Behavioral Economics for Activity Motivation in Adolescents and Young Adults with Pediatric Diabetes and Type 2 Diabetes

患有儿童糖尿病和 2 型糖尿病的青少年和年轻人活动动机的行为经济学

• 批准号: 10889466
• 负责人: Mary Ellen Vajravelu
• 金额: $ 8.58万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10889466
• 关键词: Adherence; Adolescent and Young Adult; Adolescent obesity; Advisory Committees; Attitude; Award; Behavior; Behavior Control; Belief; Body mass index; Cardiovascular system; Cellular Phone; Childhood; Childhood diabetes; Chronic; Chronic Kidney Failure; Clinical Trials; Clinical Trials Design; Development; Diabetes Mellitus; Diagnosis; Disease; Disease Progression; Endocrinology; Engineering; Environment; Fasting; Focus Groups; Funding; Glycosylated hemoglobin A; Goals; Health; Health Benefit; Health behavior change; Human; Incentives; Incidence; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Learning; Lipids; Measures; Mediator; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Motivation; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Patients; Pediatric Hospitals; Pennsylvania; Persons; Philadelphia; Physical activity; Physicians; Planning Theory; Prediabetes syndrome; Ramp; Randomized, Controlled Trials; Research; Research Design; Research Methodology; Resources; Rewards; Risk Reduction; Scientist; Structure; Testing; Text Messaging; Theory of Change; Time; Training; United States National Institutes of Health; Universities; Youth; behavior change; behavioral economics; biobehavior; career; comorbidity; discounting; effective intervention; exercise intervention; financial incentive; fitbit; improved outcome; insight; interest; mHealth; moderate-to-vigorous physical activity; multidisciplinary; multiphase optimization strategy; non-diabetic; patient engagement; peer; preference; primary outcome; secondary outcome; theories; therapy design; tool; web platform

Project Summary/Abstract Obese adolescents and young adults (AYA) with type 2 diabetes (T2D) are significantly less active than non- diabetic peers, despite the many disease-related benefits of physical activity. Because in-person physical activity interventions for obese AYA are challenging to implement and have high attrition rates, there is an urgent need to engineer targeted physical activity interventions that are effective and scalable for obese AYA with prediabetes and T2D. Aligned with NIDDK priorities, the long-term objective of the proposed research is to develop an intervention that reduces the risk of disease progression in youth with prediabetes and T2D. The applicant will take full advantage of the rich scientific environment of the Children’s Hospital of Philadelphia and University of Pennsylvania to achieve her research and training goals, supported by an expert multidisciplinary mentorship and advisory team. This K23 will support the PI’s training in mixed methods research, behavioral economics, mHealth, physical activity interventions, and biobehavioral clinical trial design and analysis. The goal of the proposed research is to develop an effective mobile health (mHealth) intervention to increase moderate to vigorous physical activity (MVPA) in AYA with prediabetes or T2D, harnessing insights from behavioral economics and leveraging a highly efficient framework to determine effective intervention components. Aim 1 will determine attitudes, beliefs, and norms about, as well as barriers and facilitators to, engaging in daily MVPA by conducting semi-structured interviews of AYA with prediabetes or T2D. In Aim 2, theory-based and empirically-informed text messages to promote MVPA will be developed through adaptation of adherence- promoting text message banks developed by the PI’s mentors, using focus groups with patient stakeholders and insights from Aim 1. Aim 3 will determine intervention component settings that effectively increase MVPA and will consist of a 12-week factorial trial (Behavioral Economics for Activity Motivation) of 4 intervention components targeting theoretical mediators of MVPA: 1) text messages targeting Theory of Planned Behavior concepts of attitudes and norms, vs. simple reminders; 2) ramping-up vs. fixed step count goals, targeting perceived behavioral control; 3) financial incentives allocated up-front and lost for unmet goals vs. earned, targeting loss aversion; and 4) daily vs. weekly goals, targeting hyperbolic discounting (preference for smaller-sooner over larger-later rewards). The primary outcome is change in MVPA. Secondary outcomes include steps/day, proportion achieving 60 minutes MVPA/day, body mass index, hemoglobin A1c, and fasting insulin and lipids. The PI and mentors hypothesize that effective component settings will include text messages targeting attitudes/norms, ramped goal, loss-framed incentives and daily goals. Through this K23, the PI will be poised to compete successfully for R01-level funding to conduct a randomized controlled trial of the optimized intervention, helping to launch her career as an independent physician-scientist with expertise in health behavior change in AYA with prediabetes and T2D.

