Testing scalable, IVR-supported cancer prevention interventions in the rural Alabama Black Belt

在阿拉巴马州黑带农村地区测试可扩展的、IVR 支持的癌症预防干预措施

• 批准号: 10397154
• 负责人: Dorothy W. Pekmezi
• 金额: $ 57.81万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397154
• 关键词: Accelerometer; Accountability; Address; Adherence; Adopted; Adult; Aerobic; African American; African American population; Alabama; American; American Cancer Society; Anxiety; Black race; Breast; Cancer Burden; Cancer Control; Cancer Death Rates; Cancer Prevention Intervention; Cessation of life; Clinic Visits; Collaborations; Colon; Colon Carcinoma; Communities; Community Health; Community Health Aides; County; Data; Deep South; Education; Educational Background; Endometrial; Fatigue; Feedback; Focus Groups; Friends; Funding; Future; HIV; Incidence; Income; Informal Social Control; Internet; Intervention; Link; Maintenance; Malignant Neoplasms; Mediator of activation protein; Mental Depression; Minority; Modeling; Neighborhoods; Not Hispanic or Latino; Organizational Policy; Participant; Patient Self-Report; Physical Performance; Physical activity; Population; Preparation; Psychosocial Factor; Randomized Controlled Trials; Reporting; Research; Resources; Review Literature; Risk; Risk Reduction; Rural; Rural Population; Sleep disturbances; Social support; Southeastern United States; Support System; System; Technology; Telephone; Testing; Transportation; Treatment Efficacy; Voice; Waiting Lists; acceptability and feasibility; active lifestyle; arm; base; built environment; cancer health disparity; cancer prevention; cancer risk; community organizations; cost; cost effectiveness; efficacy testing; exercise intervention; family support; healthy lifestyle; high risk; improved; improvement on sleep; intervention cost; intervention effect; intervention participants; lifestyle intervention; literacy; malignant breast neoplasm; member; mortality; neighborhood disadvantage; participant retention; personalized approach; pilot trial; post intervention; preference; prevent; recruit; response; rural African American; rural counties; rural dwellers; satisfaction; scale up; sedentary lifestyle; social cognitive theory; success; telephone-based; theories; treatment arm; vigorous intensity

Regular physical activity (PA) is linked to lower risk for several cancers (breast, colon, endometrial) . Yet, most Americans are inactive, particularly in the Deep South. Cancer incidence/mortality is also generally higher in this region, with underserved (rural, African American) populations reporting even less PA and disproportionate cancer burden. Factors related to culture, distance from PA facilities, income, literacy, and Internet connectivity in the Deep South may limit access to PA information/resources and contribute to existing cancer disparities. Telephone-supported interventions have shown success in increasing PA, do not require clinic visits, literacy, or costly technology, and thus may represent a promising strategy for promoting PA for cancer risk reduction in the Deep South, especially when automated with Interactive Voice Response (IVR) systems for improved cost- effectiveness and reach. Thus, we adapted an existing IVR system, used in past HIV studies, for PA promotion and cancer prevention in the Deep South through extensive literature review and formative research [11 focus groups on PA intervention needs/preferences with Deep South Network For Cancer Control community health advisors (CHAs) and community members]. A pilot trial of the resulting Deep south IVR-supported Active Lifestyle (DIAL) intervention!(R03CA177538) found high retention and participant satisfaction at 12 weeks. Moreover, DIAL produced larger increases in MVPA (42.5 more min/week) from baseline to 12 weeks than a waitlist control, along with significantly greater improvements in PA self-regulation and social support. Results have informed intervention enhancements in preparation for scale up and dissemination in rural counties (using IVR-initiated calls and wristbands to facilitate adherence; further targeting unchanged Social Cognitive Theory constructs; incorporating more interpersonal, community/organizational and policy level strategies for increased encouragement and accountability and to assess and address built environment). The current study will involve a fully powered randomized controlled trial of the refined, multi-level 12 month DIAL intervention with a waitlist control condition (N=240 rural, mostly African American adults). Recruitment will be led by Deep South Network for Cancer Control CHAs in Black Belt counties (involved in project since initial formative research). Primary aims include examining arm differences in changes in moderate intensity or greater aerobic physical activity from baseline to 6 and 12 months. Exploratory aims include examining intervention effects on physical performance and psychosocial variables; changes in physical activity from 12- 18 months; intervention costs; potential mediators (social support from family, friends, CHAs) and moderators of treatment efficacy (neighborhood/ environmental features); and potential barriers/facilitators to widespread implementation of DIAL intervention in rural Black belt counties by Deep South Network for Cancer Control. !

定期体育锻炼（PA）与多种癌症（乳腺癌，结肠，子宫内膜）的风险较低有关 。但是，大多数 美国人不活跃，尤其是在南方。癌症的发病率/死亡率通常也更高 这个地区，服务不足的（农村，非裔美国人）人口报告的PA甚至不成比例 癌症负担。与文化，与PA设施的距离有关的因素，收入，扫盲和互联网连接性 在深处，南方可能会限制对PA信息/资源的访问，并导致现有的癌症差异。 电话支持的干预措施在增加PA方面已成功，不需要诊所就诊，识字率， 或昂贵的技术，因此可能代表了促进PA降低癌症风险的有前途的策略 深南方，尤其是当与交互式语音响应（IVR）系统自动化以提高成本 - 有效性和影响力。因此，我们调整了过去HIV研究中使用的现有IVR系统，用于促进PA 通过广泛的文献综述和形成性研究，南方深处的癌症预防[11 PA干预需求/偏好的小组与深南网络有关癌症控制社区健康 顾问（CHAS）和社区成员]。对最深的南部IVR支持的活跃的试点试验 生活方式（DIAL）干预！（R03CA177538）在12周时发现了很高的保留率和参与者的满意度。 此外，拨号从基线到12周的MVPA（每周/周高42.5分钟）的增加比 候补名单控制，以及PA自我调节和社会支持的改善。结果 已告知改善干预措施，以准备在农村县进行扩展和传播 （使用IVR发起的呼叫和腕带来促进依从性；进一步针对不变的社会认知 理论构造；纳入更多人际交往，社区/组织和政策级别的策略 增加鼓励和问责制，并评估和解决建筑环境）。 当前的研究将涉及精制的多级别12个月的全功率随机对照试验 拨号列表控制条件（n = 240个农村，主要是非裔美国人）。招聘 将由黑带县的Deep South Network领导，用于癌症控制CHA（涉及项目 最初的形成性研究）。主要目的包括检查中等强度变化的手臂差异或 从基线到6个月的有氧运动活动更大。探索目的包括检查 干预对身体绩效和社会心理变量的影响；体育锻炼的变化从12- 18个月;干预费用；潜在的调解员（家人，朋友，CHAS的社会支持）和主持人 治疗功效（邻里/环境特征）；以及潜在的障碍/促进者 Deep South Network在癌症控制中对农村黑带县的拨号干预实施。 呢