Development and pilot testing of a behavioral economics mobile health digital tool to improve adherence to non-pharmacologic strategies for behavioral and psychological symptoms of dementia

开发和试点测试行为经济学移动健康数字工具，以提高对痴呆症行为和心理症状的非药物策略的依从性

• 批准号: 10349954
• 负责人: Hayley Michelle Belli
• 金额: $ 13.05万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10349954
• 关键词: Address; Adherence; Adoption; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antipsychotic Agents; Applications Grants; Area; Behavioral; Behavioral Symptoms; Caring; Chronic; Chronic Disease; Clinical; Collaborations; Data; Degenerative Disorder; Dementia; Development; Discipline; Disease Management; Drug Prescriptions; Economics; Educational workshop; Electronic Health Record; Emotional; Face; Family; Funding; Geriatrics; Goals; Guidelines; Guilt; Health; Health Technology; Health system; Healthcare; Human; Impaired cognition; Influenza vaccination; Intervention; Interview; Measures; Mental Depression; Mentors; Mentorship; Nature; New York; Outcome; Outcome Study; Patients; Peer Review; Persons; Pharmaceutical Preparations; Pilot Projects; Pragmatic clinical trial; Primary Health Care; Psychology; Publications; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Resources; Review Literature; Risk; Role; Screening for cancer; Sedation procedure; Social Workers; Societies; Stress; Stroke; Structure; Tablet Computer; Technology; Telephone; Telephone Interviews; Testing; Text Messaging; Thinking; Training; Training Programs; United States National Institutes of Health; Universities; Visit; Work; acceptability and feasibility; arm; behavior test; behavioral economics; common symptom; communication device; dementia care; design; diabetes management; digital; digital health; evidence base; experience; falls; health care settings; human old age (65+); implementation science; improved; innovation; insight; mHealth; mortality; novel; patient population; pilot test; primary outcome; prototype; psychologic; psychological symptom; recruit; research study; secondary outcome; skills; sociodemographics; symposium; tool; wearable device

PROJECT SUMMARY / ABSTRACT: Background: There are currently more than five million Americans living with Alzheimer’s disease and related dementias, a number expected to increase to nearly 14 million by 2050. Among the most common symptoms of persons living with dementia (PLWD) are behavioral and psychological disturbances. PLWD require care partners who themselves face challenges including guilt, depression, and emotional and physical stress due to the behavioral and psychological symptoms of dementia (BPSD). Guidelines by the American Geriatrics Society currently discourage antipsychotic prescriptions to treat BPSD, instead encouraging non-pharmacological approaches. While some non-pharmacologic strategies for addressing BPSD have shown to be effective, adherence is challenging. Novel concepts from behavioral economics (BE), a field that combines insights from economics and psychology to recognize that humans often make predictable decision errors, has shown promise in promoting appropriate disease management in a variety of healthcare settings. Mobile health (mHealth) technology is one mechanism for delivering non-pharmacologic care; however, no strategies to date have incorporated BE principles to improve adherence to non-pharmacologic strategies for managing BPSD. Research: This study will leverage the power of BE with mHealth to develop, user-test, and pilot a digital health tool aimed at improving adherence to non-pharmacologic strategies for BPSD. A thorough review of the literature, stakeholder interviews, and a design-thinking workshop will aid in the development of the BE nudges. Visits with PLWD-care partner dyads and semi-structured telephone interviews will be conducted to user-test and refine the BE-mHealth digital tool prototype. The culmination of this work will be an intervention ready for testing via a single-arm, 6-month pilot study within the New York University Langone Health (NYULH) system. The primary study outcome will be adherence to the non-pharmacologic strategies, and secondary outcomes will include changes in BPSD, care partner burden, and prescriptions for anti-psychotic medications. Socio- demographic, clinical, and primary/secondary study outcomes will be measured using care partner reported outcomes and patient electronic health records embedded within the BE-mHealth tool for ease of data capture. Training: The candidate’s proposed training plan builds upon prior research in the design and testing of BE digital health interventions via embedded pragmatic clinical trials. The candidate will receive training in the fields of dementia, digital health innovation, implementation science, and mixed-methods research through one-on- one mentorship, coursework, seminars, workshops, and conferences in disciplines of high relevance to the proposed research. The mentorship team is composed of discipline-specific experts with a history of working together and with the candidate on NIH funded grant proposals and peer-reviewed publications. The candidate’s long-term goal is to become an independent investigator in the development and testing of BE-inspired digital health interventions for chronic disease management in persons living with dementia.

项目摘要/摘要： 背景：目前有500多万美国人患有阿尔茨海默病及其相关疾病 痴呆症，预计到2050年，这一数字将增加到近1400万。最常见的症状包括 痴呆症(PLWD)是一种行为和心理障碍。PLWD需要护理 伴侣本身面临着包括内疚、抑郁、情绪和身体压力在内的挑战 痴呆的行为和心理症状(BPSD)。美国老年医学会指南 目前不鼓励使用抗精神病药物治疗bps，而是鼓励非药物治疗。 接近了。虽然用于解决BPSD的一些非药物策略已经被证明是有效的， 坚持下去是一件具有挑战性的事情。来自行为经济学(BE)的新概念，这是一个结合了 经济学和心理学认识到，人类经常会犯可预见的决策错误，这显示出了希望 在各种医疗保健环境中促进适当的疾病管理。移动医疗(MHealth) 技术是提供非药物护理的一种机制；然而，到目前为止还没有任何战略 纳入BE原则，以提高对治疗BPSD的非药物策略的依从性。 研究：这项研究将利用BE和mHealth的力量来开发、用户测试和试点数字健康 旨在提高对BPSD非药物治疗策略依从性的工具。彻底回顾了 文献、利益相关者访谈和设计思维研讨会将有助于BENTES的发展。 将进行与PLWD-CARE合作伙伴DYAD的访问和半结构化电话采访，以进行用户测试 并对BE-mHealth数字工具原型进行了细化。这项工作的高潮将是为 通过纽约大学朗格尼健康(NYULH)系统内的单臂、为期6个月的试点研究进行测试。 主要研究结果将是坚持非药物治疗策略，次要结果 将包括BPSD、护理伙伴负担和抗精神病药物处方的变化。社会-- 人口统计、临床和主要/次要研究结果将使用护理合作伙伴报告来衡量 BE-mHealth工具中嵌入的结果和患者电子健康记录，以便于数据捕获。 培训：应聘者提出的培训计划建立在BE设计和测试的先前研究基础上 通过嵌入式实用临床试验进行数字健康干预。应聘者将接受实地培训 痴呆症、数字健康创新、实施科学和通过一对一的混合方法研究 一位导师，课程作业，研讨会和会议，与 拟开展的研究。导师团队由有工作经验的特定学科专家组成 与候选人一起讨论NIH资助的拨款提案和同行评议的出版物。候选人的 长期目标是成为BE启发数字开发和测试的独立调查者 痴呆症患者慢性病管理的健康干预。