Goals for Adherence with Low-cost Incentives (GOALS)

坚持低成本激励的目标 (GOALS)

• 批准号: 10161248
• 负责人: Haijing Huang
• 金额: $ 72.44万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-17 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10161248
• 关键词: Adherence; American; Behavior; Behavioral; COVID-19; Car Phone; Client; Clinical; Control Groups; Cost Effectiveness Analysis; Country; Dropout; Effectiveness; Eligibility Determination; Future; Goals; HIV; HIV Seropositivity; Health behavior; Incentives; Individual; Intervention; Journals; Lead; Maintenance; Measures; Odds Ratio; Ownership; Participant; Persons; Phase; Pilot Projects; Preventive; Process; Public Health; Publishing; Randomized Controlled Trials; Reporting; Research; Resources; Rewards; Risk-Taking; Self-control as a personality trait; South Africa; Testing; Text Messaging; Time; Treatment outcome; Uganda; Viral; Viral Load result; Vulnerable Populations; Work; Youth; aged; arm; base; behavior change; behavioral economics; cognitive control; cognitive development; comparative; cost; cost effectiveness; design; discounting; effectiveness evaluation; effectiveness testing; empowerment; health inequalities; improved; insight; medication compliance; novel; primary outcome; relative effectiveness; secondary outcome; standard of care; theories; tool; treatment arm; virology; willingness

Project Summary Treatment outcomes of HIV-positive youth in Uganda and elsewhere are threatened by low medication adherence. Despite the clear need for adherence support among youth, few interventions target this particularly vulnerable group during a time of heightened risk-taking behavior and unfinished development of cognitive control processes such as planning and goal-directed behavior. Incentives informed by behavioral economics (BE) have successfully changed a range of health behaviors by countering present bias (the tendency of overly discounting the future benefits of preventive health behaviors) including our own study that improved ART adherence. However, they have rarely been tested among youth living with HIV (YLWH) who are likely to particularly benefit from such extrinsic rewards given their observed problems with self-control. Traditional incentives that require individuals to reach a uniform, high eligible threshold by design leave out those unable to meet it, often most in need of support. In a pilot study, we tested a novel incentive design that allowed even those with low initial adherence to qualify for incentives, resulting in their improved adherence. BE theory suggests that the effort exerted to reach a goal depends on how far away it is from the participant; if the goal is within close reach, the participant shows great willingness to achieve it, but if the goal is set too high, s/he becomes demotivated and may give up. Based on this insight, we restructured our incentive design to allow participants to set their own eligibility threshold. We propose to build on our pilot results using a randomized controlled trial (RCT) to establish effectiveness. Our intervention, GOALS, proposes testing externally assigned sub-goals gradually increasing towards 90% (T1, n=140) and self-chosen, participatory interim goals (T2, n=140), against a traditional, fixed goal of 90% (T3, n=140). The control group (n=140) will receive the usual standard of care. The primary outcome is electronically measured ART adherence collected throughout the study and for 12 months after incentives are withdrawn to measure the persistence of behavior change; suppressed viral load will be the secondary outcome. The Specific Aims in year 1 (Improvement Phase) is to evaluate the relative effectiveness of the three incentivization approaches for improving adherence among YLWH. In year 2 (Maintenance Phase), we test the relative effectiveness of the three ways of incentivization for maintaining adherence. In year 3 (Persistence Phase) the goal is to investigate for 12 months the relative effectiveness of the three GOALS intervention arms at creating behavioral persistence once incentives are removed. Specific Aim 4 is to perform a cost-effectiveness analysis including a comparative analysis of those GOALS intervention arms that show a positive intervention impact for improving and/or maintaining adherence.

项目摘要 乌干达和其他地方艾滋病毒阳性青年的治疗结果受到药物不足的威胁 坚持。尽管青年人明显需要坚持支持，但很少有干预措施针对这一点 特别是在高风险行为和未完成的发展时期， 认知控制过程，如计划和目标导向行为。行为激励 经济学（BE）已经成功地改变了一系列的健康行为，通过反对目前的偏见（ 过度低估预防性健康行为的未来益处的倾向），包括我们自己的研究， 改善ART依从性。然而，他们很少在青年艾滋病毒感染者（YLWH）中进行测试， 鉴于他们在自我控制方面的问题，他们可能会特别受益于这种外在奖励。 传统的激励措施要求个人达到一个统一的、高的合格门槛， 那些无法满足的人，往往最需要支持。在一项试点研究中，我们测试了一种新的激励设计， 甚至允许那些最初遵守率较低的人有资格获得奖励，从而提高了他们的遵守率。 BE理论表明，为达到目标而付出的努力取决于它与参与者的距离;如果 如果目标近在咫尺，参与者表现出极大的意愿去实现它，但如果目标也设定了， 高，她/他变得失去动力，可能会放弃。基于这一认识，我们重组了激励设计 让参与者设定自己的资格门槛。我们建议在试点成果的基础上， 随机对照试验（RCT），以确定有效性。我们的干预，目标，建议测试 外部分配的子目标逐渐增加到90%（T1，n=140），自我选择，参与 中期目标（T2，n=140），而传统的固定目标为90%（T3，n=140）。对照组（n=140）将 接受通常的护理标准。主要结局是收集的电子测量的ART依从性 在整个研究过程中，以及在激励措施撤销后的12个月内， 变化;抑制病毒载量将是次要结局。第一年的具体目标（改进） 阶段）是评估三种激励方法对提高依从性的相对有效性 在YLWH中。在第二年（维护阶段），我们测试了三种方法的相对有效性， 激励以维持依从性。在第3年（持续阶段），目标是调查12 三个月的目标干预武器在创造行为持久性的相对有效性 一旦激励措施被取消。具体目标4是进行成本效益分析，包括 对那些显示出积极干预影响的目标干预组进行比较分析， 和/或保持粘附。