An adaptive personalized text message intervention for cardiac prevention

用于心脏预防的自适应个性化短信干预

基本信息

批准号：
9979221
负责人：
Jeff C Huffman
金额：
$ 25.2万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-08 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9979221
关键词：
Adaptive Behaviors Address Adherence Affect Algorithms Behavior Behavior Therapy Behavioral Blood Pressure Cardiac Cardiac health Caring Cause of Death Consumption Data Development Devices Diet Event Feedback Goals Habits Health Health Promotion Health Psychology Health Technology Health behavior Health education Healthy Eating Heart Diseases Heart Rate Hyperlipidemia Hypertension Individual Intervention Link Lipids Measures Mental Health Minority Non-Insulin-Dependent Diabetes Mellitus Outcome Outcome Measure Participant Patients Personal Satisfaction Persons Physical Function Physical activity Population Prevention Protocols documentation Psychology Public Health Randomized Reporting Risk Risk Factors Self Management Source Strategic Planning System Technology Telephone Testing Text Messaging Theoretical model Time United States Weight Well in self Wireless Technology base behavior change behavioral health behavioral outcome clinically relevant compliance behavior cost exercise capacity flexibility good diet health difference health goals health management heart disease risk high risk improved indexing individual patient innovative technologies intervention effect learning algorithm mHealth mobile application mortality novel optimism patient oriented personalized approach personalized care pilot trial preference prevent primary outcome programs prospective psychologic psychological outcomes randomized trial success tailored messaging tool treatment as usual

项目摘要

The majority of patients at risk for heart disease are unable to adhere to key health behaviors, including regular physical activity and healthy eating. This is a major public health problem, as heart disease is the leading cause of death in the U.S., yet could be prevented in many cases through greater participation in these behaviors. Existing programs to promote health behaviors and prevent heart disease can be effective but have several limitations. First, they are costly, intensive, and attended by relatively few patients (with especially low attendance among minorities). In addition, these programs have not included positive psychology (PP) activities, which promote constructs (e.g., positive affect) that are independently linked to healthy behaviors and superior cardiac health. Finally, they are not designed to meet patients’ individual preferences and needs. Text message interventions (TMIs) may address many of the shortcomings of existing programs. TMIs are simple, low-burden, customizable, and highly accessible, and they have thus far shown promise in promoting health behaviors. Simple PP activities are well-suited to TMIs, and a TMI delivering both PP and health behavior messages could be a powerful approach to improving health and reducing cardiac risk, as combined psychological-behavioral interventions appear to have greater effects than either approach alone. A TMI that utilizes an adaptive algorithm to choose messages could be highly effective. As opposed to a single fixed set of messages, a flexible program that is deeply personalized for each individual could greatly improve engagement and impact. We have developed a novel adaptive TMI that delivers PP and health behavior text messages in English and Spanish. Based on a participant’s adherence gaps and feedback about the utility of prior messages, the program uses a dynamic, patient-specific algorithm to select new messages via multiple message-specific attributes (e.g., PP vs. health behavior-focused). Over time, the adaptive TMI increasingly delivers message content that matches the individual’s specific preferences and needs. Consistent with PA-18-389 focused on mHealth interventions for self-management, we propose a randomized pilot trial of this adaptive 12-week TMI (with daily text messages from the adaptive algorithm, twice-weekly goal-focused messages, and two brief phone check-ins to provide support) plus provision of a step counter. The TMI will be compared to enhanced usual care (step counter alone) in 60 patients with 2+ cardiac risk conditions (hypertension, type 2 diabetes, hyperlipidemia) and suboptimal physical activity and diet. The primary outcome of this R21 trial is feasibility and acceptability, measured via rates of text message feedback and participants’ ratings of message utility. As a key secondary aim, we will compare between-group differences in improvements in psychological, behavioral, and health-related outcomes at 12 and 24 weeks. If the intervention is feasible, well-accepted, and has promising effects on clinically relevant outcomes, we will conduct a larger next-step trial to assess the TMI’s impact on adherence and heart disease development.

大多数有心脏病风险的患者无法遵守关键的健康行为，包括定期体育活动和健康饮食是一个重大的公共卫生问题，因为心脏病是主要的公共卫生问题。是美国的主要原因，但在许多情况下可以通过更多地参与这些活动来预防现有的促进健康行为和预防心脏病的计划可能有效，但效果不佳。首先，它们费用昂贵、强度大，而且参与的患者相对较少（特别低）。此外，这些课程不包括积极心理学（PP）。促进与健康行为独立相关的建构（例如积极情感）的活动最后，它们并不是为了满足患者的个人喜好和需求而设计的。短信干预（TMIs）可以解决现有计划的许多缺点。简单、负担低、可定制且易于访问，迄今为止它们在简单的 PP 活动非常适合 TMI，而 TMI 既提供 PP 又提供健康行为。健康行为信息可能是改善健康和降低心脏病风险的有效方法，因为综合心理行为干预似乎比单独使用任何一种方法具有更大的效果。与此相反，利用自适应算法来选择消息的 TMI 可能非常有效。一组固定的消息，一个针对每个人深度个性化的灵活程序可以极大地我们开发了一种新颖的自适应 TMI，可实现 PP 和健康。基于参与者的遵守差距和反馈的英语和西班牙语行为短信。利用先前消息的效用，该程序使用动态的、针对患者的算法来选择新消息通过多个特定于消息的属性（例如，PP 与以健康行为为中心），随着时间的推移，自适应 TMI 会出现变化。越来越多地提供符合个人特定偏好和需求的消息内容。与专注于自我管理的移动健康干预措施的 PA-18-389 一致，我们提出了这种自适应 12 周 TMI 的随机试点试验（来自自适应算法的每日短信，每周两次以目标为中心的消息，以及两次简短的电话检查以提供支持）以及提供计步器将与 60 名 2+ 患者的强化常规护理（仅计步器）进行比较。心脏风险状况（高血压、2 型糖尿病、高脂血症）和身体活动不佳以及这项 R21 试验的主要结果是通过短信发送率来衡量的可行性和可接受性。作为关键的次要目标，我们将比较组间的反馈和参与者的信息效用评级。第 12 周和第 24 周时心理、行为和健康相关结果的改善存在差异。该干预措施是可行的、被广泛接受的，并且对临床相关结果具有良好的效果，我们将进行更大规模的下一步试验，以评估 TMI 对依从性和心脏病发展的影响。