Recipient Organization
WEST VIRGINIA UNIVERSITY
886 CHESTNUT RIDGE RD RM 202
MORGANTOWN,WV 26505-2742
Performing Department
Davis College of Agriculture
Non Technical Summary
Obesity and related chronic conditions threaten the health and quality of life of 66% of adults in the United States. West Virginia, a mostly rural state, has the highest rates of obesity-related chronic conditions and the lowest intake of fruits and vegetables in the nation. Implementation of U.S. Preventative Service Taskforce recommendations to provide patients with diet-related behavioral counseling to prevent cardiovascular disease is impeded by competing time demands of physicians, poor access to nutrition care providers, and uncertainly of reimbursement. Telenutrition, the delivery of nutrition care using technology, is an emerging area that has the potential to improve access to nutrition care by overcoming geographical barriers. Our long-term goal is to contribute toward developing effective and sustainable chronic disease prevention and management intervention that can be implemented on a wide scale across geographical locations and socioeconomic levels. The overall objectives in this application are 1) to develop and evaluate a telenutrition intervention, which includes student-delivered health coaching in rural Appalachia, and 2) to use competency-based training and experiential learning to prepare future nutrition professionals to provide telenutrition for chronic disease prevention. The research and education objectives are interdependent and offer a mutually beneficial relationship between students and community members. This integrated project directly addresses the program priority of Diet, Nutrition, and Prevention of Chronic Diseases as it aims to develop, implement and evaluate research and educational strategies to improve eating patterns that support the prevention and management of obesity-related chronic conditions in rural areas.
Animal Health Component
75%
Research Effort Categories
Basic
(N/A)
Applied
75%
Developmental
25%
Goals / Objectives
Our long-term goal is to contribute toward the development of an effective, sustainable and culturally appropriate chronic disease prevention and management intervention that can be implemented on a wide scale across geographical locations and socioeconomic levels. Our overall objectives are 1) to develop and evaluate the comparative effectiveness of two intensity levels of a dietitian and nutrition student health coach-delivered, PCP referred tele-delivered intervention in rural Appalachia and 2) to use competency-based training and experiential learning to prepare future nutrition professionals (nutrition students) to provide telenutrition interventions for obesity-related chronic disease prevention (i.e. type 2 diabetes, hypertension, hyperlipidemia and cardiovascular disease). Our central hypothesis is that the low-intensity arm will have a higher incremental cost-effectiveness ratio because the two treatments will provide similar health benefits, while the low intensity will have lower costs. This hypothesis was based upon our strong preliminary data demonstrating that the provision of enhanced usual care group which offered low-intensity care was not statistically different than the higher-intensity virtual dietary counseling and telephonic health coaching in its effectiveness for short-term weight reduction and dietary improvements among middle-aged Appalachian men at risk for CVD.
Project Methods
Aim 1.1 method:We will use intervention mapping and unpublished data from pilot participant input to further develop our exiting program. The proposed research component will integrate self-determination theoryof motivation and social-cognitive theory (SCT)with elements of socio-ecological theory. Self-determination theory (SDT)proposes that maintenance of health behaviors over time requires self-determination, or for the person internalize values and skills for change (intrinsic motivation), and that behaviors are more likely to be internalized by maximizing the person's experience of autonomy, competence and relatedness in health care settings. We aim to assist with autonomy by providing intervention support via the consistent interaction with the intervention team via virtual encounters with the RDN and one-on-one health coach calls and competence by providing input and feedback for the patient to develop skills and tools for change. The SCT concepts of behavioral capacity (the ability to perform a behavior through essential knowledge and skill), observational learning, and self-efficacy (person's confidence in their ability to perform a behavior) underpin the intervention component strategies.Aim 1.2 method:The proposed trial will use a randomized comparative effectiveness intervention design to evaluate the effectiveness of a weight loss program under two levels of intensity (high and low). The active phase of the intervention is 12 months, with a follow-up at month 18.