Improving Family Functioning in Obesity Treatment for Mexican American Women

改善墨西哥裔美国妇女肥胖治疗中的家庭功能

基本信息

批准号：
10279178
负责人：
BECKY MARQUEZ
金额：
$ 70.52万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-17 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10279178
关键词：
Acculturation Address Adherence Adoption Adult Adult Children Affect Age of Onset Age-Years Attitude Behavior Behavior Therapy Behavioral Belief Body Weight Changes Body Weight decreased Body fat Body mass index Buffers Child Code Collaborations Communication Competence Conflict (Psychology)Counseling Couples Therapy Daughter Diabetes Mellitus Diet Eating Education Effectiveness of Interventions Emotional Family Family history of Family member Glycosylated hemoglobin A Goals Health Benefit Health behavior Individual Intervention K-Series Research Career Programs Link Literature Maintenance Mediation Mental Depression Mentors Mexican Americans Modification Monitor Mothers Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Obesity Outcome Outcome Study Parent-Child Relations Parents Participant Patient Self-Report Pattern Phase Physical activity Physiological Prevalence Prevention Problem Solving Public Health Randomized Randomized Controlled Trials Recording of previous events Records Reporting Research Risk Role Structure System Techniques Testing Training Translating Treatment outcome Weight maintenance regimen Well in self Woman base behavior change cohesion commune control trial coping depressive symptoms diabetes management diabetes risk efficacy testing expectation experience follow-up improved intergenerational intervention effect lifestyle intervention member novel nutrition obesity risk obesity treatment perceived stress primary outcome psychologic secondary outcome skills skills training success treatment adherence treatment disparity waist circumference weight loss intervention weight maintenance young adult

项目摘要

SUMMARY Mexican American women are disproportionately affected by obesity and obesity-related conditions, such as type 2 diabetes. Obesity and diabetes are highly concordant in Mexican American families. Given the younger age of onset of diabetes in women with familial history, targeting mothers and their adult daughters for obesity treatment is warranted. From a family systems perspective, family-level approaches to obesity treatment can improve the adoption and maintenance of weight management behaviors. Including family members in treatment may also serve as a culturally salient intervention strategy as Mexican Americans endorse high level of familism. In contrast to traditional individual-level approaches to obesity treatment, a family-level approach grounded in familism would promote shared goals, collaborative problem solving, and communal coping when treating family members alongside each other. An important construct to consider when working with intergenerational Mexican American families is differences in acculturation, which may translate into differences in attitudes and behaviors. A wider gap in acculturation between parent and child has previously been associated with lower family functioning (e.g., poor communication, high conflict, low cohesion). However, interventions that promote bicultural competence by changing interactional patterns have been effective at improving family functioning. Hence, this study will conduct a randomized control trial testing the efficacy of a behavioral weight management intervention with brief and structured counseling on family functioning. Mexican American mothers and adult daughters (n=118 dyads) will be randomly assigned to receive standard behavioral treatment (SBT) or standard behavioral treatment plus relationship skills training (SBTR). Dyads participating in SBT or SBTR will attend 24 weekly sessions focused on nutrition and physical activity education along with behavior modification techniques. Dyads participating in SBTR will also receive experiential-based relationship skills training that draws from both general family systems concepts and behavioral family/couples therapy approaches to support familism, biculturalism, and communication competencies. The 12-month trial will consist of an intervention phase (1-6 months) and a maintenance phase (7-12 months). Assessments will be conducted at baseline and at the end of the intervention and maintenance phases. The primary outcome is weight loss. Secondary outcomes include treatment adherence (session attendance and self-monitoring records), physiological indicators of diabetes risk (hemoglobin A1c, waist circumference, and body fat percentage), health behaviors (eating and physical activity), psychological well- being (depression and perceived stress), and family functioning (subjective self-report and objective behavioral coding). Dyads in the SBTR group are expected to achieve greater improvements in primary and secondary outcomes than the STB group. Additionally, mediation by family functioning of intervention effects on primary and secondary outcomes will be examined.

概括墨西哥裔美国女性不成比例地受到肥胖和肥胖相关疾病的影响，例如 2型糖尿病。肥胖和糖尿病在墨西哥裔美国家庭中高度一致。鉴于年龄较小有家族史的女性的糖尿病发病年龄，针对肥胖的母亲及其成年女儿治疗是有必要的。从家庭系统的角度来看，家庭层面的肥胖治疗方法可以提高体重管理行为的采用和维持。包括家庭成员由于墨西哥裔美国人认可高水平治疗，治疗也可能作为一种文化上显着的干预策略的家庭主义。与传统的个人层面的肥胖治疗方法相比，家庭层面的方法以家庭主义为基础将促进共同目标、协作解决问题和共同应对对待家人彼此并肩。使用时要考虑的一个重要结构墨西哥裔美国家庭的代际差异是文化适应的差异，这可能会转化为态度和行为的差异。此前，父母和孩子之间的文化适应差距更大与较低的家庭功能有关（例如，沟通不良、冲突频繁、凝聚力低）。然而，通过改变互动模式来促进双文化能力的干预措施已经有效改善家庭功能。因此，本研究将进行一项随机对照试验来测试行为体重管理干预措施以及对家庭的简短和结构化咨询的有效性发挥作用。墨西哥裔美国母亲和成年女儿（n=118 组）将被随机分配到接受标准行为治疗 (SBT) 或标准行为治疗加关系技能培训（SBTR）。参加 SBT 或 SBTR 的双人将参加每周 24 次的课程，重点关注营养和身体健康活动教育以及行为矫正技术。参与 SBTR 的双人还将获得基于体验的关系技能培训，借鉴一般家庭系统概念和支持家庭主义、二元文化主义和沟通的行为家庭/夫妻治疗方法能力。为期 12 个月的试验将包括干预阶段（1-6 个月）和维持阶段（7-12 个月）。评估将在基线以及干预和维护结束时进行阶段。主要结果是减肥。次要结局包括治疗依从性（疗程出勤和自我监测记录）、糖尿病风险的生理指标（血红蛋白 A1c、腰围周长和体脂百分比）、健康行为（饮食和身体活动）、心理健康存在（抑郁和感知压力）和家庭功能（主观自我报告和客观行为编码）。 SBTR 组的二人组有望在小学和中学取得更大的进步结果优于 STB 组。此外，干预措施对家庭功能的调节对初级儿童的影响将检查次要结果。