Interactive Web Program and Health Coaching for Prehypertensive Adults

针对高血压前期成人的互动网络计划和健康指导

基本信息

批准号：
8527534
负责人：
AMELIA J BIRNEY
金额：
$ 40.24万
依托单位：
OREGON CENTER FOR APPLIED SCIENCE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-01 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8527534
关键词：
Administrator Adult Alcohol consumption American Antihypertensive Agents Attitude Behavior Behavior Therapy Behavioral Blood Pressure Body Weight decreased Cardiovascular system Caring Charge Computerized Medical Record Consumption DASH diet Data Databases Detection Development Diastolic blood pressure Disease Disease Management Eating Electronic Mail Elements Evaluation Evidence based program Feedback Financial cost Goals Health Health Benefit Health Personnel Health behavior Healthcare Heart Heart Diseases Hypertension Hypotension Incidence Insurance Insurance Carriers Intake Intention Internet Intervention Joints Knowledge Letters Licensing Life Style Link Maintenance Marketing Mediating Medical Medical Electronics Modeling Motivation Myocardial Infarction Myocardial Ischemia Outcome Measure Participant Patients Pharmaceutical Preparations Phase Phase II Clinical Trials Physical activity Planning Theory Positioning Attribute Preparation Prevalence Prevention Process Provider Readiness Recruitment Activity Reporting Research Resources Risk Behaviors Schedule Self Assessment Self Blood Pressure Monitoring Self Efficacy Self Management Services Sodium Stroke System TimeLine Visit base behavior change cost design evidence base falls follow-up fruits and vegetables health care delivery high risk innovation interactive multimedia interest intervention program middle age motivated behavior motivational enhancement therapy peer prevent programs prototype randomized trial satisfaction social cognitive theory therapy design tool usability web site web-based social networking

项目摘要

DESCRIPTION (provided by applicant): Approximately a third (31%) of adult Americans are prehypertensive (SBP 120-139 and/or DBP 80-89). Health care providers struggle to provide effective support for blood-pressure-lowering behavior changes, while patients continue to progress to full hypertension and the use of antihypertensive medications. Insurers and providers with access to electronic medical records and other medical data are in a unique position to identify prehypertensive adults and target them with a blood pressure self-management program. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and, more importantly, long-term costs of care for heart disease and stroke. This project will develop and evaluate a coach-guided, interactive blood pressure self-management program for adults with prehypertension. The program will target blood pressure self-monitoring and the five proven lifestyle modifications recommended by JNC-7: weight reduction, the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity, and alcohol consumption. The multi-modal program uses a combination of brief motivational health coaching, periodic engagement emails, and a robust interactive website to motivate people to take charge of their blood pressure management before they require medication. All program components were designed to conform to the underlying principles of motivational interviewing. Key program components include the use of email and Web-based social networking, personal stories, and brief motivational coaching sessions to engage participants and encourage intrinsically motivated behavior changes. Self-assessment and tracking tools are combined with educational content to help participants align their daily lifestyle choices with their personal goals. The Phase I prototype program promoted moderate physical activity and eating fruits and vegetables as part of the DASH diet. Results from the within-group (n = 39) evaluation showed moderate-to-large effect sizes for pre-to-post change in motivation, preparation behavior, self-efficacy, attitudes, and knowledge, and a small significant increase in physical activity. Participants gave the online program high ratings on satisfaction and usability, and reported improvements in confidence, readiness, clarity, change strategies, and interest in visiting the Website as a result of the coaching session. The fully developed Phase II product will be evaluated in a large randomized trial (N = 450) with a 3-month intensive period, a 3-month maintenance period, and a 3-month follow-up period. The Phase II trial is expected to show improvements in JNC-recommended BP-lowering health behaviors. These changes in the outcome measures are expected to be mediated by changes in knowledge, attitudes, self-efficacy, behavioral intention, motivation, and patient activation. The Phase II product will be marketed to large, integrated health benefits providers with both insurance and wellness products, like our Phase II evaluation partner Aetna, and to integrated health service delivery systems, like our Phase I and II evaluation partner, Providence Health.

描述（由申请人提供）：大约三分之一 (31%) 的美国成年人患有高血压前期（收缩压 120-139 和/或舒张压 80-89）。医疗保健提供者努力为降低血压的行为改变提供有效的支持，而患者则继续发展为完全高血压并使用抗高血压药物。能够访问电子病历和其他医疗数据的保险公司和提供商处于独特的地位，可以识别高血压前期成人并针对他们制定血压自我管理计划。预防或延缓高血压应该减少抗高血压药物的中期费用，更重要的是，减少心脏病和中风的长期护理费用。该项目将为患有高血压前期的成人开发和评估教练指导的交互式血压自我管理计划。该计划将针对血压自我监测和 JNC-7 建议的五种经过验证的生活方式改变：减轻体重、控制高血压的饮食方法 (DASH)、减少钠摄入、体力活动和饮酒。该多模式计划结合了简短的激励性健康指导、定期参与电子邮件和强大的互动网站，激励人们在需要药物治疗之前负责血压管理。所有计划组成部分的设计都符合动机访谈的基本原则。计划的关键组成部分包括使用电子邮件和基于网络的社交网络、个人故事和简短的激励辅导课程来吸引参与者并鼓励内在动机的行为改变。自我评估和跟踪工具与教育内容相结合，帮助参与者将日常生活方式的选择与个人目标结合起来。第一阶段原型计划提倡适度的体力活动以及吃水果和蔬菜，作为 DASH 饮食的一部分。组内 (n = 39) 评估的结果显示，动机、准备行为、自我效能、态度和知识的前后变化具有中等到大的效应大小，并且体力活动有小幅显着增加。参与者对在线计划的满意度和可用性给予了很高的评价，并报告说，由于辅导课程，他们的信心、准备程度、清晰度、改变策略以及访问网站的兴趣都得到了改善。完全开发的 II 期产品将在一项大型随机试验（N = 450）中进行评估，试验包括 3 个月的强化期、3 个月的维持期和 3 个月的随访期。 II 期试验预计将显示 JNC 推荐的降压健康行为的改善。结果测量的这些变化预计将通过知识、态度、自我效能、行为意图、动机和患者激活的变化来调节。第二阶段产品将营销给拥有保险和健康产品的大型综合健康福利提供商（例如我们的第二阶段评估合作伙伴 Aetna），以及综合医疗服务提供系统（例如我们的第一阶段和第二阶段评估合作伙伴 Providence Health）。