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

项目摘要/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 上下文。游戏化在工作场所健康计划和数字健康应用程序中普遍使用； 然而，其有效性一直有限。一个重要的机会是将来自 行为经济学，在为实现可持续发展的干预设计提供信息方面一直很有效 通过解决人类的“可预见的非理性”来改善健康行为。我们的团队已经 使用游戏化和合作或竞争进行了两项成功的临床试验，以增加 其他环境中的体力活动。我们已经对退伍军人进行了三项试点研究，以适应这些 针对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 足够的体力活动来获得这些好处。 创新和影响：这将是纳入行为经济学原理的首批临床试验之一 以及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。它也将是第一批直接检查这些干预措施对临床的影响的机构之一。 与增加体力活动相关的结果，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，包括招生 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来 检查干预措施的个性化。 具体目标：目标1：评估通过协作或竞争实现游戏化的有效性 增加体力活动。目的2：评价游戏化对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，以告知实施情况 退伍军人事务部内部的努力。目标4：对退伍军人特征进行量化评估 人口统计学、既往经历、社会网络和其他因素来确定治疗中的异质性 效果。目的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组随机对照试验 包括为期6个月的干预和3个月的随访。可穿戴设备将被用于被动地 监测体力活动水平。临床结果将通过数字体重秤和血压来获取 通过视频会议戴上手铐。干预措施将使用Way to Health技术平台进行部署 我们已经证明在退伍军人健康系统中使用是可行的。结果将包括体检 循序渐进的活动(主要)，中等到剧烈的体力活动分钟(次要)，临床变化 体重和收缩压的结果(次要)，睡眠分钟的变化(探索性)，以及 实施成本(试探性)。 下一步/执行：我们的执行分析，其中包括成本效益分析和 与退伍军人和退伍军人管理局主要利益相关者的定性访谈，将为退伍军人管理局计划的实施提供信息。 我们从以下三个运营合作伙伴那里获得了支持，以将关键知识实施到现有的退伍军人管理局 项目：弗吉尼亚州国家健康促进和疾病预防中心，包括MOVE！，弗吉尼亚州办公室 互联护理，以及退伍军人事务部首席改善和分析官。

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.