Multiphase Optimization Trial of Incentives for Veterans to Encourage Walking

背景：指南建议成年人至少应该进行适度的运动，如散步 每周150分钟，每集至少持续10分钟。一个典型的成年人可以通过以下方式达到这个门槛 每天步行7000步。不幸的是，美国只有5%的成年人符合这些要求， 45岁以上的退伍军人中，超过三分之一的人符合身体不活动的定义。耐心的激励 体力活动计划(PA)可能会有所帮助。行为经济学表明，我们长期无法开始 维持个人助理的日常生活可能是“当下偏见”的结果，这种偏见是一种看重眼前小事的倾向 在遥远的未来，回报比巨额回报更高。对于许多人来说，久坐不动的即时满足感 活动，如看电视或上网，是比无形的更强大的动力 对身体活动的生活方式的满足。患者激励可能会通过改变 对健康行为的及时奖励。在患者激励计划中，患者被给予有形的、及时的 对实现特定健康目标的奖励，例如每天步行7000步。 意义/影响：有规律的体力活动(PA)与降低死亡率和降低心脏病风险相关 许多疾病，包括2型糖尿病、心脏病和抑郁症。这项研究针对的是慢性 高铁和研发优先领域的条件。 创新：几乎没有证据表明哪种类型的激励对退伍军人最有效。我们建议研究 以一种新形式的随机试验激励PA--多阶段优化策略(MOST)试验。我们的 目的是确定鼓励步行的12周患者激励计划的最佳设计 在50-70岁的身体不活跃的退伍军人中。主要结果是优化的 干预措施将在未来与普通护理对照组进行测试，这是一项单独的随机试验。 具体目标： 目标1：进行24因素设计的筛选阶段试验，以激励增加平均步数 在身体不活跃的退伍军人中，在12周内每天步行7000步。我们将测试四种不同的 激励因素：1)彩票VS亏损框架激励，2)财务激励VS非财务激励，3)预付费 承诺明信片，提醒退伍军人对PA承诺与不承诺的内在原因 承诺明信片，以及4)一位退伍军人要求PA提供保持活跃与不要求的建议。这个 主要结果是从基线到第24周每周步数的变化。 目标2.进行成本分析和定性访谈。管理每个组件的成本以及 对每个组成部分对试验参与者的可接受性的定性评估将为决定 保留哪些成分用于后续的精炼和确认阶段试验。 目标3.召集一个专家小组，为社会变革管理计划下一阶段的审判选择组成部分。电池板 将根据其对步数(目标1)、行政成本和参与者的影响来权衡每个组成部分- 已报告的定性评估(目标2)，以及构成部分效果的理论基础的力度 关于体力活动。 方法：我们将年龄在50-70岁的退伍军人纳入筛查阶段试验。这个 干预是上述四种不同的激励因素。主要结果是在每个步骤中发生变化 从基线到第24周。 实施/下一步：此筛选阶段派生的组件将用于精炼 确定激励的最佳剂量(频率、持续时间和数量)的阶段试验。经过优化的 然后，在确认阶段试验中，将针对常规护理对照组进行干预试验。炼油和炼油 确认阶段的试验将在单独的、未来的拨款申请中提出。

Background: Guidelines recommend adults should engage in moderate exercise, such as walking, for at least 150 minutes per week in episodes of at least 10 minutes duration. A typical adult can reach this threshold by walking 7,000 steps per day. Unfortunately, only 5% of adults in the United States meet these requirements, and more than 1 in 3 Veterans over age 45 meet the definition of physically inactive. A patient incentive program for physical activity (PA) may help. Behavioral economics suggests that our chronic inability to start and maintain a PA routine may be the result of “present bias,” which is a tendency to value small immediate rewards over large rewards in the distant future. For many people, the immediate gratification of a sedentary activity, such as watching television or surfing the internet, is a more powerful motivator than the intangible satisfaction of a physically active lifestyle. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In a patient incentive program, patients are given tangible, timely rewards for achieving specific health goals, such as walking 7,000 steps per day. Significance/Impact: Regular physical activity (PA) is associated with reduced mortality and lower risks of many diseases, including type 2 diabetes, heart disease, and depression. this study addresses the chronic conditions HSR&D priority area. Innovation: There is little evidence on what type of incentive works best for Veterans. We propose to study incentives for PA in a novel form of randomized trial—A Multiphase Optimization STrategy (MOST) trial. Our objectives are to determine the optimal design of a 12-week patient incentive program to encourage walking among physically inactive Veterans age 50-70. The primary outcomes are optimized components of the intervention, which will be tested against a usual care control group in a future, separate randomized trial. Specific Aims: Aim 1: Conduct a 24 factorial designed screening-phase trial of incentives for increasing average steps per day to 7,000 steps over 12 weeks among physically inactive Veterans. We will test four different incentive factors: 1) lottery vs. loss framed incentives, 2) financial vs. non-financial incentives, 3) a pre- commitment postcard reminder of a Veteran’s stated intrinsic reason for commitment to PA vs. no pre- commitment postcard, and 4) a request for PA advice from a Veteran on staying active vs. no request. The primary outcome is change in steps per week from baseline to week 24. Aim 2. Conduct cost analyses and qualitative interviews. The cost of administering each component and qualitative assessments of the acceptability of each component to trial participants will inform the decision of which components to retain for the subsequent refining and confirmatory phase trials. Aim 3. Convene an expert panel to choose components for the next phases of the MOST trial. The panel will weigh each component in terms of its effect on step counts (Aim 1), administrative costs and participant- reported qualitative assessments (Aim 2), and the strength of the theoretical basis for the component’s effect on physical activity. Methodology: We will enroll physically inactive Veterans age 50-70 in the screening phase trial. The intervention is the four different incentive factors described above. The primary outcome is change in steps per week from baseline to week 24. Implementation/Next Steps: The components derived from this screening phase will be used in a refining phase trial that establishes the optimal dose (frequency, duration, and amount) of the incentive. The optimized intervention will then be tested against a usual care control group in the confirming phase trial. The refining and confirming phase trials will be proposed in a separate, future grant submission.