Incentives, Cognitive Training, and Internet Therapy for Teens with Poorly Contro

针对控制不良青少年的激励、认知训练和互联网治疗

基本信息

批准号：
8436585
负责人：
CATHERINE STANGER
金额：
$ 245.58万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-30 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8436585
关键词：
Achievement Address Adherence Adolescent Adult Affect Behavior Therapy Blood Glucose Blood Glucose Self-Monitoring Cognitive Cognitive Therapy Counseling Decision Making Diabetes Mellitus Distant Effectiveness of Interventions Elements Endocrinologist Evaluation Evidence based intervention Evidence based treatment Family Feasibility Studies Feedback Foundations Frequencies Future Glycosylated Hemoglobin Glycosylated hemoglobin A Goals Health Home environment Impulsivity Incentives Incidence Individual Insulin-Dependent Diabetes Mellitus Internet Intervention Lead Life Manuals Medical Memory Metabolic Control Methods Modeling Motivation Neurocognitive Outcome Parents Patients Pilot Projects Process Protocols documentation Recommendation Research Rewards Self Care Short-Term Memory Staging Target Populations Technology Teenagers Testing Time Training Treatment Protocols Treatment outcome Work Youth aged base behavior change blood glucose regulation cognitive function cognitive training cost effective design diabetic discounting economic cost effective intervention efficacy trial executive function financial incentive high risk improved innovation intervention effect mortality motivational enhancement therapy novel parental monitoring preference programs randomized trial skills therapy design treatment adherence treatment as usual trial comparing young adult

项目摘要

DESCRIPTION (provided by applicant): Type 1 diabetes in adolescents is a significant medical condition associated with high economic costs and increased mortality, and its incidence is increasing. Unfortunately, adolescents show poorer adherence to self monitoring of blood glucose (SMBG) recommendations and poorer metabolic control than adults. Although some individual and family-based interventions have shown promise in improving metabolic control, there is a critical need to develop more effective interventions. The overall goal of this DP3 project is to develop a new innovative intervention that targets decision making to help teens with poor diabetic metabolic control increase the frequency of SMBG and improve HbA1c. The target population will be teens aged 13-17 with type 1 diabetes and HbA1c >8%. Based on our prior work and a conceptual model, the proposed study will develop and pilot test a novel, multifaceted, developmentally appropriate intervention aimed at improving adolescent decision making. An integrated set of components target adolescents' need for frequent positive feedback, improved future orientation, and motivational support. While past research indicates that behavioral interventions are frequently more successful when they include multiple elements, no previous intervention has combined multiple empirically-based components that target key decision making levers in one intervention. This new intervention, called MAxIM (MotivAtion, Incentives, Memory) uses: 1) motivation enhancement therapy (MET) (an existing evidence-based treatment for adolescent with diabetes) supplemented with cognitive behavior therapy (CBT) to enhance behavior change; 2) financial incentives for daily blood glucose testing and parental monitoring to provide frequent positive feedback; and 3) working memory training (WMT), an efficacious method for strengthening specific cognitive processes that support decision-making and future orientation. The interventions will be delivered to families at home via the internet to increase the reach of the intervention to families living distant from ther treating endocrinologist. MAxIM will be teen and parent friendly and designed to increase engagement and compliance with the intervention. Primary hypotheses are that MAxIM will: (1) help teens improve and maintain glucose control, and (2) improve decision making (improve executive function and reduce delay discounting), which will predict treatment outcome. The unique set of interventions holds promise for improving adherence by affecting multiple basic mechanisms that determine poor decision making. The project will develop a novel, highly transportable, home based intervention designed to maximize and sustain HbA1c reductions and SMBG frequency over time in adolescents. Innovations include the targeting of multiple levers specific to adolescent decision making, use of technology to deliver the intervention to families at home, and testing cognitive predictors of treatment outcome for teens with diabetes. Successful achievement of this study's aims will bring the field closer to a cost effective, long-lasting intervention to improve outcomes among these high-risk youth. PUBLIC HEALTH RELEVANCE: The overall goal of this project is to develop a novel family friendly intervention that will help teens with poor metabolic control of their type 1 diabetes increase and sustain daily self monitoring of blood glucose and lower HbA1c. This is important because poor metabolic control has long-term health implications. This project will provide important information regarding new effective ways to improve outcomes among teens with poorly controlled type 1 diabetes.

描述（由申请人提供）：青少年 1 型糖尿病是一种与高经济成本和死亡率增加相关的重要疾病，并且其发病率正在增加。不幸的是，与成年人相比，青少年对自我血糖监测 (SMBG) 建议的遵守程度较差，代谢控制也较差。尽管一些基于个人和家庭的干预措施已显示出改善代谢控制的希望，但仍迫切需要开发更有效的干预措施。本次活动的总体目标 DP3 项目旨在开发一种新的创新干预措施，旨在帮助糖尿病代谢控制不佳的青少年增加 SMBG 频率并改善 HbA1c。目标人群是患有 1 型糖尿病且 HbA1c > 8% 的 13-17 岁青少年。基于我们之前的工作和概念模型，拟议的研究将开发并试点测试一种新颖的、多方面的、适合发育的干预措施，旨在改善青少年的决策。一套综合的组件针对青少年对频繁积极反馈、改善未来导向和动机支持的需求。虽然过去的研究表明，行为干预措施在包含多个要素时往往会更成功，但以前的干预措施都没有将多个基于经验的成分结合在一起，将关键决策杠杆作为一项干预措施。这种名为 MAxIM（动机、激励、记忆）的新干预措施采用：1）动机增强疗法（MET）（一种针对青少年糖尿病的现有循证治疗方法）辅以认知行为疗法（CBT）以增强行为改变； 2) 对日常血糖检测和家长监测提供经济激励，以提供频繁的积极反馈； 3）工作记忆训练（WMT），这是一种加强支持决策和未来导向的特定认知过程的有效方法。这些干预措施将通过互联网提供给家庭，以扩大干预措施对远离内分泌科医生的家庭的影响。 MAxIM 将对青少年和家长友好，旨在提高干预措施的参与度和依从性。主要假设是 MAxIM 将：(1) 帮助青少年改善和维持血糖控制，(2) 改善决策（改善执行功能并减少延迟贴现），这将预测治疗结果。这套独特的干预措施有望通过影响决定不良决策的多种基本机制来提高依从性。该项目将开发一种新颖的、高度可移植的、以家庭为基础的干预措施，旨在最大限度地提高和维持青少年 HbA1c 的降低和 SMBG 频率随时间的推移。创新包括针对青少年决策的多种杠杆，利用技术向家庭家庭提供干预，以及测试青少年糖尿病治疗结果的认知预测因素。这项研究目标的成功实现将使该领域更接近于采取具有成本效益、持久的干预措施，以改善这些高危青少年的预后。公共健康相关性：该项目的总体目标是开发一种新颖的家庭友好型干预措施，帮助 1 型糖尿病代谢控制不佳的青少年增加和维持每日血糖自我监测并降低 HbA1c。这很重要，因为代谢控制不良会对健康产生长期影响。该项目将提供有关改善 1 型糖尿病控制不佳的青少年预后的新有效方法的重要信息。