African American (AA) women, who are 80% more likely to be obese than their non-Hispanic white counterparts. AA women are also at disproportionate risk for negative obesity related health outcomes, including type 2 diabetes, hypertension, dyslipidemia, heart disease, and cancer. Further, AA women living in racially segregated, impoverished inner city neighborhoods are at even higher risk for obesity and associated sequalae, a set of problems exacerbated by the fact that they lack access to primary care and community related resources. To address barriers to primary care among these high-risk groups, Federally Qualified Health Center (FQHC) Primary Care Networks were formed, and now offer services to low SES patients who would otherwise go without care. However, DPP adaptation to this type of setting (that is, exporting DPP interventions to public housing) has not been thoroughly evaluated. Thus, there is a prime opportunity to examine whether novel partnerships linking FQHC networks with Public Housing infrastructure to deliver modified DPP programs directly into high risk communities are effective in reducing obesity and diabetes risk The goal of this R34 two-year planning project is to develop, implement, and evaluate a pilot multi-level DPP intervention. In this pilot study, we will use a randomized wait list control desig to allocate 60 participants to pilot test a translational community based DPP intervention or FHCN/FQHC usual care.
The specific aims are to: 1) Evaluate the feasibility, acceptability and implementation of the SHAPE UP intervention in Public Housing settings in the context of FHCN/FQHC infrastructure, using RE-AIM process and outcome indicators. 2) Conduct a preliminary evaluation of this intervention's effectiveness including weight loss at 24 weeks (primary outcome), secondary impact physiological measures (e.g., glucose, A1C, BP, lipids) and behavioral measures (e.g., physical activity (PA), nutrition) in intervention vs. control arms to estimate variability of measures for subsequent sample size calculation. This highly significant and novel study by an experienced team with an extensive partnership history will provide preliminary data to inform an adequately powered, larger randomized controlled trial.
This project is highly relevant to public health;African American (AA) women are 60% more likely to be obese than their non-Hispanic white counterparts and have disproportionate risk for suffering with obesity related health outcomes, including type 2 diabetes. AA women living in racially segregated impoverished inner city neighborhoods are at an even higher risk for obesity and diabetes due to their lack of access to diabetes prevention education and under-utilization of primary care services. This study will assess the feasibility of a community-based, behavior focused DPP intervention to reduce obesity and diabetes risk in public housing residents who are already eligible for Federally Qualified Health Care (FQHC) services.