 73.7 (15.1; 0-108); emotional well-being, 14.4 (4.3; 0-20); functional well-being, 11.0 (2.9;0-16); social/family well-being, 13.6 (4.1; 0-20); physical well-being 17.4 (5.3; 0-24); breast cancer concerns 17.4 (4.7; 0-28); anxiety, 0.70 (0.76; 0-4); somatization, 0.70 (0.64; 0-4); depression, 6.7 (5.3;0-24); and perceived stress, 15.7 (7.3; 0-40). Baseline outcome levels suggest there is room for improvement. A manuscript reporting on the adaptation and design of the RCT is in revise and resubmit status. Another paper reporting on the results of the trial is in process. We visited the study community sites to disseminate the results. We completed the final review of the intervention manuals and implementation guide for the Nuevo Amancer program. Final preparation of a project website is in process. Program materials will be posted on the project website so that it is accessible to the public for wider dissemination. We published a manuscript reporting on findings from a cluster randomized controlled trial with diverse adults age 60 and older (n=390) who were enrolled at 12 Administration on Aging-supported senior centers. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size ES = 0.34 and interest in life (p = .008, ES = 0.39). Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. During FY19, we published a manuscript reporting on the results of a study testing the feasibility of a mobile phone app and telephone coaching survivorship care planning program (SCPP) among 23 Spanish-speaking Latina breast cancer survivors. Compared with baseline, postintervention fatigue (B=.26; P=.02; Cohen d=0.4) and health distress levels (B=.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. During FY19, we published the results of another feasibility study in which we tested an 8-week stress management intervention to prevent depression among Spanish-speaking Latino immigrants. The intervention was delivered by 10 trained promotores (community health workers) in community settings. Promotores (n=10) improved their knowledge significantly after the training (p<0.001) and delivered the program demonstrating excellent fidelity. Participants who received the program (n=50) had significantly improved scores on immigration stress, perceived stress, and depressive symptoms (p<0.001). It is feasible to train Latino promotores to deliver an effective stress management program to low-income Latino immigrants in their communities. Results contribute to a growing literature on the value of such interventions in community settings. Cristian Escalera, a NIMHD DIR post-baccalaureate fellow, published a manuscript that demonstrated that tangible and affectionate support have protective effects on anxiety symptoms among Spanish-speaking breast cancer survivors experiencing intrusive thoughts about their illness (rumination). Finally, we co-authored a manuscript in a NIMHD special issue of the American Journal of Public Health that presented a research vision and strategies needed to build the science of successful adaptation and equitable implementation of evidence-based interventions that reduce health disparities.