MOCHA Moving Forward: a CBPR Investigation of Chronic Disease Prevention in Older, Low-income African-American Men
Condition: Chronic Disease of Cardiovascular System; Multiple Chronic Conditions; Chronic Disease
MeSH terms: Chronic Disease; Multiple Chronic Conditions
Study type: Interventional

Summary: 
      The overall goal of the research is to discover how to reduce chronic disease health
      disparities among older (ages 35-70) low-income African-American men more effectively. To
      achieve this goal, the investigators are conducting formative exploratory research with
      middle-aged, low-income African-American men; testing two versions of a novel
      community-developed intervention, MOCHA and MOCHA+ (where MOCHA+ is a modified version of the
      "standard" MOCHA program, modified to incorporate narrative communication strategies); and
      advancing the development of a Minority Stress Model through statistical modelling to test
      the relative contributions of hypothesized explanatory variables identified in the formative
      research phase of the project.
    

Detailed description: 
      Low-income, African-American men continue to be disproportionately burdened by chronic
      diseases and associated morbidities and mortalities. Primary modifiable and interrelated
      causes of chronic disease include high levels of stress, low levels of physical activity, and
      malnutrition. There are few demonstrated effective, preventive interventions that are
      culturally relevant and gender appropriate for low-income, African-American men.

      Local community concerns about health disparities led to a year-long series of community-wide
      discussions and planning that resulted in the creation of Men of Color Health Awareness
      (MOCHA) project. Started in 2010, in an unusual public-private partnership between the YMCA
      and the state Department of Public Health, MOCHA's mission is to improve the health and
      wellbeing of men of color in Springfield, MA and surrounding areas. MOCHA runs a 12-week
      program with 15-20 men per cohort to decrease chronic disease vulnerability and bolster
      resilience among low-income, African-American men, by addressing exercise, eating habits, and
      stress stemming from impoverished economic conditions, racial and class discrimination, and
      gender role strain. The MOCHA Steering Committee contacted a group of health disparities
      researchers at the University of Massachusetts School of Public Health and Health Sciences in
      2012, requesting assistance in documenting the impact of MOCHA on the community.

      Over 350 men ages 40-60 years have completed the MOCHA program and preliminary data indicate
      that the program has decreased weight, body fat percentage, and systolic blood pressure;
      increased self-reported fitness and vitality scores; and decreased mean stress scores on the
      Cohen Perceived Stress scale by 19%. Based on these preliminary data, the research team
      proposes to rigorously test MOCHA program effectiveness and to identify the causal pathways
      through which it impacts outcomes.

      In addition, the MOCHA Steering Committee has expressed strong interest in strengthening the
      quality of their program, by incorporating narrative strategies for communicating key health
      concepts and information into the existing program. Current research of the investigators
      provides strong evidence that culture-centered narrative strategies are more effective in
      producing positive health effects than didactic presentations. The collaborating partners
      have pilot tested the feasibility of developing digital stories with the MOCHA Steering
      Committee, and with this proposal, the investigators are mutually excited about the
      possibility of integrating narrative communication strategies into the MOCHA program,
      henceforth called MOCHA+.

      To test the effectiveness of the existing MOCHA chronic disease prevention program in
      decreasing stress and compare its effectiveness with a new to-be-developed MOCHA+ program
      (that integrates narrative communication strategies), the research team proposes to conduct a
      randomized-controlled trial with three arms: MOCHA, MOCHA + and wait-list control comparison
      groups. Using a community-based participatory research approach, the three specific aims of
      the proposed research are thus to:

        1. Further refine a Minority Stress Model developed by Co-PI Graham, to capture and explain
           the dynamic, reciprocal and synergistic interactions of factors affecting the health of
           low-income African-American men;

        2. (a) Determine the effectiveness of the MOCHA program in decreasing stress among
           low-income African-American men, as measured by both self-report (Cohen's Perceived
           Stress Scale) and bio-physiological measures of cortisol (assessed in hair samples); and
           (b) Determine whether the MOCHA+ program is significantly more effective than the MOCHA
           program in decreasing stress among low-income African-American men, on these same
           measures;

        3. Assess the effects of the MOCHA and MOCHA+ interventions on mediating variables along
           hypothesized causal pathways identified through intervention mapping and the
           construction of a logic model, based on the Minority Stress Model finalized in achieving
           Aim 1.

      The proposed research will proceed in two stages. During the first 18 months, phase one of
      the study will focus on (a) formative research designed to further elaborate the minority
      stress model and (b) the incorporation of narrative communications strategies into the MOCHA+
      intervention. In phase two, the investigators will recruit 240 low-income African-American
      men between 35-65 years of age over a three-year period to participate in a randomized
      controlled trial, with three arms: MOCHA, MOCHA+, or wait-list control. The primary research
      endpoint is bio-physiological assessment of the ELISA cortisol hair-test (average hormone
      levels over the past 3 months), administered at pre, post, and 3 month follow-up, as well as
      self-reported stress levels using Cohen's Perceived Stress scale. Secondary outcomes include
      the bio-physiological indicators of blood pressure and BMI.

      The proposed research will determine the effectiveness of MOCHA in reducing stress and
      whether it can be further strengthened by introducing narrative communication strategies. The
      results of the proposed research will contribute to the development of an enhanced
      theoretical model of factors affecting low-income African-American male health and to the
      evidence base of effective interventions aimed at chronic disease prevention and control
      programs in this population.
    

Intervention name(s): MOCHA
Intervention type(s): Behavioral
Intervention description(s): (see above)
Other intervention name(s): MOCHA+
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The study design uses a wait-list control to test the effectiveness and relative effectiveness of a community-driven MOCHA intervention, including discussions of salient health topics (such as stress and anger management) and an enhanced version MOCHA+, which incorporates narrative communication strategies to strenghten comprehnsion, retention and motivation.
Masking: Single (Participant)
Primary purpose: Prevention