Using Tailored mHealth Strategies to Promote Weight Management among Adolescent and Young Adult Cancer Survivors

使用量身定制的移动健康策略促进青少年和年轻癌症幸存者的体重管理

基本信息

批准号：
10650648
负责人：
Jessica Gokee LaRose
金额：
$ 64.79万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10650648
关键词：
Acceleration Accelerometer Adolescent and Young Adult Adolescent and young adult cancer patients Adult Adverse effects Aerobic Exercise Aftercare Age Aging Behavior Behavioral Behavioral Mechanisms Biological Markers Body Composition Body Weight Changes Body Weight decreased Body mass index Cancer Survivor Cardiometabolic Disease Cardiovascular Diseases Clinical Collection Competence Control Groups Country Coupled Data Development Diabetes Mellitus Diagnosis Diet Diet Monitoring Dietary intake Education Ethnic Origin Facebook Feedback Fostering Future Goals Health Health behavior change Health education Intervention Late Effects Life Life Style Link Maintenance Malignant Neoplasms Measures Mediating Mediator Mental Depression Mobile Health Application Monitor Morbidity - disease rate Obesity Outcome Overweight Participant Pattern Persons Phase Physical activity Population Protocols documentation Quality of life Questionnaires Race Randomized Randomized, Controlled Trials Recording of previous events Research Risk Risk Factors SF-36 Sampling Self Determination Subgroup Survivors Telephone Testing Time Treatment Efficacy Treatment Protocols Visit Vulnerable Populations Weight maintenance regimen actigraphy arm behavior change behavior prediction cardiometabolic risk clinical research site comorbidity comparative efficacy comparison intervention design dietary digital intervention digital monitoring digital tool efficacy evaluation efficacy testing evidence base exercise intervention follow-up food insecurity frailty health equity high risk improved improved outcome indexing intervention effect intervention participants intrinsic motivation lifestyle intervention mHealth mobile application mortality novel obesity risk obesogenic peer support post intervention primary outcome psychologic psychosocial remote delivery resistance exercise response secondary outcome sex social health determinants social networking website tailored messaging theories therapy design tool treatment arm treatment response waist circumference web site weight loss intervention weight loss program weight maintenance wireless young adult

项目摘要

PROJECT ABSTRACT/SUMMARY Survivors of adolescent and young adult cancers (AYAs) are a vulnerable and underserved subgroup of survivors at increased risk for long-term health effects, including obesity, diabetes, cardiovascular disease, additional cancers, and frailty. Furthermore, over half of AYAs already have overweight or obesity and obesogenic lifestyle behaviors are common among AYAs, which exacerbates their cardiometabolic risk. Given that obesity is associated with poorer outcomes in cancer survivors, there is a critical need for weight management interventions—yet, no weight loss interventions have been developed to meet the unique needs of AYAs. Extant research, including our own preliminary data, indicate that AYAs prefer tailored interventions (both with respect to developmental stage and cancer context) that are delivered remotely via website or app. Thus, we propose to develop a 6-month mHealth weight management intervention designed specifically for AYA cancer survivors and test its efficacy in a randomized controlled trial. The intervention will be rooted in self-determination theory in order to bolster intrinsic motivation for health behavior change by enhancing perceived competence, relatedness, and autonomy. It will include evidence-based behavioral weight loss strategies adapted for AYA survivors (e.g., simplified dietary self-monitoring, adaptive goal-setting, tailored feedback on progress) as well as personalized dietary and physical activity goals. The intervention will be paired with digital monitoring tools (wireless scale and activity tracker), as well as access to a closed Facebook group to foster peer support. AYA survivors nationwide (N=240, diagnosed between ages 15-39 [current age 18-39], posttreatment, body mass index [BMI] 25-50kg/m2) will be randomized to one of two arms: 1) mHealth intervention as described above, or 2) self-guided (digital tools + health education + Facebook). Randomization will be stratified by BMI, sex, and race/ethnicity. Assessments will occur at 0, 3, 6, and 12 months. Percent weight change at 6 months (primary outcome) will be assessed using a remote collection protocol via video weigh-in and wireless scale to facilitate enhanced reach across the US. Secondary outcomes in the full sample include frailty (frailty index), objectively measured physical activity (ActiGraph GT9X Link), dietary intake (ASA24), and quality of life (SF-36), as well as questionnaires assessing hypothesized psychosocial mediators targeted by the intervention. A subsample of participants (n=80) will complete in-person visits at each clinical site at 0, 6, and 12 months to assess changes in body composition, waist circumference, frailty, and biomarkers of aging and cardiometabolic disease. We hypothesize that compared to the self-guided arm, AYAs in the intervention arm will manifest greater percent weight loss at 6 months and better maintenance of weight loss from 6 to 12 months. We also will examine the psychological and behavioral mechanisms of action to inform future optimization efforts, and explore demographic and clinical- related moderators of intervention response. Our findings will accelerate the development of effective remotely- delivered mHealth weight loss interventions to improve outcomes and reduce the burden of morbidity in AYAs.

