Adapting Online Obesity Treatment for Primary Care Patients in Poverty

为贫困初级保健患者采用在线肥胖治疗

基本信息

批准号：
10722366
负责人：
Po-hun Chou
金额：
$ 18.81万
依托单位：
MIRIAM HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722366
关键词：
Address Adherence Adoption Adult Affect Aftercare Behavioral Body Weight decreased Cardiovascular Diseases Caring Cause of Death Characteristics Clinical Clinical Trials Communities Consolidated Framework for Implementation Research Data Data Collection Decision Making Dementia Development Diabetes Mellitus Effectiveness Eligibility Determination Epidemic Face Family Feedback Food Funding Goals Health Priorities Health Services Research Health behavior Healthcare High Prevalence Individual Internet Intervention Knowledge Link Literature Low income Malignant Neoplasms Measures Mental Depression Mental Health Mentors Methods National Institute of Diabetes and Digestive and Kidney Diseases Non-Insulin-Dependent Diabetes Mellitus Nutritional Obesity Outcome Participant Pathway interactions Patients Persons Physical activity Population Population Heterogeneity Positioning Attribute Poverty Primary Care Primary Care Physician Process Provider Public Health Readiness Recommendation Reduce health disparities Research Research Activity Research Methodology Research Personnel Resources Rhode Island Risk Role Services Severities Site Social Marketing Structure Testing Time Training Treatment/Psychosocial Effects Underserved Population United States National Institutes of Health Weight Weight maintenance regimen Work career community engaged research cost design disadvantaged background dissemination research implementation evaluation implementation outcomes implementation research improved insight intervention refinement obesity treatment patient population patient retention patient screening physical conditioning primary care clinic primary care patient primary care provider programs prototype recruit research to practice response screening social factors social health determinants socioeconomic disadvantage socioeconomic disparity structural determinants syndemic theories tool treatment program treatment research uptake usability weight loss program

项目摘要

Project Summary Poverty affects over 37 million individuals in the U.S., subjecting them to syndemics – clustered, mutually enhancing epidemics such as obesity, diabetes, and depression that arise from and perpetuate socioeconomic inequality. Syndemic theory underscores a pathway to mitigate syndemics by intervening on a single target within the cluster. Obesity’s high prevalence in poverty; role in increasing leading causes of death (e.g., cardiovascular disease, cancer, dementia); and adverse psychosocial effects (e.g., increased depression) make it a crucial, high priority target. While structural and social factors contribute to obesity in poverty, research shows the effectiveness of individual-level interventions in improving health behaviors and weight when highly responsive to overburdened populations’ needs. At the same time, evidence guiding refinement of interventions is sparse as participants with socioeconomic disadvantage are underrepresented in obesity treatment research. Reflecting this phenomenon, Rx Weight Loss, a fully automated online obesity treatment, has seen limited use among patients with low income despite past work showing it can be delivered effectively through primary care at low cost. Since 72.8% of adults in poverty have a usual primary care provider, and 83% have Internet access, this gap in adoption represents a significant opportunity for public health impact through adaptation of RxWL that increases relevance for traditionally underserved populations. Further, this research is poised to fill a critical gap in obesity treatment literature. Thus, this application aims to revise RxWL content and the process by which primary care providers refer patients to the program (referenced collectively as the “RxWL package”) to maximize responsiveness, reach, and effectiveness for those in poverty. Using mixed methods data collection, this project structures research activities using the Social Marketing Assessment and Response Tool (SMART) and examines implementation outcomes identified by the Consolidated Framework for Implementation Research (CFIR). Primary care provider (n = 23) and patient (n = 16) stakeholders will provide feedback on the existing RxWL package (Aim 1); insights and scientific knowledge will be integrated to produce a low-cost RxWL package prototype (i.e., a PDF with embedded links approximating the intended program) for usability testing (n = 8 providers, 10 patients; Aim 2); and data will drive development of a finalized RxWL package to disseminate through primary care and evaluate in an open trial (n = 12 providers, 32 patients; Aim 3). Aim 3 will examine both implementation and preliminary clinical outcomes, including effects on weight loss and syndemic sequelae; obtain insights for further refinement; and indicate readiness for a larger R- funded clinical trial. Revising RxWL holds high potential to reduce health disparities for those from socioeconomically disadvantaged backgrounds. Moreover, findings will make significant contributions to the literature on recruitment and retention of patients in poverty in obesity treatment research; adaptation of obesity treatment to fit the unique needs of traditionally underserved populations; and impact of social determinants of health on the course of obesity treatment.

项目概要贫困影响着美国超过 3700 万人，使他们患上各种综合症——聚集、相互促进肥胖、糖尿病和抑郁症等流行病是由社会经济不平等引起并使其长期存在的。该理论强调了通过干预肥胖症群中的单一目标来减轻综合症的途径。贫困率；导致死亡的主要原因（例如心血管疾病、癌症、痴呆症）；不良的社会心理影响（例如抑郁增加）使其成为重要的、高度优先的目标，同时也是结构性和社会性的。导致贫困中肥胖的因素，研究表明个人层面的干预措施可以有效改善同时，证据表明，对负担过重的人群的需求做出高度反应时的健康行为和体重。由于社会弱势群体在干预措施中的代表性不足，因此对干预措施的指导细化很少肥胖治疗研究反映了这一现象，Rx Weight Loss是一种全自动在线肥胖治疗方法。尽管过去的工作表明它可以通过以下方式有效地提供，但在低收入患者中使用有限初级保健费用低廉，因为 72.8% 的贫困成年人拥有常用的初级保健提供者，并且 83% 的人拥有互联网。的获取，这种采用差距代表着通过 RxWL 的调整对公共卫生产生影响的重大机会，此外，这项研究有望填补传统上服务不足的人群的重要空白。因此，该应用程序旨在修订 RxWL 内容和初级保健的过程。提供者将患者转介至该计划（统称为“RxWL 包”）以最大限度地提高响应能力，该项目使用混合方法收集数据，构建研究。使用社会营销评估和响应工具（SMART）开展活动并检查实施结果由实施研究综合框架 (CFIR) 确定 (n = 23) 和患者 (n = 16) 利益相关者将提供有关现有 RxWL 方案的反馈（目标 1）；知识将被整合以产生低成本的 RxWL 封装原型（即带有嵌入式链接的 PDF）近似预期程序）进行可用性测试（n = 8 名提供者，10 名患者；目标 2）；数据将驱动开发最终的 RxWL 包，通过初级保健传播并在公开试验中进行评估（n = 12 目标 3) 将检查实施情况和初步临床结果，包括对体重减轻和综合症后遗症的影响；获得进一步细化的见解；并表明已准备好进行更大的 R- 修订 RxWL 具有减少社会经济群体健康差异的巨大潜力。此外，研究结果将对招聘和招聘方面的文献做出重大贡献。在肥胖治疗研究中保留贫困患者；调整肥胖治疗以满足其独特需求传统上服务不足的人群；以及健康的社会决定因素对肥胖治疗过程的影响。