The objective of this proposed K23 award is to prepare Dr. Megan McVay for a career as an independent scientist studying patient-oriented approaches to increase engagement in evidence-based weight management treatment among adults with obesity. To this end, Dr. McVay will obtain training in the areas of qualitative research methods, digital health intervention research, and the conduct of pragmatic clinical trials in primary care settings. The candidate and her mentors have developed a five- year plan to obtain training in these areas that includes coursework, workshops, and attendance at national conferences. Dr. McVay will work closely with her primary mentor, Corrine Voils, PhD, and her co-mentors, Gary Bennett, PhD, and William Yancy, MD, who jointly have nationally and internationally recognized expertise in behavioral weight loss treatment, qualitative research, intervention development, primary care-based clinical trials, and digital health interventions. The proposed research and training will be conducted in the resource-rich environment of Duke University Medical Center. The currently proposed research addresses the problem of poor uptake of evidence-based behavioral weight loss treatment through the development and testing of an intervention delivered via the primary care setting. Specifically, a web-based intervention that is completed by patients remotely, prior to a clinical visit is proposed. The intervention content will be individually tailored and will target determinants of treatment initiation based on our conceptual model, which draws extensively on the Health Belief Model. The delivery of the intervention remotely may allow more patients to receive evidence-based weight counseling while minimizing additional demands on clinic time and space. The first step of intervention development is to better characterize Health Belief Model constructs as they relate to weight loss treatment initiation in a primary care population, which will be accomplished through focus groups (Aim 1). Next, data from Aim 1 will be used to develop intervention content and the intervention website (Sub-aim 2.a.). This preliminary version of the intervention will be refined through usability testing and post-intervention qualitative interviews with patients (Sub-aim 2.b.) and through qualitative interviews with primary care providers (Sub-aim 2c). Finally, a pilot, pragmatic cluster randomized trial will be conducted in primary care clinics to determine intervention acceptability and the feasibility of proposed study protocol (Aim 3). At the end of the award tenure, the applicant will be prepared to submit an NIH R01 to conduct an adequately powered, pragmatic clinical trial to test the effectiveness of the intervention in increasing treatment initiation and weight loss.
Over one-third of adults are obese, and most are not receiving evidence-based weight loss treatment. This research will produce a primary care-based intervention to increase the number of patients who enter evidence-based behavioral weight loss treatment. In so doing, the burden of obesity and its consequences could be reduced.
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