Department of Behavioral Science, University of Kentucky, 760 Press Avenue, 468 Healthy Kentucky Research Building, Lexington, KY, 40536, USA.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BMC Public Health. 2022 Nov 8;22(1):2043. doi: 10.1186/s12889-022-14475-0.
Rural Appalachian residents experience among the highest prevalence of chronic disease, premature mortality, and decreased life expectancy in the nation. Addressing these growing inequities while avoiding duplicating existing programming necessitates the development of appropriate adaptations of evidence-based lifestyle interventions. Yet few published articles explicate how to accomplish such contextual and cultural adaptation.
In this paper, we describe the process of adapting the Make Better Choices 2 (MBC2) mHealth diet and activity randomized trial and the revised protocol for intervention implementation in rural Appalachia. Deploying the NIH's Cultural Framework on Health and Aaron's Adaptation framework, the iterative adaptation process included convening focus groups (N = 4, 38 participants), conducting key informant interviews (N = 16), verifying findings with our Community Advisory Board (N = 9), and deploying usability surveys (N = 8), wireframing (N = 8), and pilot testing (N = 9. This intense process resulted in a comprehensive revision of recruitment, retention, assessment, and intervention components. For the main trial, 350 participants will be randomized to receive either the multicomponent MBC2 diet and activity intervention or an active control condition (stress and sleep management). The main outcome is a composite score of four behavioral outcomes: two outcomes related to diet (increased fruits and vegetables and decreased saturated fat intake) and two related to activity (increased moderate vigorous physical activity [MVPA] and decreased time spent on sedentary activities). Secondary outcomes include change in biomarkers, including blood pressure, lipids, A1C, waist circumference, and BMI.
Adaptation and implementation of evidence-based interventions is necessary to ensure efficacious contextually and culturally appropriate health services and programs, particularly for underserved and vulnerable populations. This article describes the development process of an adapted, community-embedded health intervention and the final protocol created to improve health behavior and, ultimately, advance health equity.
ClinicalTrials.gov Identifier NCT04309461. The trial was registered on 6/3/2020.
美国阿巴拉契亚农村居民所患慢性病、早逝和预期寿命缩短的比例位居全国之首。要解决这些日益严重的不平等问题，同时避免重复现有的项目，就需要对基于证据的生活方式干预措施进行适当的调整。然而，很少有已发表的文章详细说明如何实现这种背景和文化上的调整。
在本文中，我们描述了对“做出更好的选择 2 （MBC2）”移动健康饮食和活动随机试验以及修订后的农村阿巴拉契亚干预实施协议进行改编的过程。利用 NIH 的健康文化框架和 Aaron 的改编框架，迭代改编过程包括召开焦点小组（N=4，38 名参与者）、进行关键知情人访谈（N=16）、与我们的社区咨询委员会（N=9）核实调查结果，以及开展可用性调查（N=8）、线框设计（N=8）和试点测试（N=9）。这一密集的过程导致了招募、保留、评估和干预措施的全面修订。在主要试验中，将有 350 名参与者被随机分配到接受多组分 MBC2 饮食和活动干预组或积极对照组（压力和睡眠管理）。主要结果是四个行为结果的综合评分：两个与饮食有关的结果（增加水果和蔬菜摄入量，减少饱和脂肪摄入量）和两个与活动有关的结果（增加适度剧烈体力活动[MVPA]和减少久坐活动时间）。次要结果包括生物标志物的变化，包括血压、血脂、A1C、腰围和 BMI。
为确保有效的、有针对性和文化适宜的卫生服务和项目，特别是为服务不足和弱势人群，有必要改编和实施基于证据的干预措施。本文描述了一种适应性、社区嵌入式健康干预措施的开发过程，以及为改善健康行为和最终推进健康公平而制定的最终方案。
ClinicalTrials.gov 标识符 NCT04309461。该试验于 2020 年 6 月 3 日注册。
