将 ADAPT+ 推广至居住在农村社区的拉丁裔家庭：实施包含正念的健康促进项目的可行性和可接受性。
Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness.
机构信息
Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, USA.
Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA.
出版信息
J Pediatr Psychol. 2023 Aug 29;48(8):666-675. doi: 10.1093/jpepsy/jsad049.
BACKGROUND
Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities.
METHODS
In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated.
RESULTS
Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up.
CONCLUSION
Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial.
CLINICAL TRIAL REGISTRATION
This trial was registered with ClinicalTrials.gov under identifier NCT04800432.
背景
肥胖是拉丁裔青少年面临的一个主要公共卫生危机。越来越多的证据表明，压力在肥胖的发生和维持中起作用。本研究旨在探讨让社区卫生工作者（即 promotoras）为农村社区中服务不足的拉丁裔家庭提供基于家庭的健康促进项目 Adaptando Dieta y Acción Para Todos（ADAPT）+的可行性和可接受性，该项目整合了减轻压力的正念策略。
方法
在一项 ORBIT 模型第二阶段纵向准集群可行性研究中， promotoras 在佛罗里达州的农村地区提供了 6 节 ADAPT+干预课程和 1 节增强常规护理（EUC）课程。通过样本量和招募、社区随机化、数据收集完成情况以及干预的一致性来评估可行性。通过参与者保留率和对项目的满意度来评估可接受性。在基线、治疗结束和 3 个月随访时，计算条件间父母压力和正念进食的差异的效应大小。
结果
证明了可行性和可接受性。招募目标的完成率为 99%（n=95 名被招募者）。由于与 2019 年冠状病毒病相关的挑战，随机化仅限于现场一级。数据收集程序是可行的（完成率为 100%）。随访评估时的保留率为 86%，3 个月随访时为 82.6%。所有课程均已完成（一致性为 100%）。平均项目满意度为 3.91/4.00。与接受常规护理的父母相比，接受 ADAPT+的父母在 3 个月随访时报告的压力更低（差异=-3.04，中到大效应，d=0.70），正念进食更多（差异=2.00，中等效应，d=0.44）。
结论
使用 promotoras 向农村拉丁裔家庭实施研究和提供干预是可行和可接受的。关于父母压力和正念进食的有希望的发现支持更大规模的（ORBIT 第三阶段）疗效试验。
临床试验注册
该试验在 ClinicalTrials.gov 注册，标识符为 NCT04800432。
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