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：指南建议成年人至少应进行适度的运动，例如步行 每周150分钟的剧集至少10分钟。典型的成年人可以通过 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， 45岁以上的三分之一的退伍军人符合身体不活跃的定义。患者激励措施 体育锻炼计划（PA）可能会有所帮助。行为经济学表明，我们的长期无法开始 并保持PA例程可能是“当前偏见”的结果，这是一种珍视即时的趋势 在遥远的未来，奖励很大。对于许多人来说，久坐的立即满足 活动，例如看电视或互联网上浏览，比无形的电动机更强大 满足身体活跃的生活方式。患者激励措施可以通过移动来克服当前偏见 奖励随着时间的推移而前进的健康行为。在患者激励计划中，给予患者有形，及时 奖励实现特定健康目标，例如每天步行7,000步。 显着性/影响：常规身体活动（PA）与死亡率降低相关，降低的风险 许多疾病，包括2型糖尿病，心脏病和抑郁症。这项研究解决了慢性 条件HSR＆D优先区域。 创新：几乎没有证据表明哪种类型的激励措施最适合退伍军人。我们建议学习 PA的激励措施是一种新型的随机试验形式 - 多相优化策略（大多数）试验。我们的 目标是确定一个为12周的患者激励计划的最佳设计，以鼓励步行 在身体不活跃的退伍军人中，年龄在50-70岁。主要结果是优化的组件 干预措施，将在未来的单独随机试验中针对通常的护理对照组进行测试。 具体目的： AIM 1：进行24个阶乘设计的筛查相试验，以增加平均步骤的激励措施 在身体不活跃的退伍军人中，每天至7,000步。我们将测试四个不同的 激励因素：1）彩票与损失的激励措施，2）财务与非财务激励措施，3） 承诺明信片提醒退伍军人提出的固有理由是对PA的承诺 承诺明信片，以及4）向老兵请求PA的请求，以保持活跃与无请求。这 主要结果是从基线到第24周的每周步骤变化。 目标2。进行成本分析和定性访谈。管理每个组件的成本和 对每个组件对审判参与者的可接受性的定性评估将告知 哪些组件保留为随后的完善和确认阶段试验。 目标3。召集专家小组，为最下一个试验的下一个阶段选择组件。面板 将根据其对步骤计数的影响（AIM 1），行政成本和参与者的影响加权每个组件 - 报告的定性评估（AIM 2）以及组件效应的理论基础的强度 关于体育锻炼。 方法论：我们将在筛查阶段试验中注册50-70岁的身体不活跃的退伍军人。这 干预是上述四个不同的激励因素。主要结果是每步的变化 从基线到第24周的一周。 实施/下一步：从此筛选阶段得出的组件将用于精炼 建立激励措施的最佳剂量（频率，持续时间和数量）的相位试验。优化 然后，将在确认阶段试验中针对通常的护理对照组进行干预。精炼和 确认阶段试验将在单独的未来赠款提交中提出。