Expanding Delivery of an Evidence-based Weight-loss Intervention to Enhance Access and Reach Underserved Groups After TBI

Weight will be obtained at a lab local to the participant based on their preference. Weight for participants randomized to the GLB-TBI will also be captured via self-weighing using provided BodyTrace Smart Scale, which include cellular connectivity so weight will be sent directly to the research team. The scales have demonstrated good concordance rates with in-person weighing in previous weight management research.Scales will be setup by our team before being mailed to participants with instructions for use.

Hemoglobin A1c will be obtained at a lab local to the participant based on their preference.

Total cholesterol, HDL, LDL, and triglycerides will be obtained at a lab local to the participant based on their preference

Arm circumference will be measured at the mid-upper arm at a lab local to the participant based on their preference.

Waist circumference will be measured at the umbilicus at a lab local to the participant based on their preference.

Measured using an automatic cuff (average of three readings, patient seated) diastolic and systolic scores will be recorded at a lab local to the participant based on their preference.

The Framingham Heart Study diabetes risk score will be calculated using predictors including age, gender, fasting glucose, BMI, HDL cholesterol and triglyceride levels, blood pressure, and parental history. Risk score calculator and regression model are free and used in GLB weight-loss trials.

Metabolic Syndrome is a cluster of cardiovascular risk factors that include abdominal obesity (large waist circumference, high BMI), high blood pressure, high triglycerides, low HDL cholesterol and high fasting blood sugar. Individuals who have ≥3 of these risk factors have metabolic syndrome, placing them at greater risk of developing heart disease and diabetes. As metabolic syndrome is sensitive to lifestyle change, the metabolic syndrome severity score calculator is used to determine risk for future cardiovascular disease compared to the US population. Risk scores below 0 indicate a lower degree of metabolic syndrome risk than the average US adult; scores above 0 are associated with greater risk for disease. A score of 1 indicates risk is higher than 84.1% of US adults and a score of 2 is higher than 97.7% of US adults. Z scores are calculated for BMI and waist circumference.

The DPP-GLB program itself utilizes food logs as an intervention behavioral tool, however, to further evaluate intervention efficacy we will also assess dietary change at each assessment period. 24-hour dietary recalls will be collected with the latest version of the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool 1-day prior to the telephonic follow-up. This free online platform (https://epi.grants.cancer.gov/asa24/#what; uses interactive multi-pass methodology68(gold-standard in dietary assessment) and provides an overall diet quality score, the Healthy Eating Index (available online through the NCI website [https://epi.grants.cancer.gov/asa24/resources/hei.html] and aligns with federal recommendations and guidelines).

The Neighborhood Environment Walkability Scale (NEWS) assesses participants' perception of neighborhood features related to physical activity and grocery shopping, including residential density, land use mix (including both indices of proximity and accessibility), street connectivity, infrastructure for walking/cycling, neighborhood aesthetics, traffic and crime safety, and neighborhood satisfaction. Questions are rated on a 4-point Likert scale with higher scores signifying greater perceived walkability. Scores provide insight into environmental barriers faced, are sensitive to behavior change, and can be used as a covariate for weight-loss. This measure will be delivered telephonically.

The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys that collects information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. The GLB-TBI uses the two subscales of Healthy Eating and Physical Activity from the 2017 version of the BRFSS. It consists of 14 items. For this study, we will capture minutes of self-reported physical activity (higher numbers signify more physical activity and better outcome) and number of whole fruits/vegetables consumed each day (higher numbers mean better outcome). This measure will be administered telephonically.

The SRAHP includes 28 items to assess health behaviors among people with disabilities and yields a total Health Practices Score plus 4 subscale scores (Exercise, Nutrition, Health Practices, and Psychological Well Being). Items are rated on a 5-point scale from 0 'not at all' to 4 'completely.' Scores range from 0-28 with higher scores indicating higher self-efficacy for the health behaviors. This measure will be administered telephonically.

The Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) is a six-item self-report questionnaire addressing how satisfied individuals are with aspects of their functioning (physical; cognitive; emotional; participation; social life; future prospects). Answers are on a 5-point Likert scale and the sum of all items are converted to a percentage scale from 0-100. The QOLIBRI-OS has excellent reliability and internal consistency. This measure will be administered telephonically.

The Telehealth Usability Questionnaire (TUQ) is a validated assessment that measures 5 usability factors of telehealth (usefulness, ease of use, effectiveness, reliability, and satisfaction). 21 items are scored on level of agreement from 1-7, with higher scores indicating greater agreement. All subscales have good to excellent reliability (α=.79-.92). This measure will be administered telephonically.

Participants will be asked to complete an exit survey at the 12-month assessment. This survey will ask about participant experience in, and satisfaction with, the GLB-TBI telehealth program and suggestions for improvement. The survey will be emailed to participants via a secure link.