Multiphase Optimization Trial of Incentives for Veterans to Encourage Walking

退伍军人鼓励步行激励措施的多阶段优化试验

• 批准号: 10217248
• 负责人: PAUL L. HEBERT
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10217248
• 关键词: Accelerometer; Address; Adult; Age; Area; Award; Behavior; Cardiovascular Diseases; Chronic; Complex; Cost Analysis; Diabetes Mellitus; Disease; Distant; Dose; Educational Background; Employee; Enrollment; Exercise; Female; Frequencies; Future; Gender; Goals; Grant; Guidelines; Habits; Health; Health behavior change; Heart Diseases; Incentives; Income; Internet; Intervention; Interview; Knowledge; Low income; Maintenance; Mental Depression; Mental Health; Methodology; Moderate Exercise; Non-Insulin-Dependent Diabetes Mellitus; PF4 Gene; Participant; Patients; Persons; Phase; Physical activity; Population; Probability; Reporting; Research; Research Design; Rewards; Risk; Running; System; Taxes; Testing; Time; United States; United States Department of Veterans Affairs; Veterans; Walking; Work; active lifestyle; base; behavior change; behavioral economics; cost; design; exercise regimen; fitbit; health care delivery; health goals; healthy aging; improved; incentive program; innovation; male; military veteran; mortality; multiphase optimization strategy; novel; payment; physical conditioning; physical inactivity; prevent; primary outcome; randomized trial; satisfaction; screening; sedentary; sedentary activity; theories; therapy design; treatment as usual; tv watching; usual care arm

Background: Guidelines recommend adults should engage in moderate exercise, such as walking, for at least 150 minutes per week in episodes of at least 10 minutes duration. A typical adult can reach this threshold by walking 7,000 steps per day. Unfortunately, only 5% of adults in the United States meet these requirements, and more than 1 in 3 Veterans over age 45 meet the definition of physically inactive. A patient incentive program for physical activity (PA) may help. Behavioral economics suggests that our chronic inability to start and maintain a PA routine may be the result of “present bias,” which is a tendency to value small immediate rewards over large rewards in the distant future. For many people, the immediate gratification of a sedentary activity, such as watching television or surfing the internet, is a more powerful motivator than the intangible satisfaction of a physically active lifestyle. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In a patient incentive program, patients are given tangible, timely rewards for achieving specific health goals, such as walking 7,000 steps per day. Significance/Impact: Regular physical activity (PA) is associated with reduced mortality and lower risks of many diseases, including type 2 diabetes, heart disease, and depression. this study addresses the chronic conditions HSR&D priority area. Innovation: There is little evidence on what type of incentive works best for Veterans. We propose to study incentives for PA in a novel form of randomized trial—A Multiphase Optimization STrategy (MOST) trial. Our objectives are to determine the optimal design of a 12-week patient incentive program to encourage walking among physically inactive Veterans age 50-70. The primary outcomes are optimized components of the intervention, which will be tested against a usual care control group in a future, separate randomized trial. Specific Aims: Aim 1: Conduct a 24 factorial designed screening-phase trial of incentives for increasing average steps per day to 7,000 steps over 12 weeks among physically inactive Veterans. We will test four different incentive factors: 1) lottery vs. loss framed incentives, 2) financial vs. non-financial incentives, 3) a pre- commitment postcard reminder of a Veteran’s stated intrinsic reason for commitment to PA vs. no pre- commitment postcard, and 4) a request for PA advice from a Veteran on staying active vs. no request. The primary outcome is change in steps per week from baseline to week 24. Aim 2. Conduct cost analyses and qualitative interviews. The cost of administering each component and qualitative assessments of the acceptability of each component to trial participants will inform the decision of which components to retain for the subsequent refining and confirmatory phase trials. Aim 3. Convene an expert panel to choose components for the next phases of the MOST trial. The panel will weigh each component in terms of its effect on step counts (Aim 1), administrative costs and participant- reported qualitative assessments (Aim 2), and the strength of the theoretical basis for the component’s effect on physical activity. Methodology: We will enroll physically inactive Veterans age 50-70 in the screening phase trial. The intervention is the four different incentive factors described above. The primary outcome is change in steps per week from baseline to week 24. Implementation/Next Steps: The components derived from this screening phase will be used in a refining phase trial that establishes the optimal dose (frequency, duration, and amount) of the incentive. The optimized intervention will then be tested against a usual care control group in the confirming phase trial. The refining and confirming phase trials will be proposed in a separate, future grant submission.

背景：指南建议成年人应该进行适度的运动，例如步行至少 每周 150 分钟，每次持续时间至少 10 分钟 典型成年人可以达到此阈值。 每天步行 7,000 步不幸的是，美国只有 5% 的成年人满足这些要求， 超过三分之一的 45 岁以上退伍军人符合身体不活动 A 患者激励的定义。 行为经济学表明，我们长期无法开始身体活动，这可能会有所帮助。 并维持 PA 常规可能是“当前偏见”的结果，即倾向于重视即时的小事 对于许多人来说，久坐带来的即时满足感胜过遥远未来的巨大奖励。 诸如看电视或上网之类的活动是比无形事物更强大的动力 患者对积极的生活方式的满意度可以通过改变现有的偏见来克服。 及时奖励健康行为 在患者激励计划中，患者会得到切实、及时的奖励。 对实现特定健康目标（例如每天步行 7,000 步）的奖励。 意义/影响：定期体力活动 (PA) 与降低死亡率和降低患病风险相关 这项研究针对的是许多疾病，包括 2 型糖尿病、心脏病和抑郁症。 条件 HSR&D 优先领域。 创新：几乎没有证据表明哪种激励措施最适合退伍军人。我们建议进行研究。 一种新型随机试验形式的 PA 激励措施——我们的多阶段优化策略 (MOST) 试验。 目标是确定为期 12 周的患者激励计划的最佳设计，以鼓励步行 50-70 岁缺乏身体活动的退伍军人中的主要结果是优化的组成部分。 干预措施，将在未来的单独随机试验中针对常规护理对照组进行测试。 具体目标： 目标 1：进行 24 因子设计的筛选阶段试验，以提高平均步数的激励措施 不运动的退伍军人在 12 周内每天步行 7,000 步 我们将测试四种不同的方法。 激励因素：1) 抽奖与亏损框架激励，2) 财务激励与非财务激励，3) 预 承诺明信片提醒退伍军人声明承诺参加 PA 的内在原因与没有预先承诺的原因 承诺明信片，以及 4) 向退伍军人请求 PA 关于保持活跃与不提出请求的建议。 主要结果是从基线到第 24 周每周步数的变化。 目标 2. 进行成本分析和定性访谈，了解管理每个组件的成本和成本。 对试验参与者每个组成部分的可接受性进行定性评估将有助于做出决定 保留哪些成分用于后续的精炼和验证阶段试验。 目标 3. 召集专家小组为 MOST 试验的下一阶段选择组件。 将根据其对步数（目标 1）、管理成本和参与者的影响来权衡每个组件 - 报告的定性评估（目标 2），以及成分效果的理论基础的强度 关于身体活动。 方法：我们将招募年龄 50-70 岁、身体不活跃的退伍军人参加筛选阶段试验。 干预是上述四种不同激励因素的主要结果是每步的变化。 从基线到第 24 周的周。 实施/后续步骤：从此筛选阶段获得的成分将用于精炼 确定最佳激励剂量（频率、持续时间和金额）的阶段试验。 然后，将在确认阶段试验中针对常规护理对照组对干预措施进行测试。 确认阶段试验将在未来单独提交的赠款中提出。