||5R01CA238335-03 Interpret this number
||Boston Medical Center
||Digital Health Supported Weight Management Intervention Delivered By Community Health Workers Among Public Housing Residents
Overweight/obesity is strongly linked to mortality from multiple chronic diseases, including obesity-related
cancers. For health disparity-facing populations, including racial/ethnic minority and/or low income individuals,
who have both high prevalence of obesity and cancer, interventions promoting behavioral change for nutrition,
physical activity, and weight are a national health priority. A growing knowledge base documents the efficacy of
community health worker supported interventions for improving behavioral change due, at least in part, to their
unique insights into how an intervention should be adapted to social and environmental contexts. While there
has been a rapid expansion in the use of digital technologies for delivering health interventions, there has been
little study of the potential use of these technologies in the U.S. by non-professional health workers, including
community health workers. Yet, it is not yet clear if digital technologies alone are efficacious for weight loss,
particularly among health disparity-facing populations, or if a more intense intervention consisting of a
combination of community health workers plus digital technologies will be needed to successfully promote
weight loss among health disparity-facing populations. In the proposed research study, we will target weight
management among obese residents of Boston's public housing developments who are low-income and
predominately from racial/ethnic minority groups. This R01 proposal seeks to examine the efficacy of an
intervention approach that combines mHealth technology plus website-driven behavioral counseling from
community health workers. Our hypothesis is that in a 12-month cluster-randomized trial (n=504) comparing 3
public housing developments (n=168 participants) who receive community health worker motivational
interviewing behavioral counseling plus mHealth self-monitoring/text message feedback (mHealth+CHW),
versus 3 developments (n=168) who receive the mHealth self-monitoring/text message feedback only
(mHealth only), versus 3 developments (n=168) who receive assessment only (control group), both
mHealth+CHW and mHealth only will outperform assessment only control and mHealth+CHW will outperform
mHealth only in terms of weight loss at 12 months. For secondary outcomes, we will examine intervention
effects on diet and physical activity behaviors. We will also examine mediating effects of Social Cognitive
Theory constructs and moderating effects of participant characteristics and social contextual variables on the
effect of the intervention. Finally, we will conduct a cost-effectiveness analysis. Our results will enable a better
understanding of efficacious approaches to weight management among health disparity-facing populations,
which may be applied to other modifiable cancer risk behaviors and be extended into the larger federal network
of public housing administrations.
Mobile health plus community health worker support for weight management among public housing residents (Path to Health): A randomized controlled trial protocol.
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Contemporary clinical trials, 2022 Aug; 119, p. 106836.