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

项目总结/摘要 背景：游戏化是在非游戏中使用游戏设计元素，如点数和关卡。 contexts.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，其效力有限。一个重要的机会是将 行为经济学，它有效地为实现持续的干预设计提供了信息， 通过解决人类“可预测的非理性”来改善健康行为。我们集团 进行了两项成功的临床试验，使用游戏化以及合作或竞争来增加 在其他环境下的体力活动。我们与退伍军人进行了三项试点研究， 他们的具体需求和经验。 更高水平的定期体力活动与心血管疾病风险降低相关 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达到 足够的身体活动来获得这些好处。 创新和影响：这将是第一个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身体活动， 高血压它也将是第一个直接检查这些干预措施对临床 与增加体力活动相关的结果，并检查成本效益 减少退伍军人的负担，整个研究将远程进行，包括入组 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：评估游戏化与合作或竞争的有效性， 增加身体活动。目的2：评估游戏化改善临床结局的有效性。 目标3：进行定性过程评价和执行情况分析，为执行工作提供信息 努力在VA。目的4：对退伍军人的特征进行定量评估， 人口统计学、既往经验、社交网络和其他因素，以确定治疗异质性 方面的影响.目标5：评估游戏化干预措施的成本效益。 方法：将患有高血压的肥胖退伍军人纳入一项三臂随机对照试验 包括6个月的干预和3个月的随访。可穿戴设备将用于被动地 监测身体活动水平。将通过数字体重秤和血压采集临床结局 通过视频会议被铐起来干预措施将使用“健康之路”这一技术平台部署 我们已经证明在VA卫生系统中使用是可行的。结果将包括物理 步数活动（主要），中度至剧烈体力活动分钟数（次要），临床 体重和收缩压结局（次要），睡眠分钟数变化（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 与退伍军人和关键VA利益相关者的定性访谈，将告知VA计划的实施。 我们得到以下三个运营合作伙伴的支持，以将关键的经验教训应用到现有的VA中 项目：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.