Part 1: Needs Assessment<\/p>\n
Population and setting: the intervention will be conducted in urban Shanghai overweight (BMI>24.9) but otherwise healthy men age between 40 to 74, who have been enrolled in the\u00a0The shanghai men\u2019s health study (SMHS).<\/p>\n
According to the study, the prevalence of overweight and obesity among men aged between 40 to 74 in urban Shanghai, China was 33.1% and 2.6%, respectively (Shu\u00a0et al.,\u00a0<\/em>2015).<\/p>\n The numbers from the study are highly likely to increase due to rapid development in economy and urbanization. Two major risks overweight and obesity pose to health are cardiovascular diseases (CVD) and type II diabetes mellitus(T2DM). \u00a0The financial burdens from either disease are huge for Chinese residents because of the medical system in China, which is reliant on patients paying for services. There is no fixed scheme of medical reimbursement for the majority of people and medical insurance is in its infancy (Perk\u00a0et al.,\u00a0<\/em>2007). For example, a domestic heart stent normally costs more than 9,000 RMB, while the average annual income is 28,752 RMB (about $4,755). Regular exercise can help manage body weight, regulate blood glucose and lipid, lower blood pressure, and prevent metabolic syndrome. All these effects lower the risks of developing CVD. The costs of regular exercise, compared to medical cost of managing CVD and T2DM, are minimal.<\/span><\/p>\n In the same study, only 35.5% of all subjects, \u00a0representing men between 40 to 74 in urban Shanghai, reported regular exercise. The number for overweight\/obese subjects was not given in the study, but it is possibly lower than that for all subjects. Because of the \u00a0cost-effectiveness of exercise in preventing obesity-led diseases, along with the concerning size of overweight and sedentary population, the exercise intervention in our target population is well needed.<\/p>\n <\/p>\n References:<\/p>\n Shu, X. O., Li, H., Yang, G., Gao, J., Cai, H., Takata, Y., … & Xiang, Y. B. (2015). Cohort profile: The shanghai men\u2019s health study. International journal of epidemiology<\/i>, 44<\/i>(3), 810-818.<\/p>\n Perk, J., Gohlke, H., Hellemans, I., Mathes, P., McGee, H., Monp\u00e8re, C., … & Sellier, P. (Eds.). (2007). Cardiovascular prevention and rehabilitation<\/i>. London: Springer.<\/p>\n <\/p>\n How likely is it going to be successful?<\/td>\n What theory is the intervention based upon?<\/td>\n How does that influence our future study on this population?<\/td>\n Likelihood in publishing a follow-up study focusing on this population’s BMI and metabolic profile.<\/span><\/td>\n Unlikely future collaboration;<\/p>\n Failure to get any benefit from providing sensitive information.<\/p>\n <\/td>\n<\/tr>\n What’s the cost?<\/p>\n How long does it last?<\/td>\n How to prescript exercise and how often do we follow up with the subject?<\/span><\/p>\n How and what to communicate with program coordinators?<\/span><\/td>\n Maintenance of the app throughout the program.<\/span><\/td>\n What features does the app need to include?<\/span><\/p>\n How much will you be willing to pay?<\/span><\/td>\n Can further develop the app into a popular weight-management app that attract more users and investors.<\/span><\/p>\n Money compensation.<\/span><\/td>\n Failure to improve reputation.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Part 2: Intervention Identification<\/p>\n The intervention strategy is \u00a0Technology-Supported Multicomponent Coaching or Counseling Interventions To Reduce Weight. As the name suggest, the multicomponent coaching or counseling \u00a0intervention uses modern technological components such as computers, internet and computerized telephone system to facilitate the communication between coaches\/counselors and subjects. Its goal is to influence many factors contributing to and resulting from ones’ weight status. The intervention may also incorporate non-technology components such as in-person counseling, manual tracking, printed lessons and written feedback.<\/p>\n The strategy has been used effectively in many U.S. home and community settings, with subjects usually overweight\/obese adults recruited through flyers, newspaper and emails.\u00a0Bond, 2007 also applied this strategy to diabetics in\u00a0Seattle, WA. Follow-up time ranges from 2 months to 24 months, with the majority of the studies used 3 to 6 months.