项目摘要/总结青少年和青年癌症幸存者 (AYA) 是弱势且得不到充分服务的幸存者亚群长期健康影响的风险增加，包括肥胖、糖尿病、心血管疾病、其他此外，超过一半的 AYA 已经存在超重或肥胖以及导致肥胖的生活方式。肥胖行为在 AYA 中很常见，这会恶化他们的心脏代谢风险。癌症幸存者的预后较差，因此迫切需要体重管理干预措施——然而，尚未开发出任何减肥干预措施来满足现有 AYA 的独特需求。研究（包括我们自己的初步数据）表明，AYA 更喜欢量身定制的干预措施（既尊重发育阶段和癌症背景），通过网站或应用程序远程提供。制定专为 AYA 癌症幸存者设计的为期 6 个月的 mHealth 体重管理干预措施，以及在随机对照试验中测试其功效。该干预措施将植根于自我决定理论。为了通过增强感知能力、相关性来增强健康行为改变的内在动机，它将包括适用于 AYA 幸存者的基于证据的行为减肥策略（例如，简化的饮食自我监控、适应性目标设定、量身定制的进展反馈）以及个性化饮食和身体活动目标将与数字监测工具（无线秤和活动跟踪器），以及访问一个封闭的 Facebook 群组，以促进全国 AYA 幸存者的支持。（N=240，诊断年龄在 15-39 岁之间 [当前年龄 18-39]，治疗后，体重指数 [BMI] 25-50kg/m2）将被随机分配到两个组之一：1) 如上所述的移动健康干预，或 2) 自我引导（数字化）工具 + 健康教育 + Facebook）。随机化将按 BMI、性别和种族/民族进行分层。评估将在 0、3、6 和 12 个月时进行，6 个月时的体重变化百分比（主要结果）将是。通过视频称重和无线秤使用远程收集协议进行评估，以促进扩大覆盖范围整个样本中的次要结果包括虚弱（虚弱指数）、客观测量的身体状况。活动 (ActiGraph GT9X Link)、饮食摄入量 (ASA24) 和生活质量 (SF-36) 以及调查问卷评估干预措施针对的绝望心理社会调解者的子样本（n = 80）。将在第 0、6 和 12 个月时在每个临床地点完成亲自访视，以评估身体成分的变化，腰围、虚弱以及衰老和心脏代谢疾病的生物标志物。与自我引导组相比，干预组中的 AYA 在 6 岁时体重减轻百分比更高 6 至 12 个月，更好地维持减肥效果。我们还将检查心理和健康状况。行动的行为机制，为未来的优化工作提供信息，并探索人口统计和临床- 我们的研究结果将加速有效远程干预的发展。提供移动健康减肥干预措施，以改善结果并减轻 AYA 的发病负担。