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1型糖尿病是一种与高经济成本和死亡率增加相关的重要医学疾病，其发病率正在增加。不幸的是，青少年对自我血糖监测（SMBG）建议的依从性较差，代谢控制也不如成年人。虽然一些以个人和家庭为基础的干预措施已显示出改善代谢控制的前景，但迫切需要制定更有效的干预措施。总的目标是 DP 3项目旨在开发一种新的创新干预措施，旨在帮助糖尿病代谢控制不良的青少年增加SMBG的频率并改善HbA 1c。目标人群为13-17岁的1型糖尿病和HbA 1c> 8%的青少年。基于我们以前的工作和概念模型，拟议的研究将开发和试点测试一种新的，多方面的，发展适当的干预措施，旨在改善青少年的决策。一套综合的组成部分针对青少年对经常性的积极反馈、改善未来定位和激励支持的需要。虽然过去的研究表明，行为干预往往是更成功的，当他们包括多个元素，没有以前的干预措施结合了多个基于实践的组件，目标是在一个干预的关键决策杠杆。这种新的干预，称为MAxIM（动机，激励，记忆）用途：1）动机增强疗法（MET）（针对青少年糖尿病患者的现有循证治疗）辅以认知行为疗法（CBT）以促进行为改变; 2）对每日血糖检测和父母监测进行经济激励，以提供频繁的积极反馈; 3）工作记忆训练（WMT），一种强化特定认知过程以支持决策和未来定向的有效方法。干预措施将通过互联网提供给家庭，以增加干预措施对远离治疗内分泌学家的家庭的影响。MAxIM将是青少年和家长友好的，旨在增加参与和遵守干预。主要假设是MAxIM将：（1）帮助青少年改善和维持血糖控制，（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不良决策的多种基本机制来提高依从性。该项目将开发一种新型的、高度便携的、基于家庭的干预措施，旨在最大限度地降低和维持青少年的HbA 1c和SMBG频率。创新包括针对青少年决策的多个杠杆，使用技术在家中向家庭提供干预，以及测试青少年糖尿病治疗结果的认知预测因素。成功实现这项研究的目标将使该领域更接近一个具有成本效益的，持久的干预措施，以改善这些高风险青年的结果。 公共卫生关系：该项目的总体目标是开发一种新型的家庭友好干预措施，帮助1型糖尿病代谢控制不良的青少年增加和维持每日自我血糖监测和降低HbA 1c。这一点很重要，因为代谢控制不良会对健康产生长期影响。该项目将提供有关改善控制不良的1型糖尿病青少年结局的新有效方法的重要信息。