Médecine communautaire et éducation à la santé

Abstrait

HOPE Works: A Community-Based Obesity Intervention Addressing Social Determinants as Underlying Factors

Marci K. Campbell, Salli Benedict, Ziya Gizlice, Kristine Kelsey, Katie Barnes, Amy Ries, Brenda DeVellis and Barbara Harris

Objectives: HOPE Works was an innovative, community-based participatory research (CBPR) intervention aimed at addressing health promotion and obesity in the context of social determinants for obese, low-income and minority rural North Carolina women. This study incorporated multiple social health determinants, including hope, which assesses participants’ abilities to set and achieve goals to reach desired health and life changes. Methods: Community Coordinators identified women to serve as HOPE Circle Leaders who received training and recruited women from their social networks. Thirty-four Circles met bi-weekly for 6 months following a manual-based curriculum and received tailored newsletters addressing health and economic literacy. Comparison women were drawn from the same communities. The primary outcome was weight loss. Secondary outcomes were moderate and vigorous physical activity (MVPA), fruit and vegetable (F&V) consumption, and hope. Outcomes were analyzed using the completer cohort and intent-to-treat (ITT), controlling for baseline weight, socioeconomic variables, and Circle cluster effects. Results: A total of 485 women (73% of baseline sample) completed both baseline and follow-up surveys (208 intervention; 277 comparison). Non-completers (117 intervention; 119 comparison) differed by race, employment status, household income, and contribution to household income in the past two years (all p < 0.05). Intervention women lost 4.5 (±1.2) pounds compared to 0.4 (±0.4) pounds for comparison women (p = 0.054 cohort, p = 0.154 ITT); 22.5% and 13.1% of the intervention and comparison groups respectively lost ≥5% of their body weight. Mean (SE) difference in total MVPA between groups was +51.8 (±19.2) minutes/week (p = 0.007), with non-significant improvement in F&V (p = 0.136). Overall hope level did not significantly increase; however, intervention women marginally improved on Agency (goal directed energy) (p = 0.060). Conclusion: Women receiving a community-based weight management program based on addressing social determinants can successfully lose weight. Future, streamlined efforts addressing the needs of women including those unable to participate are important to enhance program reach and public health impact.