Digital Technology to Support Adherence to Hypertension Medications for Older Adults with Mild Cognitive Impairment

数字技术支持患有轻度认知障碍的老年人坚持高血压药物治疗

基本信息

批准号：
10618618
负责人：
KATHLEEN C INSEL
金额：
$ 86.65万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-04 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10618618
关键词：
Acceleration Activities of Daily Living Address Adherence Adoption Adult Age Android Antihypertensive Agents Attention Blood Pressure COVID-19 pandemic COVID-19 pandemic effects Caring Cerebrovascular Disorders Chronic Cognition Cognitive Collaborations Communities Compensation Competence Control Groups Dementia Deterioration Development Dose Drug Prescriptions Education Educational Intervention Elderly Ensure Evaluation Failure Family Friends Future Health Health Personnel Health Professional Health system Healthcare Heart failure Human Hypertension Impaired cognition Impairment Individual Intervention Interview Learning Skill Medication Management Memory Monitor Myocardial Infarction Outcome Persons Pharmaceutical Preparations Population Populations at Risk Quality of life Randomized, Controlled Trials Reminder Systems Risk Self Determination Self Management Self Medication Standardization Stroke Structure Support System System Technology Testing Time Vulnerable Populations cardiovascular risk factor cognitive ability cognitive function cognitive skill comorbidity dementia risk design digital digital health digital intervention digital technology digital treatment efficacy evaluation efficacy study experience group intervention heuristics high risk improved lonely individuals mHealth mHealth self-management medication compliance medication nonadherence member mild cognitive impairment preservation procedural memory prospective memory randomized, clinical trials rate of change remote monitoring support tools theories tool usability user centered design web portal

项目摘要

Abstract Mild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and is associated with an increased risk for failure to take prescribed medications. Hypertension is prevalent among persons with MCI (PwMCI) and nonadherence to medications increases the risk of accelerated cognitive decline through cerebrovascular disease. Adherence is often only 46% or lower among PwMCI. Further, the COVID-19 pandemic has resulted in the isolation of these individuals from care partners (friends, family, and healthcare workers) who assist with medication management, uncovering the urgent need for developing self- management tools. We have previously developed a theory-based mobile health (mHealth) system called Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) to support adherence in cognitively normal older adults, which can be adapted for PwMCI. No existing studies have evaluated the benefits of mHealth self-management tools to support hypertension medication adherence for PwMCI. In order for such digital interventions to be beneficial, they have to be carefully designed/adapted to meet the unique capabilities and limitations of PwMCI. User-centered technology has been shown to promote independence and autonomy by compensating for lost cognitive skills. In this proposal, we are poised to address the unique needs for digital technology use in this at-risk population of PwMCI based on user-centered design to guide the development of Medication Education, Decision Support, Reminding, and Monitoring-Memory (MEDSReM-M) system, conduct iterative usability testing to optimize the system for PwMCI, and examine the efficacy to support hypertension medication adherence. In Aim 1, facilitators and barriers for use of MEDSReM will be identified by interviewing PwMCI and their care partners, after they are shown the self-management system to guide the development of MEDSReM-M. Then using heuristic evaluations and cognitive walkthroughs, and through iterative usability testing with PwMCI, we will test, redesign, and optimize the system for PwMCI. In Aim 2 we will conduct a randomized controlled trial involving 100 PwMCI to test the effects of MEDSReM-M relative to an standardized educational control group on outcomes including adherence to hypertension medications, blood pressure, self-determination (competence and autonomy), and technology acceptance. We will then test predictors of the rate of change in medication adherence over 3 months to inform future large- scale deployment. Taking a human factors approach to identify needs and requirements for technological support to take medications as intended, and iterative testing for the usability of MEDSReM-M among PwMCI with a consequent RCT, will result in a digital health intervention system that has the potential to reduce cognitive decline associated with cardiovascular risks, save healthcare dollars, and promote autonomy and quality of life in this vulnerable population.

抽象的轻度认知障碍（MCI）的特征是一种或多种认知功能轻度受损，与不服用处方药的风险增加有关。高血压流行于患有 MCI (PwMCI) 且不坚持服药的人会增加认知加速的风险因脑血管疾病而下降。 PwMCI 中的依从性通常仅为 46% 或更低。此外， COVID-19 大流行导致这些人与护理伙伴（朋友、家人和医疗保健工作者）协助药物管理，发现发展自我管理的迫切需要管理工具。我们之前开发了一种基于理论的移动医疗（mHealth）系统，称为药物教育、决策支持、提醒和监测 (MEDSReM)，以支持依从性认知正常的老年人，可以适应 PwMCI。现有研究尚未评估 mHealth 自我管理工具在支持 PwMCI 高血压药物依从性方面的优势。为了为了使此类数字干预措施发挥作用，必须仔细设计/调整它们以满足独特的需求 PwMCI 的功能和局限性。以用户为中心的技术已被证明可以促进独立性通过补偿失去的认知技能来获得自主权。在本提案中，我们准备解决独特的问题基于以用户为中心的设计来指导 PwMCI 高危人群对数字技术使用的需求药物教育、决策支持、提醒和监测记忆 (MEDSReM-M) 的发展系统，进行迭代可用性测试以优化 PwMCI 系统，并检查其有效性支持高血压药物的依从性。在目标 1 中，使用 MEDSReM 的促进因素和障碍将是在向 PwMCI 及其护理伙伴展示自我管理系统后，通过采访他们来确定指导 MEDSReM-M 的发展。然后使用启发式评估和认知演练，以及通过与PwMCI的迭代可用性测试，我们将为PwMCI测试、重新设计和优化系统。在目标 2 我们将进行一项涉及 100 名 PwMCI 的随机对照试验来测试 MEDSReM-M 的效果相对于标准化教育对照组的结果（包括高血压依从性）药物、血压、自决（能力和自主权）和技术接受度。我们然后将测试 3 个月内药物依从性变化率的预测因素，以告知未来的重大变化规模部署。采用人为因素的方法来确定技术的需求和要求支持按预期服药，并迭代测试 MEDSReM-M 在 PwMCI 中的可用性以及随后的随机对照试验，将产生一个数字健康干预系统，该系统有可能减少与心血管风险相关的认知能力下降，节省医疗费用，并促进自主权和这些弱势群体的生活质量。