Incentives, Cognitive Training, and Internet Therapy for Teens with Poorly Contro

针对控制不良青少年的激励、认知训练和互联网治疗

• 批准号: 8436585
• 负责人: CATHERINE STANGER
• 金额: $ 245.58万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8436585
• 关键词: Achievement; Address; Adherence; Adolescent; Adult; Affect; Behavior Therapy; Blood Glucose; Blood Glucose Self-Monitoring; Cognitive; Cognitive Therapy; Counseling; Decision Making; Diabetes Mellitus; Distant; Effectiveness of Interventions; Elements; Endocrinologist; Evaluation; Evidence based intervention; Evidence based treatment; Family; Feasibility Studies; Feedback; Foundations; Frequencies; Future; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health; Home environment; Impulsivity; Incentives; Incidence; Individual; Insulin-Dependent Diabetes Mellitus; Internet; Intervention; Lead; Life; Manuals; Medical; Memory; Metabolic Control; Methods; Modeling; Motivation; Neurocognitive; Outcome; Parents; Patients; Pilot Projects; Process; Protocols documentation; Recommendation; Research; Rewards; Self Care; Short-Term Memory; Staging; Target Populations; Technology; Teenagers; Testing; Time; Training; Treatment Protocols; Treatment outcome; Work; Youth; aged; base; behavior change; blood glucose regulation; cognitive function; cognitive training; cost effective; design; diabetic; discounting; economic cost; effective intervention; efficacy trial; executive function; financial incentive; high risk; improved; innovation; intervention effect; mortality; motivational enhancement therapy; novel; parental monitoring; preference; programs; randomized trial; skills; therapy design; treatment adherence; treatment as usual; trial comparing; young adult

DESCRIPTION (provided by applicant): Type 1 diabetes in adolescents is a significant medical condition associated with high economic costs and increased mortality, and its incidence is increasing. Unfortunately, adolescents show poorer adherence to self monitoring of blood glucose (SMBG) recommendations and poorer metabolic control than adults. Although some individual and family-based interventions have shown promise in improving metabolic control, there is a critical need to develop more effective interventions. The overall goal of this DP3 project is to develop a new innovative intervention that targets decision making to help teens with poor diabetic metabolic control increase the frequency of SMBG and improve HbA1c. The target population will be teens aged 13-17 with type 1 diabetes and HbA1c >8%. Based on our prior work and a conceptual model, the proposed study will develop and pilot test a novel, multifaceted, developmentally appropriate intervention aimed at improving adolescent decision making. An integrated set of components target adolescents' need for frequent positive feedback, improved future orientation, and motivational support. While past research indicates that behavioral interventions are frequently more successful when they include multiple elements, no previous intervention has combined multiple empirically-based components that target key decision making levers in one intervention. This new intervention, called MAxIM (MotivAtion, Incentives, Memory) uses: 1) motivation enhancement therapy (MET) (an existing evidence-based treatment for adolescent with diabetes) supplemented with cognitive behavior therapy (CBT) to enhance behavior change; 2) financial incentives for daily blood glucose testing and parental monitoring to provide frequent positive feedback; and 3) working memory training (WMT), an efficacious method for strengthening specific cognitive processes that support decision-making and future orientation. The interventions will be delivered to families at home via the internet to increase the reach of the intervention to families living distant from ther treating endocrinologist. MAxIM will be teen and parent friendly and designed to increase engagement and compliance with the intervention. Primary hypotheses are that MAxIM will: (1) help teens improve and maintain glucose control, and (2) improve decision making (improve executive function and reduce delay discounting), which will predict treatment outcome. The unique set of interventions holds promise for improving adherence by affecting multiple basic mechanisms that determine poor decision making. The project will develop a novel, highly transportable, home based intervention designed to maximize and sustain HbA1c reductions and SMBG frequency over time in adolescents. Innovations include the targeting of multiple levers specific to adolescent decision making, use of technology to deliver the intervention to families at home, and testing cognitive predictors of treatment outcome for teens with diabetes. Successful achievement of this study's aims will bring the field closer to a cost effective, long-lasting intervention to improve outcomes among these high-risk youth. PUBLIC HEALTH RELEVANCE: The overall goal of this project is to develop a novel family friendly intervention that will help teens with poor metabolic control of their type 1 diabetes increase and sustain daily self monitoring of blood glucose and lower HbA1c. This is important because poor metabolic control has long-term health implications. This project will provide important information regarding new effective ways to improve outcomes among teens with poorly controlled type 1 diabetes.

描述(由申请人提供)：青少年中的1型糖尿病是一种与高昂的经济成本和增加的死亡率相关的重大疾病，其发病率正在增加。不幸的是，与成年人相比，青少年对自我血糖监测(SMBG)建议的遵守程度更低，代谢控制也更差。尽管一些以个人和家庭为基础的干预措施在改善代谢控制方面显示出了希望，但迫切需要开发更有效的干预措施。这个项目的总体目标是 DP3项目旨在开发一种新的创新干预措施，针对决策，帮助患有糖尿病代谢控制不良的青少年增加SMBG的频率，并改善HbA1c。目标人群将是患有1型糖尿病的13-17岁青少年，HbA1c&gt；8%。基于我们之前的工作和一个概念模型，这项拟议的研究将开发和试点测试一种新的、多方面的、适合发展的干预措施，旨在改善青少年的决策。一套完整的组成部分，旨在满足青少年对频繁的积极反馈、改进的未来导向和动机支持的需求。虽然过去的研究表明，当行为干预包括多个要素时，它们往往更成功，但以前的干预从未将多个以经验为基础的组成部分结合在一个干预中，这些组成部分针对关键的决策杠杆。这项名为Maxim(动机、激励、记忆)的新干预措施使用：1)动机增强疗法(MET)(现有的一种针对青少年糖尿病患者的循证治疗)，辅之以认知行为疗法(CBT)，以促进行为改变；2)对日常血糖检测和父母监测进行经济奖励，以提供频繁的积极反馈；以及3)工作记忆训练(WMT)，这是一种加强支持决策和未来定向的特定认知过程的有效方法。这些干预措施将通过互联网传递给在家的家庭，以增加干预措施的覆盖范围，使居住在远离内分泌科医生的家庭接受干预。Maxim将对青少年和家长友好，旨在提高参与度和对干预的遵从性。基本假设是Maxim将：(1)帮助青少年改善和维持血糖控制，以及(2)改善决策(改善执行功能和减少延迟折扣)，这将预测治疗结果。这套独特的干预措施有望通过影响决定糟糕决策的多个基本机制来提高遵从性。该项目将开发一种新颖的、高度可运输的、以家庭为基础的干预措施，旨在最大限度地降低并维持青少年的糖化血红蛋白降低和SMBG频率。创新包括针对青少年决策的多个杠杆，使用技术将干预提供给家庭，以及测试青少年糖尿病患者治疗结果的认知预测因素。这项研究目标的成功实现将使该领域更接近于成本效益高的长期干预措施，以改善这些高危青年的结果。 公共卫生相关性：该项目的总体目标是开发一种新的家庭友好型干预措施，帮助1型糖尿病代谢控制不良的青少年增加并维持每日自我监测血糖和降低HbA1c。这一点很重要，因为糟糕的新陈代谢控制会对健康产生长期影响。该项目将提供有关新的有效方法来改善控制不佳的1型糖尿病青少年的预后的重要信息。