Implementing an evidence-based mHealth diet and activity intervention: Make Better Choices 2 for rural Appalachians

实施循证移动健康饮食和活动干预：为阿巴拉契亚农村地区做出更好的选择 2

基本信息

批准号：
10618205
负责人：
Nancy E. Schoenberg
金额：
$ 74.07万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10618205
关键词：
Acceleration Accelerometer Accountability Address Adult Appalachian Region Behavior Behavioral Blood Pressure Body mass index Budgets Cardiovascular Diseases Cellular Phone Characteristics Chronic Chronic Disease Clinical Communities Consolidated Framework for Implementation Research Consumption Data Devices Diabetes Mellitus Diet Effectiveness Elements Equipment and supply inventories Evidence based intervention Fatty acid glycerol esters Focus Groups Future Goals Health Influentials Intake Internet Intervention Interview Leisures Life Style Lipids Malignant Neoplasms Methods Modality Monitor Morbidity - disease rate Obesity Outcome Participant Physical activity Population Process Public Health Randomized Randomized, Controlled Trials Recommendation Reporting Research Activity Resources Rural Rural Appalachia Rural Population Shapes Techniques Technology Testing Time Training Support Underserved Population Unhealthy Diet Vulnerable Populations acceptability and feasibility active control active lifestyle arm attentional control behavior change cardiovascular disorder risk contextual factors cost design effectiveness evaluation effectiveness research effectiveness study effectiveness testing effectiveness trial effectiveness/implementation study effectiveness/implementation trial evidence base experience financial incentive fruits and vegetables good diet health equity health inequalities hybrid type 1 design implementation context implementation evaluation implementation outcomes implementation research implementation science implementation study improved informant information gathering insight intervention cost intervention delivery intervention program iterative design knowledge base low socioeconomic status mHealth meetings mortality physical inactivity poor health outcome prevent primary outcome programs rural dwellers rural underserved scale up secondary outcome sedentary sedentary lifestyle smartphone application smartphone based device stress management successful intervention tool tv watching usability virtual waist circumference

项目摘要

ABSTRACT We propose a type 1 hybrid effectiveness-implementation study to test an adapted evidence-based intervention and explore critical implementation issues, including feasibility, acceptability, and costs, that influence scale-up and sustainment. We focus this adaptation, effectiveness, and implementation study on underserved rural residents, a population that maintains extremely high rates of suboptimal diet and sedentary behaviors, placing them at elevated risk for cardiovascular disease, obesity, diabetes, cancer, and other chronic conditions. Within the vulnerable low socioeconomic status population of rural residents, Appalachian Kentuckians experience even worse health outcomes, including among the highest rates of morbidity and mortality in the nation. Such adversity is exacerbated by and associated with inadequate community resources. Increasingly, however, Appalachian residents and other vulnerable populations are gaining access to modalities that may be useful in addressing these health challenges, including internet connectivity and nearly ubiquitous cell phone use. Despite this accelerating technology use, the evidence base on personal technology-associated interventions (mHealth) in a rural, high need population remains sparse. We propose finalizing adaptation and testing an evidence-based multicomponent mHealth intervention, Make Better Choices 2 (MBC2), a behavioral program consisting of personalized health coaching, an app, accelerometer, and financial incentives. In a recent randomized controlled trial among urban adults, MBC2 produced large, sustained diet and physical activity improvements by leveraging effective behavior change techniques, including goal-setting, self-monitoring, accountability, and support. To prepare for the implementation of this successful intervention with a new population marked by extreme health inequities and sparse resources, our team has engaged in extensive foundational efforts based on the Dynamic Adaptation Process framework. These include: (1) completing focus groups and key informant interviews to assess the feasibility and acceptability for rural Appalachian residents to use the MBC2 program; (2) undertaking a comprehensive community inventory to reveal existing and needed resources; (3) engaging stakeholders in community and academic team meetings, including community forums and CAB meetings; and (4) identifying MBC2 programmatic and structural elements in need of adaptation. With this extensive preliminary activity, we now propose a type 1 hybrid effectiveness-implementation trial in which we: (1) finalize adaptation by wireframe and usability testing MBC2 with local Appalachian residents; (2) conduct a RCT to test the effectiveness of the adapted MBC2 compared to an active control arm; and (3) explore implementation outcomes and contextual factors, with a focus on sustainment. This project aspires to demonstrate that systematic adaptation and implementation of an evidence-based intervention can lead to meaningful and sustained behavioral changes, and to prepare for potential scale-up and sustainment of the intervention to maximize its public health impact.

抽象的我们提出了一项1型混合有效性研究研究，以测试适应的循证干预和探索关键的实施问题，包括可行性，可接受性和成本，影响扩大和维持。我们将这种适应性，有效性和实施研究重点放在服务不足的农村居民，该人口保持极高的饮食和久坐的次数极高行为，使其处于心血管疾病，肥胖，糖尿病，癌症和其他的风险较高慢性条件。在脆弱的农村居民社会经济地位人口中，阿巴拉契亚肯塔基人的健康状况更糟，包括发病率最高和全国死亡率。这种逆境因社区资源不足而加剧并关联。然而，越来越多的阿巴拉契亚居民和其他弱势群体正在访问可能在应对这些健康挑战的可能性，包括互联网连接和几乎无处不在的手机使用。尽管技术的加速使用，但证据基于个人在农村地区，与技术相关的干预措施（MHealth）仍然很少。我们建议最终确定适应并测试基于证据的多组分MHealth干预措施，使得更好选择2（MBC2），一种行为计划，由个性化的健康教练，应用程序，加速度计，加速度计，和经济激励措施。在城市成年人最近的一项随机对照试验中，MBC2产生了大型，通过利用有效的行为改变技术来持续饮食和身体活动改善，包括目标设定，自我监控，问责制和支持。为实施做准备以极端健康不平等和稀疏资源为标志的新人群的成功干预，我们团队根据动态适应过程框架进行了广泛的基础工作。其中包括：（1）完成焦点小组和关键的线人访谈，以评估可行性和阿巴拉契亚农村居民使用MBC2计划的可接受性；（2）全面社区库存以揭示现有和需要的资源；（3）吸引利益相关者参与社区和学术团队会议，包括社区论坛和出租车会议；（4）识别MBC2 需要适应的程序化和结构元素。有了这项广泛的初步活动，我们现在提出了1型混合有效性 - 实施试验，其中我们：（1）通过线框最终改编可用性测试MBC2与当地的阿巴拉契亚居民；（2）进行RCT测试与主动对照组相比，改编的MBC2；（3）探索实现结果和上下文因素，重点是维持。该项目渴望证明系统适应和实施基于证据的干预可以导致有意义且持续的行为改变，并为潜在的扩大和维持干预措施做准备，以最大程度地发挥其公共卫生影响。