\u00a0Interventions were usually delivered by counselors and other types of healthcare providers, with assorted technologies being utilized in facilitating interaction.<\/p>\n The target population for the current study is\u00a0overweight but otherwise healthy men age between 40 to 74, who have been enrolled in the\u00a0The shanghai men\u2019s health study (SMHS). The intervention will take place in urban Shanghai communities, where the participants originally live. It is an overweight and adult population, but is not within U.S. or Canada, so there is a lot cultural (trust between participants and coaches, diet, patience, motivation, etc.) and socioeconomic differences (availability of gyms, parks, time,etc.) compared to the populations among which the strategy has already been successfully evaluated.\u00a0The target population, while overweight, are significantly less obese than populations involved in previously successful studies, for the average BMI and percentage of overweight\/obese are significantly lower than those in the U.S. The participants, especially the younger portion of them, may be harder to approach because many of them believe more in traditional Chinese medicine than exercise\/diet. Availability of gyms is poor, considering the huge population. Memberships are too expensive for an average, retired man. Because of the reasons above, the exercise programs have to be tailored to resources each individual has.<\/span><\/p>\n The strategy is recommended by the Task Force\u00a0on the basis of sufficient evidence that they are effective in improving weight-related behaviors or weight-related outcomes. The task force listed 18 studies that examined technology-supported multicomponent coaching or counseling interventions relevant to weight loss, all of the them reported reductions in weight. However, comparison groups in many studies received some sort of interventions as well. For example, one comparison group in McKay, 2002 had access to the web \u201cconference area\u201d and to articles online, while the treatment group had Internet access to a diabetes diet coach twice weekly, plus web self-monitoring of blood glucose and access to articles online. Because the heterogeneity among the treated comparison groups added uncertainty to the effect estimates, the Task Force considered these studies to provide sufficient rather than strong evidence of intervention effectiveness. \u00a0No evidence of harms from these interventions were found.<\/p>\n Article 1:\u00a0Harvey-Berino, J., West, D., Krukowski, R., Prewitt, E., VanBiervliet, A., Ashikaga, T., & Skelly, J. (2010). Internet delivered behavioral obesity treatment. Preventive medicine<\/i>, 51<\/i>(2), 123-128.<\/p>\n Article 2:\u00a0Polzien, K. M., Jakicic, J. M., Tate, D. F., & Otto, A. D. (2007). The Efficacy of a Technology\u2010based System in a Short\u2010term Behavioral Weight Loss Intervention. Obesity<\/i>, 15<\/i>(4), 825-830.<\/p>\n The<\/span> objective<\/span> was<\/span> to<\/span> examine<\/span> the<\/span> efficacy<\/span> of\u00a0<\/span><\/span>adding<\/span> a<\/span> technology-based<\/span> program<\/span> to<\/span> an<\/span> in-person,<\/span> behav<\/span>ioral<\/span> weight<\/span> loss<\/span> intervention. Subjects were 57 individuals whose BMIs were between 25 to 39.9. They all had <\/span><\/span>computer<\/span> and<\/span> Internet<\/span> access,<\/span> and<\/span> demon<\/span>strated<\/span> adequate<\/span> computer<\/span> skills<\/span> before<\/span> participation.\u00a0<\/span><\/span>Participants<\/span> received<\/span> a<\/span> 12-week<\/span><\/span> behavioral<\/span> weight<\/span> loss\u00a0<\/span>intervention composed of\u00a0reduced<\/span> caloric<\/span> intake,<\/span> increased<\/span> physical<\/span> activity,<\/span> and\u00a0<\/span>behavior<\/span> therapy. Three randomized groups were:\u00a0<\/span><\/span>1)<\/span> Standard<\/span> In-Person<\/span> Behavioral<\/span> Weight<\/span> Control<\/span> Program\u00a0<\/span>(SBWP), \u00a02)<\/span> Intermittent<\/span> Technology-Based<\/span> Behavioral\u00a0<\/span>Weight<\/span> Control<\/span> Program<\/span> (INT-TECH),<\/span> or<\/span> 3)<\/span> Continuous\u00a0<\/span>Technology-Based<\/span> Behavioral<\/span> Weight<\/span> Control<\/span> Program\u00a0<\/span>(CON-TECH). SBWP participants received\u00a0<\/span><\/span>7<\/span> in-person<\/span> individualized<\/span> counseling<\/span> sessions,<\/span> held\u00a0<\/span>weekly<\/span> during<\/span> month<\/span> 