A micro-randomized trial of JITAI messaging to improve adherence to multiple weight loss behaviors in young adults

JITAI 消息传递的微随机试验可提高年轻人对多种减肥行为的依从性

• 批准号: 10345627
• 负责人: CARMINA G VALLE
• 金额: $ 76.98万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345627
• 关键词: Accelerometer; Achievement; Address; Adherence; Adult; Age; Behavior; Behavior Therapy; Behavioral; Body Weight Changes; Body Weight decreased; Body mass index; Calories; Characteristics; Collection; Diet; Eating; Electronic Mail; Engineering; Experimental Designs; Feedback; Food; Future; Gender; Goals; Individual; Internet; Intervention; Location; Monitor; Morbidity - disease rate; Nature; Obesity; Outcome; Overweight; Participant; Patient Self-Report; Persons; Population; Randomized; Recording of previous events; Schedule; Structure; Techniques; Testing; Text Messaging; Time; Update; Weight; Weight Gain; adaptive intervention; base; behavior change; clinically significant; contextual factors; cost; digital; digital health; digital intervention; efficacious intervention; evidence base; health data; high risk; improved; meetings; mobile application; mortality; multiphase optimization strategy; obesity treatment; pilot trial; programs; public health intervention; randomized trial; success; tailored messaging; tool; trial design; web-based intervention; weight loss intervention; wireless; young adult

PROJECT ABSTRACT An estimated 1 in 2 US adults will have obesity by 2030, which is a major cause of morbidity and mortality. The highest risk of weight gain is among young adults ages 18-35 years. In-person behavioral interventions generally produce clinically significant weight losses, but cost and reduced reach limit their ability to impact obesity at a population level. Web-based interventions that mimic the structure of weekly face-to-face treatment have proven a viable alternative, though weight losses are generally smaller than in-person treatment. Mobile treatments have the potential for high reach, but have been less effective, producing 1-3 kgs over 6 months. Newer digital intervention approaches called “just-in-time adaptive interventions” (JITAIs) promise to improve upon mobile outcomes by offering adaptive, personalized feedback on behavior, which consists of providing the “right type of support” at “the right time” rather than on a fixed schedule. This “just-in- time,” or JIT, approach is made possible by the emergence of low-cost and widely available digital health tools that allow for the collection of continually updated health data. However, to date, no JITAIs have successfully targeted multiple weight-related behaviors (weighing, activity, and diet), and there has been no systematic examination of what types of messaging interventions best promote adherence to these three weight loss behaviors, for whom they are effective, and under what conditions. To address this problem, we will use a micro-randomized trial to evaluate the effects of 7 types of intervention messages targeting specific behavior change techniques (i.e., BCT messages) delivered in JIT moments on daily achievement of behavioral goals among n=201 young adults with overweight and obesity. All participants will receive a 6-month behavioral weight loss intervention using our Nudge mobile app, which includes evidence-based weekly lessons, tailored feedback, self-monitoring, and daily BCT messages. Participants will receive a wireless scale, activity tracker, and track “red” foods (high-calorie foods) in the app and have 3 goals: weigh daily, a daily active minutes goal that gradually increases if met, and a daily red foods limit. At 3 decision points per day, participants will be micro-randomized to receive or not receive 1 of 7 types of BCT messages. Each intervention message has unique decision rules for availability. Candidate intervention message options have been carefully selected from empirical evidence, tested in our prior studies, or are from our pilot micro-randomized trial. Assessments will occur daily, and at 0, 3 and 6 months, to accomplish the following specific aims: 1) Evaluate the effects of each behavior change technique message (i.e., BCT message) on daily adherence to weight loss behaviors; 2) Determine whether the effects of BCT messages on proximal outcomes change over time; and 3) Assess whether the effects of BCT messages on proximal outcomes are moderated by participants’ contextual factors. Findings will guide how adaptive, behaviorally- and contextually-dependent messages are incorporated into future JITAIs for weight loss.

项目摘要 据估计，到 2030 年，二分之一的美国成年人将患有肥胖症，这是发病和死亡的主要原因。这 体重增加的风险最高的是 18-35 岁的年轻人。面对面的行为干预 通常会产生临床上显着的体重减轻，但成本和减少的范围限制了它们影响的能力 人口水平的肥胖。基于网络的干预措施模仿每周面对面的结构 治疗已被证明是一种可行的替代方案，尽管体重减轻通常小于面对面治疗 治疗。移动处理具有高覆盖范围的潜力，但效果较差，产生 1-3 公斤 超过6个月。称为“及时适应性干预”（JITAI）的新型数字干预方法 承诺通过提供自适应、个性化的行为反馈来改善移动结果， 包括在“正确的时间”而不是按固定的时间表提供“正确类型的支持”。这个“刚刚—— 低成本且广泛使用的数字健康工具的出现使得“准时”（JIT）方法成为可能 允许收集不断更新的健康数据。然而，迄今为止，还没有 JITAI 成功 针对多种与体重相关的行为（称重、活动和饮食），但目前还没有系统的研究 检查哪些类型的信息干预措施最能促进坚持这三种减肥 行为、对谁有效以及在什么条件下有效。为了解决这个问题，我们将使用一个 微随机试验评估针对特定行为的 7 种干预信息的效果 改变在 JIT 时刻交付的关于每日行为目标实现的技术（即 BCT 消息） n=201 名超重和肥胖的年轻人。所有参与者都将接受为期 6 个月的行为测试 使用我们的 Nudge 移动应用程序进行减肥干预，其中包括量身定制的基于证据的每周课程 反馈、自我监控和每日 BCT 消息。参与者将收到无线秤、活动追踪器、 并在应用程序中跟踪“红色”食物（高热量食物）并设定 3 个目标：每日称重、每日活跃分钟数目标 如果满足，则逐渐增加，并且每日红色食品限量。在每天 3 个决策点，参与者将 微随机化接收或不接收 7 种 BCT 消息中的一种。每条干预消息都有 独特的可用性决策规则。候选人干预消息选项都经过精心挑选 来自经验证据，在我们之前的研究中测试过，或者来自我们的试点微观随机试验。评估 将每天进行，并在第 0、3 和 6 个月进行，以实现以下具体目标： 1) 评估 关于每日坚持减肥行为的每项行为改变技术信息（即 BCT 信息）； 2） 确定 BCT 消息对近期结果的影响是否随时间变化； 3) 评估 BCT 信息对近期结果的影响是否受到参与者的背景因素的调节。 研究结果将指导如何将适应性、行为和情境相关的信息纳入到 未来的 JITAI 减肥。