IVR-Supported Interventions for Cancer Prevention in the Deep South

IVR 支持的南方腹地癌症预防干预措施

基本信息

批准号：
8700045
负责人：
Dorothy W. Pekmezi
金额：
$ 7.35万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-04-07 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8700045
关键词：
Address Adherence Aerobic African American Alabama Algorithms American Area Body Composition Body Weight Body fat Cancer Control Cancer Prevention Intervention Cessation of life Clinic Visits Colon Carcinoma Communities Community Health Computers Consumer Satisfaction Counseling County Data Deep South Diet Education Energy Metabolism Feedback Focus Groups Funding Future Goals Gonadal Steroid Hormones Guidelines HIV risk Home environment Hour Incidence Income Individual Insulin Internet Intervention Life Link Malignant Neoplasms Minority Groups Monitor Outcome Participant Pathway interactions Physical activity Preparation Process Public Health Reporting Research Resources Review Literature Risk Risk Behaviors Risk Reduction Rural Self Efficacy Social support Support System System Technology Telephone Test Result Testing Time Voice Walking Weight Weight maintenance regimen arm base cancer health disparity cancer risk cost cost effectiveness efficacy testing efficacy trial expectation fitness health disparity improved innovation literacy malignant breast neoplasm meetings member mortality outreach preference prevent programs public health relevance response rural area sedentary social cognitive theory success telehealth therapy development willingness

项目摘要

DESCRIPTION (provided by applicant): Each year, more than 572,000 Americans die of cancer and approximately a third of these deaths are linked to physical inactivity, poor diet, and excess weight and thus can be prevented. While exact mechanisms have yet to be determined, physical activity (PA) may impact breast and colon cancer risk by promoting weight control or perhaps independently by altering biologic pathways related to such cancers (improving energy metabolism, reducing circulating concentrations of sex hormones and insulin). ACS guidelines emphasize the importance of > 150 min/week of moderate-intensity PA in reducing cancer risk. However, most of the U.S. is inactive, with particularly low PA levels found in the South. Low education and income levels in this largely rural area, along with cultural differences regarding PA and barriers (childcare, costs) reported by African Americans (largest racial minority group in U.S., most of whom live in the South and report high rates of inactivity) may limit access to PA information and/or contribute to related cancer disparities. Telehealth interventions can overcome such obstacles by not requiring frequent clinic visits, expensive technology, or literacy and thus may represent a promising approach to promoting PA in the Deep South and extending ongoing community health worker efforts by the Deep South Network for Cancer Control. Most telehealth interventions have relied on staff counseling, but such processes can be automated using an Interactive Voice Response (IVR) system to enhance cost-effectiveness, reach, and potential disseminability. Given our team's past success using IVR systems for self monitoring of HIV risk behaviors and the paucity of research in this area on PA, we adapted the existing IVR system format for PA promotion and cancer risk reduction in the Deep South through extensive formative research (11 focus groups on PA barriers, intervention needs/preferences with Deep South Cancer Control community health advisors and community members from rural and urban AL counties) and now propose to test the resulting Home-based IVR-supported PA (HIP) intervention in a pilot RCT (N=60) with a waitlist control. Study goals are to document willingness to call IVR system, vet newly developed intervention modules addressing the PA barriers identified in focus groups, and beta-test Social Cognitive Theory (SCT) based tailoring algorithms in preparation for an R01-funded fully powered RCT to test the efficacy of the program and eventual dissemination through the Deep South Network for Cancer Control. PA (7-Day PAR, accelerometers), fitness (6MWT), and body weight and composition (% body fat, BIA) will be assessed at baseline and 3 months. Primary aims include assessing the feasibility, acceptability, and preliminary efficacy of the HIP intervention for cancer risk reducton in the Deep South. Secondary aims include exploring arm differences in changes in fitness, body weight/composition, and SCT variables from baseline to 3 months and assessing the relationship between min/week of >moderate intensity PA reported via IVR system vs. accelerometers at 2 time points (7 days before baseline and 3 month assessment).

描述（由申请人提供）：每年，超过 572,000 名美国人死于癌症，其中约三分之一的死亡与缺乏身体活动、不良饮食和体重过重有关，因此是可以预防的。虽然确切的机制尚未确定，但体力活动 (PA) 可能通过促进体重控制或可能通过改变与此类癌症相关的生物途径（改善能量代谢、降低性激素和胰岛素的循环浓度）独立地影响乳腺癌和结肠癌风险。 ACS 指南强调每周 > 150 分钟的中等强度 PA 对于降低癌症风险的重要性。然而，美国大部分地区不活跃，南部地区的 PA 水平特别低。这个主要农村地区的教育和收入水平较低，以及非洲裔美国人（美国最大的少数族裔群体，他们大多数居住在南方，报告不活动率很高）报告的 PA 和障碍（儿童保育、费用）方面的文化差异可能会限制对 PA 信息的获取和/或导致相关癌症差异。远程医疗干预措施可以克服这些障碍，不需要频繁的就诊、昂贵的技术或识字能力，因此可能是在南方腹地促进 PA 和扩大南方腹地癌症控制网络正在进行的社区卫生工作者努力的一种有前景的方法。大多数远程医疗干预措施都依赖于工作人员咨询，但此类流程可以使用交互式语音应答 (IVR) 系统实现自动化，以提高成本效益、覆盖范围和潜在的传播能力。鉴于我们团队过去使用 IVR 系统自我监测 HIV 风险行为的成功经验以及该领域 PA 研究的缺乏，我们通过广泛的形成性研究，调整了现有的 IVR 系统格式，以促进南部腹地的 PA 推广和癌症风险降低 (11重点小组讨论 PA 障碍、干预需求/偏好（与深南癌症控制社区健康顾问和来自阿拉巴马县农村和城市的社区成员），现在建议在试点中测试由此产生的基于家庭 IVR 支持的 PA (HIP) 干预措施带有候补名单控制的 RCT (N=60)。研究目标是记录呼叫 IVR 系统的意愿，审查新开发的干预模块，以解决焦点小组中发现的 PA 障碍，并对基于社会认知理论 (SCT) 的定制算法进行 Beta 测试，为 R01 资助的全面 RCT 测试做好准备该计划的功效以及最终通过深南癌症控制网络传播。 PA（7 天 PAR、加速计）、体能 (6MWT) 以及体重和成分（体脂百分比，BIA）将在基线和 3 个月时进行评估。主要目标包括评估 HIP 干预在南方腹地降低癌症风险的可行性、可接受性和初步效果。次要目标包括探索从基线到 3 个月的手臂健康、体重/成分和 SCT 变量变化的差异，并评估通过 IVR 系统报告的 > 中等强度 PA 的分钟/周与加速度计在 2 个时间点 (7基线和 3 个月评估前的天数）。