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

项目摘要/摘要 患有2型糖尿病(T2D)的肥胖青少年和青壮年(Aya)比非肥胖青少年(T2D)活动明显减少 糖尿病同龄人，尽管体力活动有许多与疾病相关的好处。因为面对面的体力活动 对肥胖AYA的干预措施实施起来具有挑战性，且流失率高，迫切需要 设计有针对性的体力活动干预措施，对糖尿病前期肥胖的Aya进行有效和可扩展的干预 和T2D。根据NIDDK的优先事项，拟议研究的长期目标是开发一种 减少患有糖尿病前期和T2D的青少年疾病进展风险的干预措施。申请者将会 充分利用费城儿童医院和华盛顿大学丰富的科学环境 在专家的多学科指导下，宾夕法尼亚州实现了她的研究和培训目标 和顾问团队。这个K23将支持PI在混合方法研究、行为经济学、 移动健康、体力活动干预和生物行为临床试验设计和分析。的目标是 拟议的研究是开发一种有效的移动健康(MHealth)干预措施，以增加适度到 在患有糖尿病前期或T2D的Aya患者中进行剧烈体育活动(MVPA)，利用来自行为的洞察力 并利用一个高效的框架来确定有效的干预措施组成部分。目标1 将确定参与日常MVPA的态度、信念和规范，以及障碍和促进者 通过对患有糖尿病前期或T2D的阿雅进行半结构化访谈。在目标2中，以理论为基础和 将通过调整遵守情况来开发促进MVPA的经验性短信- 推广由PI的导师开发的文本消息库，使用与患者利益相关者和 来自目标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)，包括4个干预成分 MVPA目标理论中介：1)短信目标理论 态度和规范，与简单的提醒；2)提高与固定的步数目标，以感知的目标为目标 行为控制；3)预先分配的财务激励和未实现目标的损失与已获得的目标损失 厌恶；以及4)每日目标与每周目标，目标是双曲线折扣(偏好较小的-越快越好 更大-更晚的奖励)。主要结果是MVPA的变化。次要结果包括步数/天， 每天达到60分钟MVPA的比例，体重指数，血红蛋白A1c，空腹胰岛素和血脂。 PI和导师假设有效组件设置将包括以文本消息为目标 态度/规范、渐进式目标、亏损框架的激励和日常目标。通过这一K23，PI将准备好 成功争取R01级资金，进行优化干预的随机对照试验， 帮助开启了她作为一名独立内科医生兼科学家的职业生涯，在健康行为改变方面拥有专业知识 阿雅有糖尿病前期和T2D。

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.