A Randomized Trial of Behaviorally Designed Gamification and Social Incentives to Increase Physical Activity Among Overweight and Obese Veterans

项目概要/摘要 背景：游戏化是在非游戏中使用积分、关卡等游戏设计元素 上下文。游戏化通常用于工作场所健康计划和数字健康应用程序； 然而，其效果有限。一个重要的机会是纳入以下原则： 行为经济学，有效地为实现可持续的干预设计提供信息 通过解决人类的“可预测的非理性”来改善健康行为。我们组有 使用游戏化和协作或竞争来提高效率，进行了两项成功的临床试验 其他环境中的体力活动。我们与退伍军人进行了三项试点研究，以定制这些 满足他们的具体需求和经验的方法。 意义：较高水平的定期体力活动与降低心血管疾病风险相关 疾病、糖尿病、高血压、肥胖和死亡率。尽管如此，超过一半的退伍军人没有实现 足够的体力活动以获得这些好处。 创新和影响：这将是首批纳入行为经济学原理的临床试验之一 游戏化设计中的社会激励措施，以增加肥胖退伍军人的体力活动 高血压。它也将是第一个直接检查这些干预措施对临床的影响的国家之一。 与增加身体活动相关的结果并检查成本效益以提高可扩展性 并减轻退伍军人的负担，整个研究将远程完成，包括注册 和干预措施。此外，我们将使用最先进的统计和机器学习技术 检查干预措施的个性化。 具体目标： 目标 1：通过协作或竞争来评估游戏化的有效性 增加体力活动。目标 2：评估游戏化改善临床结果的有效性。 目标 3：进行定性过程评估和实施分析，为实施提供信息 VA 内部的努力。目标 4：对退伍军人特征进行定量评估 人口统计数据、过去的经历、社交网络和其他因素来识别治疗的异质性 影响。目标 5：评估游戏化干预措施的成本效益。 方法：患有高血压的肥胖退伍军人将被纳入一项三臂随机对照试验 包括为期 6 个月的干预和 3 个月的随访。可穿戴设备将被用来被动地 监测体力活动水平。数字体重秤和血压将记录临床结果 通过视频会议戴上手铐。将使用技术平台 Way to Health 部署干预措施 我们已经证明在 VA 卫生系统内使用是可行的。结果将包括身体 步数活动（主要）、中等至剧烈身体活动的分钟数（次要）、临床变化 体重和收缩压的结果（次要）、睡眠时间的变化（探索性）以及 实施成本（探索性）。 后续步骤/实施：我们的实施分析，包括成本效益分析和 对退伍军人和退伍军人事务部主要利益相关者的定性访谈将为退伍军人事务部实施该计划提供信息。 我们得到以下三个运营合作伙伴的支持，将关键知识应用到现有的 VA 中 计划： VA 国家健康促进和疾病预防中心，包括 MOVE！、VA 办公室 Connected Care 和 VA 首席改进和分析官。

PROJECT SUMMARY/ABSTRACT Background: Gamification is the use of game design elements such as points and levels in non-game contexts. Gamification is used commonly within workplace wellness programs and digital health applications; however, its effectiveness has been limited. A significant opportunity is to incorporate principles from behavioral economics, which have been effective in informing intervention designs that achieve sustained improvements in health behavior by addressing the ‘predictable irrationality’ of humans. Our group has conducted two successful clinical trials using gamification and either collaboration or competition to increase physical activity in other settings. We have conducted three pilot studies with Veterans to tailor these approaches to their specific needs and experiences. Significance: Higher levels of regular physical activity are associated with reduced risk of cardiovascular disease, diabetes, hypertension, obesity, and mortality. Despite this, more than half of Veterans do not achieve enough physical activity to obtain these benefits. Innovation and Impact: This will be one of the first clinical trials to incorporate behavioral economic principles and social incentives within the design of gamification to increase physical activity among obese Veterans with hypertension. It will also be one of the first to directly examine the impact of these interventions on clinical outcomes associated with increased physical activity and examine cost-effectiveness To improve scalability and decrease burden on Veterans, the entire study will be conducted completed remotely including enrollment and interventions. Moreover, we will use state-of-the-art statistical and machine learning techniques to examine personalization of interventions. Specific Aims: Aim 1: To evaluate the effectiveness of gamification with collaboration or competition to increase physical activity . Aim 2: To evaluate the effectiveness of gamification to improve clinical outcomes. Aim 3: To conduct a qualitative process evaluation and implementation analysis to inform implementation efforts within VA. Aim 4: To conduct a quantitative evaluation of Veteran characteristics related to demographics, past experiences, social networks, and other factors to identify heterogeneity in treatment effects. Aim 5: To assess the cost-effectiveness of the gamification interventions. Methodology: Obese Veterans with hypertension will be enrolled into a three-arm randomized, controlled trial comprised of a 6-month intervention and a 3-month follow-up. Wearable devices will be used to passively monitor physical activity levels. Clinical outcomes will be captured by digital weight scales and blood pressure cuffs through video conferencing. Interventions will be deployed using Way to Health, a technology platform that we have demonstrated is feasible to use within the VA Health System. Outcomes will include physical activity in steps (primary), minutes of moderate-to-vigorous physical activity (secondary), changes in clinical outcomes of weight and systolic blood pressure (secondary), change in minutes of sleep (exploratory), and cost of implementation (exploratory). Next Steps/Implementation: Our implementation analysis, which includes cost-effectiveness analysis and qualitative interviews with Veterans and key VA stakeholders, will inform implementation of the program in VA. We have support from the following three operational partners to implement key learnings into existing VA programs: VA National Center for Health Promotion and Disease Prevention including MOVE!, VA Office of Connected Care, and the VA Chief Improvement and Analytics Officer.