Development and pilot testing of a behavioral economics mobile health digital tool to improve adherence to non-pharmacologic strategies for behavioral and psychological symptoms of dementia

开发和试点测试行为经济学移动健康数字工具，以提高对痴呆症行为和心理症状的非药物策略的依从性

• 批准号: 10580000
• 负责人: Hayley Michelle Belli
• 金额: $ 13.05万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580000
• 关键词: Address; Adherence; Adoption; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antipsychotic Agents; Applications Grants; Area; Behavioral; Behavioral Symptoms; Caring; Chronic; Chronic Disease; Clinical; Collaborations; Data; Degenerative Disorder; Dementia; Development; Discipline; Disease Management; Drug Prescriptions; Economics; Educational workshop; Electronic Health Record; Emotional; Face; Family; Funding; Geriatrics; Goals; Guidelines; Guilt; Health; Health Technology; Health system; Healthcare; Human; Impaired cognition; Influenza vaccination; Intervention; Interview; Measures; Mental Depression; Mentors; Mentorship; Nature; New York; Outcome; Outcome Study; Peer Review; Persons; Pharmaceutical Preparations; Pilot Projects; Pragmatic clinical trial; Primary Care; Psychology; Publications; Recording of previous events; Research; Research Methodology; Research Personnel; Resources; Review Literature; Risk; Role; Screening for cancer; Sedation procedure; Social Workers; Societies; Stress; Stroke; Structure; Tablet Computer; Technology; Telephone; Telephone Interviews; Testing; Text Messaging; Thinking; Training; Training Programs; United States National Institutes of Health; Universities; Visit; Work; acceptability and feasibility; arm; behavior test; behavioral economics; common symptom; communication device; dementia care; design; diabetes management; digital; digital health; digital tool; electronic patient reported outcomes; evidence base; experience; falls; health care settings; human old age (65+); implementation science; improved; innovation; insight; mHealth; mortality; novel; patient population; pilot test; primary outcome; prototype; psychologic; psychological symptom; recruit; secondary outcome; skills; sociodemographics; symposium; tool; wearable device

PROJECT SUMMARY / ABSTRACT: Background: There are currently more than five million Americans living with Alzheimer’s disease and related dementias, a number expected to increase to nearly 14 million by 2050. Among the most common symptoms of persons living with dementia (PLWD) are behavioral and psychological disturbances. PLWD require care partners who themselves face challenges including guilt, depression, and emotional and physical stress due to the behavioral and psychological symptoms of dementia (BPSD). Guidelines by the American Geriatrics Society currently discourage antipsychotic prescriptions to treat BPSD, instead encouraging non-pharmacological approaches. While some non-pharmacologic strategies for addressing BPSD have shown to be effective, adherence is challenging. Novel concepts from behavioral economics (BE), a field that combines insights from economics and psychology to recognize that humans often make predictable decision errors, has shown promise in promoting appropriate disease management in a variety of healthcare settings. Mobile health (mHealth) technology is one mechanism for delivering non-pharmacologic care; however, no strategies to date have incorporated BE principles to improve adherence to non-pharmacologic strategies for managing BPSD. Research: This study will leverage the power of BE with mHealth to develop, user-test, and pilot a digital health tool aimed at improving adherence to non-pharmacologic strategies for BPSD. A thorough review of the literature, stakeholder interviews, and a design-thinking workshop will aid in the development of the BE nudges. Visits with PLWD-care partner dyads and semi-structured telephone interviews will be conducted to user-test and refine the BE-mHealth digital tool prototype. The culmination of this work will be an intervention ready for testing via a single-arm, 6-month pilot study within the New York University Langone Health (NYULH) system. The primary study outcome will be adherence to the non-pharmacologic strategies, and secondary outcomes will include changes in BPSD, care partner burden, and prescriptions for anti-psychotic medications. Socio- demographic, clinical, and primary/secondary study outcomes will be measured using care partner reported outcomes and patient electronic health records embedded within the BE-mHealth tool for ease of data capture. Training: The candidate’s proposed training plan builds upon prior research in the design and testing of BE digital health interventions via embedded pragmatic clinical trials. The candidate will receive training in the fields of dementia, digital health innovation, implementation science, and mixed-methods research through one-on- one mentorship, coursework, seminars, workshops, and conferences in disciplines of high relevance to the proposed research. The mentorship team is composed of discipline-specific experts with a history of working together and with the candidate on NIH funded grant proposals and peer-reviewed publications. The candidate’s long-term goal is to become an independent investigator in the development and testing of BE-inspired digital health interventions for chronic disease management in persons living with dementia.

项目摘要/摘要： 背景：目前有超过 500 万美国人患有阿尔茨海默病及相关疾病 痴呆症患者的数量预计到 2050 年将增加到近 1400 万。 痴呆症患者 (PLWD) 存在行为和心理障碍，需要护理。 自己面临挑战的伴侣，包括内疚、抑郁以及由于以下原因造成的情绪和身体压力 美国老年医学会的痴呆症行为和心理症状 (BPSD)。 目前不鼓励使用抗精神病处方来治疗 BPSD，而是鼓励非药物治疗 虽然一些解决 BPSD 的非药物策略已被证明是有效的， 行为经济学 (BE) 的新概念结合了来自不同领域的见解。 经济学和心理学认识到人类经常会犯可预测的决策错误，已经显示出希望 促进各种医疗保健环境中适当的疾病管理。 技术是提供非药物护理的一种机制；然而，迄今为止还没有策略； 纳入 BE 原则，以提高对管理 BPSD 的非药物策略的依从性。 研究：本研究将利用 BE 与 mHealth 的力量来开发、用户测试和试点数字健康 旨在提高 BPSD 非药物策略依从性的工具。 文献、利益相关者访谈和设计思维研讨会将有助于 BE 推动的发展。 将访问 PLWD 护理合作伙伴二人组并进行半结构化电话访谈以进行用户测试 并完善 BE-mHealth 数字工具原型，这项工作的高潮将是为干预做好准备。 通过纽约大学 Langone Health (NYULH) 系统内一项为期 6 个月的单臂试点研究进行测试。 主要研究结果将是遵守非药物策略，次要结果是 将包括 BPSD、护理伙伴负担和抗精神病药物处方的变化。 将使用报告的护理合作伙伴来衡量人口统计、临床和主要/次要研究结果 BE-mHealth 工具中嵌入了结果和患者电子健康记录，以便于数据捕获。 培训：候选人提出的培训计划建立在 BE 设计和测试的先前研究的基础上 通过嵌入式实用临床试验进行数字健康干预。候选人将接受该领域的培训。 通过一对一的方式研究痴呆症、数字健康创新、实施科学和混合方法研究 与行业高度相关的学科导师、课程作业、研讨会、讲习班和会议 导师团队由具有工作经验的特定学科专家组成。 与候选人一起讨论 NIH 资助的拨款提案和同行评审的出版物。 长期目标是成为开发和测试 BE 启发的数字技术的独立研究者 痴呆症患者慢性病管理的健康干预措施。