项目概要/摘要 患有 2 型糖尿病 (T2D) 的肥胖青少年和年轻人 (AYA) 的活动量明显低于非糖尿病患者 糖尿病同龄人，尽管体力活动有许多与疾病相关的好处，因为亲自进行体力活动。 对肥胖 AYA 的干预措施实施起来具有挑战性，并且流失率很高，迫切需要 设计针对患有糖尿病前期的肥胖 AYA 有效且可扩展的有针对性的身体活动干预措施 与 NIDDK 的优先事项一致，拟议研究的长期目标是开发一种 降低患有前驱糖尿病和 T2D 的青少年疾病进展风险的干预措施。 充分利用费城儿童医院和费城大学丰富的科学环境 宾夕法尼亚州在专家多学科指导的支持下实现她的研究和培训目标 该 K23 将支持 PI 的混合方法研究、行为经济学、 移动健康、身体活动干预以及生物行为临床试验设计和分析。 拟议的研究是开发一种有效的移动健康（mHealth）干预措施，以增加中度至 利用行为学见解，对患有糖尿病前期或 T2D 的 AYA 进行剧烈体力活动 (MVPA) 经济学并利用高效的框架来确定有效的干预措施目标 1。 将决定参与日常 MVPA 的态度、信念和规范，以及障碍和促进因素 在目标 2 中，对患有糖尿病前期或 T2D 的 AYA 进行半结构化访谈。 将通过调整依从性来开发以经验为依据的短信，以促进 MVPA 推广由 PI 导师开发的短信库，利用患者利益相关者的焦点小组，以及 目标 1 的见解。目标 3 将确定有效增加 MVPA 和 将包括为期 12 周的析因试验（活动动机的行为经济学），涉及 4 个干预措施 针对 MVPA 的理论中介：1）针对计划行为理论概念的短信 态度和规范，与简单的提醒；2）逐步增加与固定步数目标，针对感知 行为控制；3）预先分配并因未实现目标而损失的财务激励与已获得的目标损失的财务激励 厌恶；4) 每日目标与每周目标，针对双曲线贴现（偏好较小的较快的目标） 主要结果是 MVPA 的变化，次要结果包括步数/天。 实现 60 分钟 MVPA/天、体重指数、糖化血红蛋白以及空腹胰岛素和血脂。 PI 和导师认为有效的组件设置将包括短信定位 通过这个 K23，PI 将准备好：态度/规范、逐步目标、损失框架激励和日常目标。 成功竞争 R01 级资金以进行优化干预的随机对照试验， 帮助她开启作为一名独立医师科学家的职业生涯，在健康行为改变方面拥有专业知识 AYA 伴有糖尿病前期和 T2D。

项目成果

Pediatric Obesity: Complications and Current Day Management.

• DOI: 10.3390/life13071591
• 发表时间: 2023-07-20
• 期刊: Life (Basel, Switzerland)

Mobile Health and Telehealth Interventions to Increase Physical Activity in Adolescents with Obesity: a Promising Approach to Engaging a Hard-to-Reach Population.

• DOI: 10.1007/s13679-021-00456-8
• 发表时间: 2021-12
• 期刊: Current obesity reports
• 影响因子: 8.8
• 作者: Vajravelu ME;Arslanian S
• 通讯作者: Arslanian S

Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes.

儿童机会指数和青少年糖尿病诊断的临床特征：1 型糖尿病与 2 型糖尿病。

• DOI: 10.1136/bmjdrc-2023-003968
• 发表时间: 2024
• 期刊: BMJ open diabetes research & care
• 影响因子: 4.1
• 作者: Hoyek,Kim;Libman,Ingrid;Mkparu,Nkeiruka;Hong,YongHee;Arslanian,Silva;Vajravelu,MaryEllen
• 通讯作者: Vajravelu,MaryEllen