Samuel-Hodge Carmen D, Pham Lisa, Lyons Kiira, Draeger Lindy B, Jiang Li, Lin Feng-Chang, Ram Rachel, Leeman Jennifer
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Public Health. 2025 Jun 5;13:1564567. doi: 10.3389/fpubh.2025.1564567. eCollection 2025.
Major disparities persist in heart disease, diabetes, and obesity, with rates highest among those living in the southeastern and central parts of the US. Intervening to improve lifestyle behaviors represents an opportunity to address health inequities. Although the scientific rationale for lifestyle interventions is robust, evidence is limited on how to implement these interventions at scale.
Using a type 3 hybrid implementation-effectiveness design, we evaluated a statewide scale-up trial implementing the Med-South Lifestyle Program in mostly rural community health centers and health departments across North Carolina, in the southeastern US. Implementation outcomes were measured at the site level and program effectiveness outcomes were assessed by physiologic and behavioral changes at the participant level. Descriptive statistics and paired -tests comprised our statistical analyses.
We invited 200 public health sites to participate in the study and 28 (14%) expressed interest. Among those expressing interest, 21 (75%) signed a Memorandum of Agreement. The statewide scale-up resulted in the enrollment of 95% (19/20) of the proposed sites-13 health departments (68%) and six community health centers. The majority of the 235 study participants who started the program were adults self-identifying as non-Hispanic White (45%) or non-Hispanic Black (37%); 11% identified as Hispanic and 5% as American Indian. Most participants were female (88%), with a mean age of 51 years, and educational attainment of a 2- or 4-year college degree (57%). Implementation outcomes included 17 sites (89%) retained throughout the study and a 79% participant retention rate. Program uptake was high, with 87% of planned counseling sessions and 83% of follow-up calls completed. For our effectiveness outcomes we observed small but statistically significant changes in weight of -2.3 lbs. Similarly, systolic but not diastolic blood pressure was reduced significantly (-2.3 mm Hg). There was a significant increase in the mean weekly intakes of nuts and healthy fats, improved daily fruit-vegetable-bean scores, and a decrease in daily sugar-sweetened beverage intake. For sedentary behaviors, daily sitting time was significantly reduced.
These results show successfully adapted implementation and delivery approaches to fit Med-South into the context of public health settings during the COVID-19 pandemic.
ClinicalTrials.gov: NCT05067816, October 5, 2021.
心脏病、糖尿病和肥胖症方面的重大差异依然存在，美国东南部和中部地区的发病率最高。通过干预来改善生活方式行为是解决健康不平等问题的一个契机。尽管生活方式干预的科学依据很充分，但关于如何大规模实施这些干预措施的证据却很有限。
我们采用3型混合实施-效果设计，评估了一项在美国东南部北卡罗来纳州主要农村社区卫生中心和卫生部门开展的全州范围扩大规模试验，该试验实施了“南方医疗生活方式项目”。在机构层面测量实施结果，在参与者层面通过生理和行为变化评估项目效果。描述性统计和配对检验构成了我们的统计分析。
我们邀请了200个公共卫生机构参与研究，28个（14%）表示有兴趣。在表示有兴趣的机构中，21个（75%）签署了合作协议。全州范围的扩大规模导致95%（19/20）的拟设机构参与，其中包括13个卫生部门（68%）和6个社区卫生中心。开始该项目的235名研究参与者中，大多数是自我认定为非西班牙裔白人（45%）或非西班牙裔黑人（37%）的成年人；11%为西班牙裔，5%为美洲印第安人。大多数参与者为女性（88%），平均年龄51岁，教育程度为两年制或四年制大学学位（57%）。实施结果包括在整个研究过程中保留了17个机构（89%），参与者保留率为79%。项目参与度很高，完成了87%的计划咨询课程和83%的随访电话。在效果方面，我们观察到体重有微小但具有统计学意义的变化，减轻了2.3磅。同样，收缩压显著降低（-2.3毫米汞柱），但舒张压未降低。坚果和健康脂肪的平均每周摄入量显著增加，每日水果-蔬菜-豆类得分提高，每日含糖饮料摄入量减少。对于久坐行为，每日久坐时间显著减少。
这些结果表明，在新冠疫情期间，成功地调整了实施和交付方法，使南方医疗项目适应公共卫生环境。
ClinicalTrials.gov：NCT05067816，2021年10月5日。
