Integrating Behavioral Economics and Self-Determination Theory to Advance Patient Engagement in Diabetes Prevention

整合行为经济学和自我决定理论，促进患者参与糖尿病预防

• 批准号: 10443856
• 负责人: JEFFREY KULLGREN
• 金额: $ 57.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10443856
• 关键词: Address; Adult; Behavior; Behavioral; Caring; Chronic Disease; Collaborations; Consolidated Framework for Implementation Research; Control Groups; Data; Diabetes prevention; Effectiveness; Enrollment; Evidence based intervention; Glycosylated hemoglobin A; Health; Health Insurance; Health Promotion; Health system; Healthcare; Healthcare Systems; Incentives; Individual; Intervention; Interview; Lead; Link; Measures; Mediator of activation protein; Medicine; Metformin; Michigan; Modeling; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Participant; Patients; Persons; Prediabetes syndrome; Prevention; Prevention strategy; Program Evaluation; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Rewards; Risk; Risk Factors; Role; Self Determination; Surveys; Testing; Time; Universities; Weight; Workplace; base; behavior change; behavioral economics; community organizations; compare effectiveness; diabetes prevention program; eHealth; effective intervention; evidence base; financial incentive; health care model; health plan; implementation framework; implementation intervention; incentive program; innovation; insight; insurance claims; novel; novel strategies; patient engagement; prevent; primary outcome; program costs; programs; screening; secondary outcome; tailored messaging; theories; waist circumference

The estimated 84 million US adults with prediabetes can significantly reduce their risk of developing type 2 diabetes mellitus (T2DM) by engaging in a Diabetes Prevention Program (DPP) or using metformin. Although these evidence-based interventions are widely available, few patients who would benefit use them. An opportune time to increase engagement of patients with prediabetes in strategies to prevent T2DM is after they are detected through a screening. One scalable and sustainable way to increase patient engagement after screenings would be to offer patients financial incentives for participating in a DPP or using metformin. Such financial incentives could be made more effective by integrating insights from behavioral economics with principles of self-determination theory (SDT). This integration could be achieved by adding to incentives automated tailored messages that link incentives and T2DM prevention to people's roles, values, and strengths. Our team of experts in T2DM prevention, behavioral economics, and SDT will conduct a 12-month pragmatic randomized controlled trial in which we will randomize 380 patients with prediabetes to 1 of 4 groups: (1) financial incentives plus tailored messages based on SDT principles; (2) financial incentives alone; (3) tailored messages based on SDT principles alone; or (4) an enhanced control group. Aim 1: Compare the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles in decreasing hemoglobin A1c, weight, and waist circumference and in increasing participation in a DPP or use of metformin. We will assess changes in the primary outcome of hemoglobin A1c and in secondary outcomes of weight and waist circumference at 6 and 12 months. We will use health insurance claims data to measure the secondary outcome of participation in a DPP or use of metformin. Aim 2: Identify mediators and moderators of the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. To measure these, we will survey participants at baseline, 6, and 12 months. Aim 3: Evaluate facilitators of and barriers to scalability, acceptability, and sustainability of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. We will interview patients, workplace health promotion staff, and health system staff to conduct a comprehensive evaluation of program implementation and sustainability using an integration of the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. If effective, this novel approach that leverages insights from behavioral economics and SDT could serve as a model for how health care systems and community organizations can partner to help at-risk patients prevent T2DM as well as modify other behavioral risk factors for chronic disease and poor health.

据估计，8400 万患有前驱糖尿病的美国成年人可以显着降低患 2 型糖尿病的风险 通过参与糖尿病预防计划 (DPP) 或使用二甲双胍来预防糖尿病 (T2DM)。虽然 这些基于证据的干预措施已广泛使用，但很少有患者会受益于使用它们。一个 增加糖尿病前期患者参与预防 T2DM 策略的最佳时机是在他们 是通过筛查检测出来的。一种可扩展且可持续的方式来提高患者术后参与度 筛查的目的是为患者提供参与 DPP 或使用二甲双胍的经济奖励。这样的 通过将行为经济学的见解与 自决理论（SDT）的原则。这种整合可以通过增加激励措施来实现 自动定制的消息将激励措施和 T2DM 预防与人们的角色、价值观和行为联系起来 的优势。我们的 T2DM 预防、行为经济学和 SDT 专家团队将进行为期 12 个月的研究 务实的随机对照试验，我们将 380 名糖尿病前期患者随机分为 4 名中的 1 名 团体：(1) 经济激励加上基于 SDT 原则的定制信息； (2) 单纯的经济激励； (3) 仅基于SDT原则定制消息；或（4）增强对照组。目标 1：比较 财务激励措施的有效性以及基于 SDT 原则、财务 激励措施以及基于 SDT 原则的定制信息，以降低血红蛋白 A1c、体重和 腰围和增加 DPP 的参与或二甲双胍的使用。我们将评估 血红蛋白 A1c 的主要结果以及体重和腰围的次要结果的变化 6 个月和 12 个月时的周长。我们将使用健康保险索赔数据来衡量次要的 参与 DPP 或使用二甲双胍的结果。目标 2：确定调解者和调节者 财务激励措施的有效性以及基于 SDT 原则、财务 激励措施以及基于 SDT 原则的定制消息。为了衡量这些，我们将对参与者进行调查 基线、6 个月和 12 个月。目标 3：评估可扩展性、可接受性和可扩展性的促进因素和障碍 财务激励措施的可持续性以及基于 SDT 原则、财务 激励措施以及基于 SDT 原则的定制消息。我们将采访患者、工作场所健康状况 推广人员和卫生系统工作人员对方案实施情况进行全面评估 和可持续性，综合考虑范围、有效性、采用、实施和 实施研究框架的维护和综合框架。如果有效的话，这本小说 利用行为经济学和 SDT 的见解的方法可以作为健康如何 护理系统和社区组织可以合作帮助高危患者预防 T2DM 并改善病情 慢性病和健康状况不佳的其他行为风险因素。