A Just-In-Time Adaptive Mobile Application Intervention To Reduce Sodium Intake And Blood Pressure In Hypertensive Patients

实时自适应移动应用干预可减少高血压患者的钠摄入量和血压

基本信息

批准号：
10302713
负责人：
Michael Dorsch
金额：
$ 77.61万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-15 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10302713
关键词：
Adherence Advocate American American Heart Association Atherosclerosis Blood Pressure Body Weight Calories Cardiovascular system Chronic Clinical Consumption Data Development Diagnosis Diet Dietary Component Dietary Sodium Disease Education Electronic Health Record Enrollment Event Food Fostering Future Goals Guidelines Health behavior Home Home Blood Pressure Monitoring Hypertension Intake Intervention Knowledge Learning Life Style Link Measures Mediating Mediator of activation protein Medicine Michigan Morbidity - disease rate Notification Participant Patient Recruitments Patients Potassium Probability Process Psychological reinforcement Randomized Randomized Controlled Trials Research Restaurants Self Management Sodium Sodium-Restricted Diet Source Technology Testing Time Wireless Technology Work adaptive intervention base blood pressure reduction dietary digital health efficacy evaluation group intervention habituation improved intervention effect mobile application novel nutrition patient engagement prevent programs prospective randomized trial theories tool trend wearable device

项目摘要

PROJECT SUMMARY High dietary sodium intake is linked to incident hypertension (HTN) and cardiovascular events. Conversely, lower sodium intake has been shown to reduce both blood pressure (BP) and prevent atherosclerotic cardiovascular diseases (ASCVD). American Heart Association guidelines advocate daily sodium intake of less than 2,300 mg, but the estimated average sodium intake for Americans is 3,400 mg per day. In recent years, consumption of pre-processed and restaurant foods has substantially increased, and more than 75% of sodium in the average U.S. diet now comes from these sources. Despite widespread knowledge of the harms of high dietary sodium intake, an ongoing challenge for clinicians is engaging patients in lifestyle-based treatments to reverse these trends as well as promote ongoing self- management and long-term adherence to low sodium diets. Although there is growing hope that digital health platforms may help to overcome these issues, few empirical studies have demonstrated their efficacy over time. Relying on a strong conceptual framework in health behavior theory, we recently demonstrated in early work that a mobile application-based just-in-time adaptive intervention (JITAI) reduces dietary sodium intake (R21HS024567). This JITAI uses geofencing technology to provide tailored and contextual push notifications at home, grocery stores, and restaurants with links to sodium-based nutrition information within the mobile application. While our preliminary results were exciting, the critical gaps in knowledge that remain to be tested are 1) whether a mobile application-based JITAI focused on lowering sodium intake will lead to a decrease in BP, 2) which dietary components mediate the intervention's effect on BP, and 3) how to optimize participant engagement to sustain both dietary and BP effects over time and prevent habituation. The long-term goal of our research program is to develop successful mobile application-based strategies, driven by adaptive technologies, that support patient self-management in common cardiovascular conditions. Our overall objectives are to evaluate the efficacy of a dietary sodium JITAI on reducing BP, establish the changes in diet that mediate improvement in BP, and optimize the JITAI for long-term patient engagement. Our central hypothesis is that JITAIs targeting dietary sodium will reduce BP over time and that these effects will be better sustained through optimization of JITAIs. Accordingly, we will perform a two-step sequential, prospective, randomized controlled trial in 400 HTN patients to meet our overall objectives. In the first step, we will investigate the effect of the JITAI on BP and perform a micro-randomized trial to optimize the JITAI for patient engagement. In the second step, we will study the sustained effects of an optimized JITAI on BP.

项目摘要高饮食钠摄入量与入射高血压（HTN）和心血管事件有关。反过来，已经显示出下钠摄入量可以降低血压（BP）并预防动脉粥样硬化心血管疾病（ASCVD）。美国心脏协会指南倡导每日钠摄入量减少超过2300毫克，但美国人的估计平均钠摄入量为每天3,400毫克。最近几年，食用预处理和餐厅食品已大大增加，钠的75％以上现在，美国平均饮食来自这些来源。尽管广泛了解高饮食钠摄入量的危害，但对临床医生来说是持续的挑战正在吸引患者接受基于生活方式的治疗以扭转这些趋势并促进持续的自我管理和长期遵守低钠饮食。尽管越来越希望数字健康平台可能有助于克服这些问题，很少有实证研究证明了它们的功效时间。依靠健康行为理论中的强大概念框架，我们最近在早期证明了基于移动应用程序的及时自适应干预（JITAI）的工作减少了饮食钠的摄入量（R21HS024567）。这款Jitai使用地理申请技术在家居，杂货店和餐馆，在手机中提供了基于钠的营养信息的链接应用。尽管我们的初步结果令人兴奋，但知识的关键差距仍有待测试是1）基于移动应用程序的Jitai是否专注于降低钠摄入量会导致减少 BP，2）饮食成分介导干预对BP的影响，以及3）如何优化参与者参与以维持饮食和BP的影响，并防止习惯。我们研究计划的长期目标是制定成功的基于移动应用程序的策略，在自适应技术的驱动下，支持患者在常见心血管疾病中的自我管理。我们的总体目标是评估饮食中钠钠对减少BP的功效，建立介导BP改善并优化Jitai的饮食变化，以进行长期患者参与。我们的中心假设是，靶向饮食钠的吉塔斯会随着时间的流逝而减少bp，这些影响将是通过优化Jitais更好地维持。因此，我们将执行两步顺序 400名HTN患者的前瞻性，随机对照试验可满足我们的整体目标。在第一步中，我们将研究Jitai对BP的影响并执行微型试验，以优化Jitai 病人参与。在第二步中，我们将研究优化的Jitai对BP的持续影响。