This submission is in response to NOT-OD-09-058., """"""""NIH Announces Availability of Recovery Act Funds for Competitive Revision Applications"""""""". Our previous study, Healthy Directions (HD1) evaluated an intervention designed to reduce multiple risk factors for cancer among multiethnic, working class populations through community health centers. The intervention led to significant improvements in outcomes. However, the reach into the target population was less than optimal, and the intervention delivery was more labor intensive than is sustainable. Our current study, Healthy Directions 2 (HD2) is designed to take an adapted version of the intervention to scale, and to focus on increasing reach and generalizability, and improving sustainability. The HD2 parent study is a cluster randomized trial conducted at two health centers with the primary care provider as the unit of randomization. The original design had two conditions: Usual Care;and HD2 web/print plus coaching calls intervention. The HD2 intervention consists of: (1) 'prescription'and brief endorsement of behavior change by the participant's health care provider;(2) two telephone counseling calls;(3) tailored print materials delivered through the web or print;(4) automated reminders to increase engagement in behavior change;(5) companion print materials for social network members;and (6) linkage with key community-based resources. An important limitation of the original study design is that it does not help determine which of the primary HD2 intervention components are key to maximizing intervention effectiveness. This competitive revision will allow us to separate out the key intervention components and to determine their comparative efficacy. We will also test the impact of providing automated reminders on intervention engagement. These are very important comparisons, because many health centers may have capacity to deliver automated interventions that require relatively little labor, but less capacity to deliver person-to- person interventions. As a result, this revision will provide very important information for the health care community on the added benefit, if any, of person-delivered interventions and reminders, and will be critically important to future translation of the HD2 intervention into practices across the country. This revision will also speed the tempo of our research by about 4 years, and create an additional 3 research positions in year 1 and 2 research positions in year 2, and help to retain 5 mid-career level scientists/ staff.
The parent study, Healthy Directions 2, tests a low-cost cancer prevention intervention for community health centers. This revision will allow us to learn which of the intervention components are most important. As a result, this revision will provide very important information for the health care community on the best way to deliver cancer prevention interventions, which can have life-saving benefit for large numbers of people if implemented widely.
