WOOP VA: Mental Contrasting With Implementation Intentions to Promote Weight Management in Primary Care

背景：大约40%的退伍军人患有肥胖症。强化体重管理 像MOVE！促进临床显著的体重减轻，但只有3-7%的合格 退伍军人出席。低入学率和高流失率是由于旅行、成本和 动机经过20多年的研究， 实施意向（MCII）是一种新的，以证据为基础的干预措施，以增加动机 和行为改变。MCII已被证明可以增加身体活动和消耗 水果和蔬菜，促进减肥，我们最近证明，MCII是 对于退伍军人来说，这是可行的，也是可以接受的。然而，还没有经过测试 在初级保健中没有充分的表现，也没有表现出退伍军人的体重减轻。我们建议 评估MCII在行为改变和体重减轻方面的有效性和实施情况， 退伍军人在初级保健时，与VA移动相结合！程序. 意义/影响：本提案与VA HSRD“初级保健实践”一致， 复杂慢性病管理”的资助优先事项。初级保健提供者和PACT 会员没有提供足够的咨询，以增加与移动的参与！ 程序. MCII可以由外行教育工作者教授，并可以与MOVE！ 和其他体重管理治疗。 创新：MCII在图像的使用方面具有创新性，易于由外行教育工作者提供，新颖 行动机制（通过无意识的动机和认知过程），以及 与其他方案相结合。退伍军人可以在10分钟内自行练习MCII。 MCII使用标准化的4步成像程序，称为WOOP，可以在30分钟内教授 分钟退伍军人可以继续使用WOOP定期，与援助的WOOP 包含视频、音频和纸质工具的应用程序和网站。本研究将首先 MCII在初级保健中的随机对照试验和第一个RCT，以测试疗效和 结合MOVE！在退伍军人。 具体目标：1。比较MCII + MOVE的影响！与MOVE！单独重量百分比 6个月和12个月时的变化和腰围。2.比较MCII + MOVE的影响！ vs.动起来！独自一人移动！6岁和12岁时的出勤率、体育活动和健康饮食 个月3.评价多边基金气候影响指标的执行情况。我们将使用覆盖率、有效性、采用率， 实施、维护（RE-AIM）框架7、8，以评估实施障碍， 以及多边气候举措的成果。 方法：我们将366名初级保健退伍军人随机分为MCII +电话- 移动交付！（干预）与电话传递MOVE！独自一人（控制）在曼哈顿 弗吉尼亚在6个月和12个月时，参与者将返回诊所进行研究访问，其中体重，饮食， 并对两组的体力活动进行评估。我们将使用意向治疗分析。 实施/后续步骤：MCII旨在在各种环境中轻松实施 以及各种各样的行为。免费提供的在线培训材料将有助于 实施.为了指导未来的实施和政策变化，我们将提供以下数据： 我们的目标3实施分析，并从经验丰富的利益相关者和当地人那里获得投入 NCP和NCP领导人。如果发现有效，我们将进行混合 在一项多地点研究中对多边气候变化倡议的有效性/执行情况进行研究。

Background: Approximately 40% of Veterans have obesity. Intensive weight management programs such as MOVE! promote clinically significant weight loss, but only 3-7% of eligible Veterans attend. Low enrollment and high attrition are due to obstacles such as travel, cost, and motivation. Developed through over 20 years of research, Mental Contrasting with Implementation Intentions (MCII) is a novel, evidence-based intervention to increase motivation and behavior change. MCII has been shown to increase physical activity and consumption of fruits and vegetables and promote weight loss, and we recently demonstrated that MCII is feasible and acceptable to Veterans for weight management. However, has not been tested adequately within primary care nor demonstrated weight loss in Veterans. We propose to evaluate the efficacy and implementation of MCII for behavior change and weight loss in Veterans within primary care when combined with the VA MOVE! Program. Significance/Impact: This proposal aligns with the VA HSRD “primary care practice and management of complex chronic diseases” funding priority. Primary care providers and PACT members do not provide sufficient counseling to increase engagement with the MOVE! Program. MCII can be taught by lay educators and can be delivered in conjunction with MOVE! and other weight management treatments. Innovation: MCII is innovative in its use of imagery, ease of delivery by lay educators, novel mechanisms of action (via non-conscious motivational and cognitive processes), and ability to be combined with other programs. Veterans can practice MCII on their own in under 10 minutes. MCII uses a standardized, 4-step imagery procedure called WOOP that can be taught in 30 minutes. Veterans can then continue to use WOOP regularly, with the assistance of a WOOP App and website containing video-, audio-, and paper-based tools. This study will be the first randomized controlled trial of MCII within primary care and the first RCT to test the efficacy and implementation of MCII for weight management when combined with MOVE! in Veterans. Specific Aims: 1. Compare the impact of MCII + MOVE! vs. MOVE! alone on percent weight change and waist circumference at 6 and 12 months. 2. Compare the impact of MCII + MOVE! vs. MOVE! alone on MOVE! attendance, physical activity, and healthy eating at 6 and 12 months. 3. Evaluate implementation of MCII. We will use the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework7,8 to evaluate implementation barriers, facilitators, and outcomes of MCII. Methodology: We will randomize 366 Veterans within primary care to either MCII + telephone- delivered MOVE! (intervention) vs. telephone-delivered MOVE! alone (control) at the Manhattan VA. At 6 and 12 months, participants will return to the clinic for a study visit where weight, diet, and physical activity will be assessed in both groups. We will use intention-to-treat analyses. Implementation/Next Steps: MCII is designed to be easily implemented in a variety of settings and for a variety of behaviors. Freely available online training materials will facilitate implementation. To guide future implementation and policy change, we will present data from our Aim 3 implementation analyses and obtain input from Veteran stakeholders as well as local VA and NCP leaders. If found to be efficacious, we will conduct hybrid effectiveness/implementation studies of MCII in a multi-site study.