Interactive Web Program and Health Coaching for Prehypertensive Adults

针对高血压前期成人的互动网络计划和健康指导

• 批准号: 8527534
• 负责人: AMELIA J BIRNEY
• 金额: $ 40.24万
• 依托单位: OREGON CENTER FOR APPLIED SCIENCE, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8527534
• 关键词: Administrator; Adult; Alcohol consumption; American; Antihypertensive Agents; Attitude; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body Weight decreased; Cardiovascular system; Caring; Charge; Computerized Medical Record; Consumption; DASH diet; Data; Databases; Detection; Development; Diastolic blood pressure; Disease; Disease Management; Eating; Electronic Mail; Elements; Evaluation; Evidence based program; Feedback; Financial cost; Goals; Health; Health Benefit; Health Personnel; Health behavior; Healthcare; Heart; Heart Diseases; Hypertension; Hypotension; Incidence; Insurance; Insurance Carriers; Intake; Intention; Internet; Intervention; Joints; Knowledge; Letters; Licensing; Life Style; Link; Maintenance; Marketing; Mediating; Medical; Medical Electronics; Modeling; Motivation; Myocardial Infarction; Myocardial Ischemia; Outcome Measure; Participant; Patients; Pharmaceutical Preparations; Phase; Phase II Clinical Trials; Physical activity; Planning Theory; Positioning Attribute; Preparation; Prevalence; Prevention; Process; Provider; Readiness; Recruitment Activity; Reporting; Research; Resources; Risk Behaviors; Schedule; Self Assessment; Self Blood Pressure Monitoring; Self Efficacy; Self Management; Services; Sodium; Stroke; System; TimeLine; Visit; base; behavior change; cost; design; evidence base; falls; follow-up; fruits and vegetables; health care delivery; high risk; innovation; interactive multimedia; interest; intervention program; middle age; motivated behavior; motivational enhancement therapy; peer; prevent; programs; prototype; randomized trial; satisfaction; social cognitive theory; therapy design; tool; usability; web site; web-based social networking

DESCRIPTION (provided by applicant): Approximately a third (31%) of adult Americans are prehypertensive (SBP 120-139 and/or DBP 80-89). Health care providers struggle to provide effective support for blood-pressure-lowering behavior changes, while patients continue to progress to full hypertension and the use of antihypertensive medications. Insurers and providers with access to electronic medical records and other medical data are in a unique position to identify prehypertensive adults and target them with a blood pressure self-management program. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and, more importantly, long-term costs of care for heart disease and stroke. This project will develop and evaluate a coach-guided, interactive blood pressure self-management program for adults with prehypertension. The program will target blood pressure self-monitoring and the five proven lifestyle modifications recommended by JNC-7: weight reduction, the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity, and alcohol consumption. The multi-modal program uses a combination of brief motivational health coaching, periodic engagement emails, and a robust interactive website to motivate people to take charge of their blood pressure management before they require medication. All program components were designed to conform to the underlying principles of motivational interviewing. Key program components include the use of email and Web-based social networking, personal stories, and brief motivational coaching sessions to engage participants and encourage intrinsically motivated behavior changes. Self-assessment and tracking tools are combined with educational content to help participants align their daily lifestyle choices with their personal goals. The Phase I prototype program promoted moderate physical activity and eating fruits and vegetables as part of the DASH diet. Results from the within-group (n = 39) evaluation showed moderate-to-large effect sizes for pre-to-post change in motivation, preparation behavior, self-efficacy, attitudes, and knowledge, and a small significant increase in physical activity. Participants gave the online program high ratings on satisfaction and usability, and reported improvements in confidence, readiness, clarity, change strategies, and interest in visiting the Website as a result of the coaching session. The fully developed Phase II product will be evaluated in a large randomized trial (N = 450) with a 3-month intensive period, a 3-month maintenance period, and a 3-month follow-up period. The Phase II trial is expected to show improvements in JNC-recommended BP-lowering health behaviors. These changes in the outcome measures are expected to be mediated by changes in knowledge, attitudes, self-efficacy, behavioral intention, motivation, and patient activation. The Phase II product will be marketed to large, integrated health benefits providers with both insurance and wellness products, like our Phase II evaluation partner Aetna, and to integrated health service delivery systems, like our Phase I and II evaluation partner, Providence Health.

描述（由申请人提供）：大约三分之一（31%）的美国成年人患有高血压前期（SBP 120-139和/或DBP 80-89）。卫生保健提供者努力为降低血压的行为改变提供有效的支持，而患者继续发展为完全高血压和使用抗高血压药物。能够访问电子病历和其他医疗数据的保险公司和供应商在识别高血压前期成年人并针对他们实施血压自我管理计划方面处于独特的地位。预防或延缓高血压应该减少抗高血压药物的中期费用，更重要的是，减少心脏病和中风的长期护理费用。该项目将开发和评估一个教练指导的，互动的血压自我管理计划的成年人与高血压前期。该计划将针对血压自我监测和JNC-7推荐的五种经过验证的生活方式改变：减轻体重，停止高血压的饮食方法（DASH）饮食，减少钠，体育活动和饮酒。多模式计划使用简短的激励性健康指导，定期参与电子邮件和强大的互动网站的组合，以激励人们在需要药物治疗之前负责他们的血压管理。所有的程序组件的设计符合动机面试的基本原则。关键的计划组成部分包括使用电子邮件和基于Web的社交网络，个人故事和简短的激励教练课程，以吸引参与者，并鼓励内在动机的行为改变。自我评估和跟踪工具与教育内容相结合，以帮助参与者将他们的日常生活方式选择与他们的个人目标相结合。第一阶段的原型计划促进适度的身体活动，并将水果和蔬菜作为DASH饮食的一部分。组内（n = 39）评价结果显示，从动机，准备行为，自我效能，态度和知识的前到后的变化，以及体力活动的小的显着增加的中到大的效果大小。参与者对在线计划的满意度和可用性给予了很高的评价，并报告了信心，准备，清晰度，变革策略以及访问网站的兴趣的改善。将在一项大型随机试验（N = 450）中对完全开发的II期产品进行评价，该试验包括3个月强化期、3个月维持期和3个月随访期。II期试验预计将显示JNC推荐的降血压健康行为的改善。这些变化的结果措施，预计将介导的知识，态度，自我效能，行为意图，动机和患者激活的变化。第二阶段的产品将销售给大型综合健康福利提供商，包括保险和健康产品，如我们的第二阶段评估合作伙伴安泰，以及综合健康服务提供系统，如我们的第一阶段和第二阶段评估合作伙伴普罗维登斯健康。