1,<\/span> twice<\/span> during<\/span> month<\/span> 2,<\/span> and<\/span> once\u00a0<\/span>during month<\/span> 3. CON-TECH participants\u00a0<\/span><\/span>received<\/span> all<\/span> components<\/span> of\u00a0<\/span>SBWP,<\/span> in<\/span> addition to\u00a0<\/span><\/span>a<\/span> wearable<\/span> body<\/span> monitor<\/span>\u00a0for<\/span> objective\u00a0<\/span>energy<\/span> expenditure<\/span> measurement,<\/span> Internet<\/span> monitoring<\/span> of\u00a0energy intake, and feedback related to energy balance. INT-TECH <\/span><\/span>participants<\/span> received<\/span> all<\/span> components<\/span> of CON-TECH, but the use of technology-based components was restricted to only\u00a0<\/span><\/span>3\u00a0<\/span>weeks<\/span> (1,<\/span> 5,<\/span> and<\/span> 9)<\/span> during<\/span> the<\/span> 12-week<\/span> intervention.<\/span><\/p>\n<\/div>\n<\/li>\n\n
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\n Stakeholder<\/strong><\/td>\n Role in Intervention<\/strong><\/td>\n Questions from Stakeholder<\/strong><\/td>\n Effect on Stakeholder of a Successful Program<\/strong><\/td>\n Effect on Stakeholder of an Unsuccessful Program<\/strong><\/td>\n<\/tr>\n \n \u00a0Me<\/td>\n \u00a0Design the intervention; employ program coordinators; and analyze data<\/td>\n Goals of the study?<\/p>\n Respect in the field; experience in how to conduct a successful intervention program.<\/td>\n Less likely to be sponsored in the future; bad reputation in the field;<\/td>\n<\/tr>\n \n \u00a0Shanghai Government<\/td>\n Provide fundings<\/td>\n Goal and economic effectiveness?<\/p>\n \u00a0Healthier workforce and trust from people; Positive reputation and public image.<\/td>\n \u00a0Money wasted; Harms to public image and citizen trust; less participation in future program sponsored by the government.<\/span><\/td>\n<\/tr>\n \n \u00a0Program Coordinator(s)<\/td>\n \u00a0Recruit qualified participants; communicate program design with other stakeholders; Implementing the program; collect data.<\/td>\n How to successfully implement the program as designed? Any standards and procedures to follow?<\/td>\n Experience in a successful health intervention research and improved resume quality;<\/td>\n Frustration from working \u00a0for an unsuccessful health intervention research; failure in improving their resume quality.<\/td>\n<\/tr>\n \n \u00a0Authors of the cohort study<\/td>\n Provide participant contact information and more details of the study relevant to current intervention<\/td>\n \u00a0What benefit the participants are likely to get?<\/p>\n \u00a0Contribution to a successful study;<\/span><\/p>\n <\/p>\n \n Participants<\/td>\n Participate in the program as guided by program coordinators; communicate \u00a0progress with coordinators; attend baseline and post-intervention evaluations.<\/td>\n Why would I want to participate and stick to the program?<\/p>\n Successfully lose weight and improve fitness;\u00a0Positive lifestyle change and confidence in exercise; Decreased risk in developing CVD, T2DM or metabolic syndrome<\/span>.<\/td>\n \u00a0Don’t achieve goal weight and lose their belief in exercise and trust in government. Little improvement in metabolic profile; Unchanged CVD and T2DM risk factors.<\/span><\/td>\n<\/tr>\n \n \u00a0Fitness Instructor, Trainers or Exercise Physiologists<\/span><\/td>\n Provide initial assessments of the subjects; educate participants in exercise frequency, intensity, duration and types; provide individualized exercise prescription and follow up using chosen technology-supported apps; report to program coordinators periodically.<\/span><\/td>\n The goal of the study?<\/span><\/p>\n Increased recognition from industry and increased clientele, possibly from participants; Successful experience working with older population.<\/span><\/td>\n \u00a0Unsuccessful experience working with older population; decreased\u00a0recognition from industry and decreased clientele.<\/span><\/td>\n<\/tr>\n \n \u00a0App Developers<\/span><\/td>\n Developing an App (for web, android, ios) for the program that allows participants, instructors, program coordinators to communicate exercise, nutrition plans and any concerns. The App will be the main tool used for this program.<\/span><\/p>\n <\/p>\n Increased recognition from industry.<\/span><\/p>\n Money compensation.<\/span><\/p>\n \n
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