A micro-randomized trial of JITAI messaging to improve adherence to multiple weight loss behaviors in young adults

JITAI 消息传递的微随机试验可提高年轻人对多种减肥行为的依从性

• 批准号: 10545279
• 负责人: CARMINA G VALLE
• 金额: $ 73.31万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10545279
• 关键词: Accelerometer; Achievement; Address; Adherence; Adult; Age; Behavior; Behavior Therapy; Behavioral; Body Weight Changes; Body Weight decreased; Body mass index; Calories; Characteristics; Collection; Diet; Eating; Electronic Mail; Engineering; Experimental Designs; Feedback; Food; Future; Gender; Goals; Individual; Internet; Intervention; Location; Monitor; Morbidity - disease rate; Nature; Obesity; Outcome; Overweight; Participant; Patient Self-Report; Persons; Population; Randomized; Recording of previous events; Schedule; Self Assessment; Structure; Techniques; Testing; Text Messaging; Time; Update; Weight; Weight Gain; adaptive intervention; behavior change; clinically significant; contextual factors; cost; digital; digital health; digital intervention; efficacious intervention; evidence base; health data; high risk; improved; meetings; mobile application; mortality; multiphase optimization strategy; obesity treatment; pilot trial; programs; public health intervention; randomized trial; success; tailored messaging; tool; trial design; web-based intervention; weight loss intervention; wireless; young adult

PROJECT ABSTRACT An estimated 1 in 2 US adults will have obesity by 2030, which is a major cause of morbidity and mortality. The highest risk of weight gain is among young adults ages 18-35 years. In-person behavioral interventions generally produce clinically significant weight losses, but cost and reduced reach limit their ability to impact obesity at a population level. Web-based interventions that mimic the structure of weekly face-to-face treatment have proven a viable alternative, though weight losses are generally smaller than in-person treatment. Mobile treatments have the potential for high reach, but have been less effective, producing 1-3 kgs over 6 months. Newer digital intervention approaches called “just-in-time adaptive interventions” (JITAIs) promise to improve upon mobile outcomes by offering adaptive, personalized feedback on behavior, which consists of providing the “right type of support” at “the right time” rather than on a fixed schedule. This “just-in- time,” or JIT, approach is made possible by the emergence of low-cost and widely available digital health tools that allow for the collection of continually updated health data. However, to date, no JITAIs have successfully targeted multiple weight-related behaviors (weighing, activity, and diet), and there has been no systematic examination of what types of messaging interventions best promote adherence to these three weight loss behaviors, for whom they are effective, and under what conditions. To address this problem, we will use a micro-randomized trial to evaluate the effects of 7 types of intervention messages targeting specific behavior change techniques (i.e., BCT messages) delivered in JIT moments on daily achievement of behavioral goals among n=201 young adults with overweight and obesity. All participants will receive a 6-month behavioral weight loss intervention using our Nudge mobile app, which includes evidence-based weekly lessons, tailored feedback, self-monitoring, and daily BCT messages. Participants will receive a wireless scale, activity tracker, and track “red” foods (high-calorie foods) in the app and have 3 goals: weigh daily, a daily active minutes goal that gradually increases if met, and a daily red foods limit. At 3 decision points per day, participants will be micro-randomized to receive or not receive 1 of 7 types of BCT messages. Each intervention message has unique decision rules for availability. Candidate intervention message options have been carefully selected from empirical evidence, tested in our prior studies, or are from our pilot micro-randomized trial. Assessments will occur daily, and at 0, 3 and 6 months, to accomplish the following specific aims: 1) Evaluate the effects of each behavior change technique message (i.e., BCT message) on daily adherence to weight loss behaviors; 2) Determine whether the effects of BCT messages on proximal outcomes change over time; and 3) Assess whether the effects of BCT messages on proximal outcomes are moderated by participants’ contextual factors. Findings will guide how adaptive, behaviorally- and contextually-dependent messages are incorporated into future JITAIs for weight loss.

项目摘要 到2030年，估计有十分之一的美国成年人将肥胖，这是发病率和死亡率的主要原因。这 年龄在18-35岁的年轻人中，体重增加的最高风险是。面对面的行为干预 通常会产生临床上显着的体重减轻，但成本和降低到达限制了其影响的能力 人口水平的肥胖。基于网络的干预措施，模仿每周面对面的结构 治疗已证明是可行的替代方案，尽管体重减轻通常小于面亲身 治疗。移动治疗具有高覆盖范围的潜力，但效率较低，产生1-3公斤 超过6个月。较新的数字干预方法称为“即时自适应干预措施”（Jitais） 通过提供适应性的，个性化的反馈来改善移动结果的行为，这 包括在“正确的时间”而不是按固定时间表提供“合适的支持类型”。这个“恰好 时间，”或JIT，通过低成本和广泛可用的数字健康工具的出现使方法成为可能 这允许收集不断更新的健康数据。但是，迄今为止，没有成功的 有针对性的多重体重相关行为（称重，活动和饮食），并且没有系统 检查哪种类型的消息传递干预措施最能促进这三种体重减轻的依从性 行为，对他们有效，在什么条件下。为了解决这个问题，我们将使用 微随机试验评估针对特定行为的7种类型的干预消息的影响 在日常实现行为目标的情况下，在JIT时刻传达的更改技术（即BCT消息） 在n = 201个超重和肥胖的年轻人中。所有参与者将获得6个月的行为 使用Nudge Mobile App的减肥干预措施，其中包括基于证据的每周课程，量身定制 反馈，自我监控和每日BCT消息。参与者将收到无线规模，活动跟踪器， 并在应用程序中跟踪“红色”食品（高热量食品），并有3个目标：每天重量，每天活跃的会议记录目标 如果满足，这会逐渐增加，每天的红食品限制。在每天3个决策点，参与者将 Micro-randomized接收或未接收7种7种类型的BCT消息中的1个。每个干预消息都有 唯一可用性决策规则。候选干预消息选项已仔细选择 根据经验证据，在我们先前的研究中进行了测试，或者来自我们的Pilot微型试验。评估 将每天发生，在0、3和6个月内完成以下特定目的：1）评估 每个行为改变技术信息（即BCT消息）每天遵守减肥行为； 2） 确定BCT消息对近端结果的影响是否会随着时间的推移而变化； 3）评估 BCT消息对近端结果的影响是否受到参与者的上下文因素的调节。 调查结果将指导如何将自适应，行为和上下文依赖性消息纳入 减肥的未来Jitais。