Use of the Track Health Function of the MyHealtheVet Personal Health Record

MyHealtheVet 个人健康记录的追踪健康功能的使用

• 批准号: 8678394
• 负责人: JOSEPH SHARIT
• 金额: --
• 依托单位: MIAMI VA HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8678394
• 关键词: Abdomen; Accounting; Address; Adherence; Adopted; Adoption; Adult; Behavior; Belief; Blood Pressure; Body Weight decreased; Categories; Chronic Disease; Clinic; Clinical; Cognitive; Collection; Complement; Coupled; Data; Devices; Diabetes Mellitus; Diet; Dietary intake; Epidemiologic Studies; Exclusion Criteria; Exercise; Feedback; Food; Goals; Group Affiliation; Health; Healthcare; Height; Hour; Improve Access; Incentives; Individual; Instruction; Internet; Intervention; Intervention Studies; Intervention Trial; Interview; Journals; Lead; Life Style; Measurement; Measures; Metabolic; Motivation; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Outcome; Outcome Measure; Outpatients; Participant; Patients; Personal Health Records; Physical activity; Physiologic pulse; Physiological; Pilot Projects; Population; Prediabetes syndrome; Primary Health Care; Provider; Reading; Recruitment Activity; Regimen; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk Factors; Role; Sampling; Secure; Self Efficacy; Self Management; Structure; Suggestion; Surveys; System; Time; Training; Trust; United States; Veterans; Visit; Weight; Work; base; comparative effectiveness; compliance behavior; cost effective; design; diabetic; diabetic patient; diaries; effective intervention; effectiveness clinical trial; evidence base; fasting plasma glucose; good diet; health literacy; improved; inclusion criteria; innovation; instrument; literacy; mathematical ability; meetings; member; post intervention; programs; psychologic; research study; satisfaction; tool; usability

In the US, 26 million adults have either type 1 or type 2 diabetes (11% of the population), with Type 2 diabetes mellitus (T2DM) accounting for 90-95% of all cases. Additionally, 79 million individuals (35% of the adult population) have been estimated to have pre-diabetes. Epidemiologic studies suggest that 9 out of 10 cases of T2DM can be blamed on modifiable lifestyle behaviors that result in critical risk factors, with the major one being obesity. This pilot research study is intended to address the large and growing problem of diabetes, particularly among veterans, by examining the ability for systematic instruction on the use of the VA's MyHealtheVet (MHV) personal health record to better enable pre-diabetic obese veterans to adopt and adhere to more positive diet and physical activity. Specifically, veterans will receive instruction on the use of the track health function (THF) of MHV, which provides sophisticated interactive tools for maintaining food and activity journals and for entering and viewing measures of physiological health. Instruction will include how to concurrently track the lifestyle and physiological measures and how to infer cause-effect relationships. Study participants will also be instructed to use the secure messaging feature of MHV to regularly communicate with members of the research team in order to maintain participants' motivation in the program. A recent survey on veterans' use of MHV indicated that the THF has been mostly unused; thus its potential as a health self- management tool has been largely unexploited. In addition to the unique and powerful interactive features contained within MHV's track health functionality, the benefits of using MHV as a vehicle for instigating and promoting adherence to physical activity and diet lifestyle changes is believed to derive from its ability to address content and resources tailored to the needs of veterans, and thus elicit trust by this group through its in-group affiliation. The study goal is to recruit a sample of 100 obese pre-diabetic veterans attending primary care clinics at the Bruce W. Carter Miami VAMC. The inclusion criteria related to the pre-diabetes obesity criterion include HbA1C 5.7-6.4% and fasting plasma glucose 100-125 mg/dL (or oral glucose tolerance test 140-199 mg/dL; the exclusion criteria include currently following a weight loss diet or presence of diabetes mellitus. The intervention will be a single group, longitudinal, repeated measures design. Key outcome measures that will be obtained from participants at baseline and at three months include physical activity (measured with an accelerometer which will sample physical activity every minute for seven days), dietary intake, physical activity self-efficacy (exercise beliefs), diet self-efficacy (diet beliefs), intent to perform physical activity, and intent to adhere to diet. In addition, measures of health literacy, objective numeracy ability, and graphical literacy will be collected at baseline. During the baseline visit, blood pressure, pulse, weight, height, and abdominal circumference measurements will be obtained, and participants will also receive an accelerometer and instructions on its use. Participants will then return a week later, at which time the accelerometer data will be collected. They will receive a second two-hour training session on the THF of MHV, and then begin using MHV functions weekly as instructed, with secure messages sent weekly by the research team. At their three-month visit, participants will complete the post-intervention instruments and again receive an accelerometer, and will be asked to return the device a week later when the accelerometer data will be collected and an semi-structured exit interview will be conducted. This pilot research study is expected to demonstrate the utility of using the THF of MHV in terms of these participants' satisfaction in engaging with the THF, and in increasing their self-efficacy and intent to adhere to physical activity and diet, as well as their actual adherence to physical activity and diet. It is also expected to yield valuable data concerning the roles of numeracy ability, health and graphical literacy in the ability to use the THF effectively, as well as suggestions for redesigning this function to better meet the cognitive capabilities of a larger sample of users of MHV.

在美国，2600 万成年人患有 1 型或 2 型糖尿病（占人口的 11%），其中 2 型糖尿病 糖尿病 (T2DM) 占所有病例的 90-95%。此外，7900 万人（占成年人的 35%） 人口）估计患有糖尿病前期。流行病学研究表明，十分之九的病例 T2DM 可以归咎于可改变的生活方式行为，这些行为导致了关键的危险因素，其中主要的一个 肥胖。这项试点研究旨在解决日益严重的糖尿病问题， 特别是在退伍军人中，通过检查使用 VA 的系统指导的能力 MyHealtheVet (MHV) 个人健康记录可以更好地帮助糖尿病前期肥胖退伍军人采用和遵守 更积极的饮食和身体活动。具体来说，退伍军人将接受有关使用赛道的指导 MHV 的健康功能 (THF)，为维持食物和活动提供复杂的互动工具 期刊以及输入和查看生理健康指标。说明将包括如何 同时跟踪生活方式和生理测量以及如何推断因果关系。学习 参与者还将被指导使用 MHV 的安全消息传递功能定期与 研究团队成员，以保持参与者参与该计划的动力。最近的一项调查 退伍军人对 MHV 的使用表明 THF 大部分未被使用；因此它作为一种健康自我治疗的潜力 管理工具基本上尚未得到利用。除了独特而强大的交互功能 包含在 MHV 的赛道健康功能中，使用 MHV 作为煽动和 促进坚持身体活动和饮食生活方式的改变被认为源自其以下能力： 提供适合退伍军人需求的内容和资源，从而通过其 团体内的隶属关系。该研究的目标是招募 100 名就读小学的肥胖糖尿病前期退伍军人作为样本 Bruce W. Carter 迈阿密 VAMC 的护理诊所。与糖尿病前期肥胖相关的纳入标准 标准包括 HbA1C 5.7-6.4% 和空腹血糖 100-125 mg/dL（或口服葡萄糖耐量试验） 140-199 毫克/分升；排除标准包括目前正在进行减肥饮食或患有糖尿病 梅利图斯。干预措施将是单组、纵向、重复措施设计。主要成果 参与者在基线和三个月后获得的测量结果包括体力活动 （使用加速度计测量，该加速度计将在 7 天内每分钟对身体活动进行采样）、饮食 摄入量、身体活动自我效能（运动信念）、饮食自我效能（饮食信念）、进行身体活动的意图 活动，并有意坚持饮食。此外，还包括健康素养、客观计算能力和 将在基线时收集图形读写能力。在基线访视期间，测量血压、脉搏、体重、身高、 将获得腹围测量值，参与者还将收到 加速度计及其使用说明。参与者将在一周后返回，届时 将收集加速度计数据。他们将接受关于 MHV 的 THF 的第二次两小时培训课程， 然后按照指示每周开始使用 MHV 功能，研究人员每周发送安全消息 团队。在为期三个月的访问中，参与者将完成干预后工具并再次获得 一个加速度计，并会被要求在一周后归还设备，届时加速度计数据将被 收集并进行半结构化离职面谈。这项试点研究预计将 证明使用 MHV 的 THF 在这些参与者参与活动的满意度方面的效用 THF，并提高他们的自我效能和坚持身体活动和饮食的意愿，以及他们的 实际坚持身体活动和饮食。它还有望产生有关以下角色的有价值的数据： 有效使用 THF 的计算能力、健康状况和图形素养以及建议 重新设计该功能，以更好地满足 MHV 更大样本用户的认知能力。