Use of the Track Health Function of the MyHealtheVet Personal Health Record

MyHealtheVet 个人健康记录的追踪健康功能的使用

• 批准号: 8678394
• 负责人: JOSEPH SHARIT
• 金额: --
• 依托单位: MIAMI VA HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8678394
• 关键词: Abdomen; Accounting; Address; Adherence; Adopted; Adoption; Adult; Behavior; Belief; Blood Pressure; Body Weight decreased; Categories; Chronic Disease; Clinic; Clinical; Cognitive; Collection; Complement; Coupled; Data; Devices; Diabetes Mellitus; Diet; Dietary intake; Epidemiologic Studies; Exclusion Criteria; Exercise; Feedback; Food; Goals; Group Affiliation; Health; Healthcare; Height; Hour; Improve Access; Incentives; Individual; Instruction; Internet; Intervention; Intervention Studies; Intervention Trial; Interview; Journals; Lead; Life Style; Measurement; Measures; Metabolic; Motivation; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Outcome; Outcome Measure; Outpatients; Participant; Patients; Personal Health Records; Physical activity; Physiologic pulse; Physiological; Pilot Projects; Population; Prediabetes syndrome; Primary Health Care; Provider; Reading; Recruitment Activity; Regimen; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk Factors; Role; Sampling; Secure; Self Efficacy; Self Management; Structure; Suggestion; Surveys; System; Time; Training; Trust; United States; Veterans; Visit; Weight; Work; base; comparative effectiveness; compliance behavior; cost effective; design; diabetic; diabetic patient; diaries; effective intervention; effectiveness clinical trial; evidence base; fasting plasma glucose; good diet; health literacy; improved; inclusion criteria; innovation; instrument; literacy; mathematical ability; meetings; member; post intervention; programs; psychologic; research study; satisfaction; tool; usability

In the US, 26 million adults have either type 1 or type 2 diabetes (11% of the population), with Type 2 diabetes mellitus (T2DM) accounting for 90-95% of all cases. Additionally, 79 million individuals (35% of the adult population) have been estimated to have pre-diabetes. Epidemiologic studies suggest that 9 out of 10 cases of T2DM can be blamed on modifiable lifestyle behaviors that result in critical risk factors, with the major one being obesity. This pilot research study is intended to address the large and growing problem of diabetes, particularly among veterans, by examining the ability for systematic instruction on the use of the VA's MyHealtheVet (MHV) personal health record to better enable pre-diabetic obese veterans to adopt and adhere to more positive diet and physical activity. Specifically, veterans will receive instruction on the use of the track health function (THF) of MHV, which provides sophisticated interactive tools for maintaining food and activity journals and for entering and viewing measures of physiological health. Instruction will include how to concurrently track the lifestyle and physiological measures and how to infer cause-effect relationships. Study participants will also be instructed to use the secure messaging feature of MHV to regularly communicate with members of the research team in order to maintain participants' motivation in the program. A recent survey on veterans' use of MHV indicated that the THF has been mostly unused; thus its potential as a health self- management tool has been largely unexploited. In addition to the unique and powerful interactive features contained within MHV's track health functionality, the benefits of using MHV as a vehicle for instigating and promoting adherence to physical activity and diet lifestyle changes is believed to derive from its ability to address content and resources tailored to the needs of veterans, and thus elicit trust by this group through its in-group affiliation. The study goal is to recruit a sample of 100 obese pre-diabetic veterans attending primary care clinics at the Bruce W. Carter Miami VAMC. The inclusion criteria related to the pre-diabetes obesity criterion include HbA1C 5.7-6.4% and fasting plasma glucose 100-125 mg/dL (or oral glucose tolerance test 140-199 mg/dL; the exclusion criteria include currently following a weight loss diet or presence of diabetes mellitus. The intervention will be a single group, longitudinal, repeated measures design. Key outcome measures that will be obtained from participants at baseline and at three months include physical activity (measured with an accelerometer which will sample physical activity every minute for seven days), dietary intake, physical activity self-efficacy (exercise beliefs), diet self-efficacy (diet beliefs), intent to perform physical activity, and intent to adhere to diet. In addition, measures of health literacy, objective numeracy ability, and graphical literacy will be collected at baseline. During the baseline visit, blood pressure, pulse, weight, height, and abdominal circumference measurements will be obtained, and participants will also receive an accelerometer and instructions on its use. Participants will then return a week later, at which time the accelerometer data will be collected. They will receive a second two-hour training session on the THF of MHV, and then begin using MHV functions weekly as instructed, with secure messages sent weekly by the research team. At their three-month visit, participants will complete the post-intervention instruments and again receive an accelerometer, and will be asked to return the device a week later when the accelerometer data will be collected and an semi-structured exit interview will be conducted. This pilot research study is expected to demonstrate the utility of using the THF of MHV in terms of these participants' satisfaction in engaging with the THF, and in increasing their self-efficacy and intent to adhere to physical activity and diet, as well as their actual adherence to physical activity and diet. It is also expected to yield valuable data concerning the roles of numeracy ability, health and graphical literacy in the ability to use the THF effectively, as well as suggestions for redesigning this function to better meet the cognitive capabilities of a larger sample of users of MHV.

在美国，2600万成年人患有1型或2型糖尿病（占人口的11%），其中2型糖尿病 糖尿病（T2 DM）占所有病例的90-95%。此外，7900万人（35%的成年人） 据估计，这些人都患有糖尿病前期。流行病学研究表明，10例中有9例 T2 DM可归咎于可改变的生活方式行为，这些行为导致关键的风险因素，其中主要的风险因素是 肥胖症。这项试验性研究旨在解决糖尿病这一日益严重的问题， 特别是在退伍军人中，通过检查系统指导使用VA的能力， MyHealtheVet（MHV）个人健康记录，以更好地使糖尿病前期肥胖退伍军人采用和坚持 更积极的饮食和体育锻炼。具体来说，退伍军人将接受关于使用赛道的指导 MHV的健康功能（THF），它为维持食物和活动提供了复杂的互动工具 日志和输入和查看生理健康的措施。指导将包括如何 同时跟踪生活方式和生理措施，以及如何推断因果关系。研究 还将指导参与者使用MHV的安全消息传递功能，定期与 为了保持参与者在计划中的积极性，研究小组的成员。最近一项关于 退伍军人对MHV的使用表明，THF大部分未被使用;因此，它作为一种健康自我保护的潜力， 管理工具在很大程度上尚未开发。除了独特而强大的互动功能外， 包含在MHV的跟踪健康功能，使用MHV作为一种工具， 促进坚持体育活动和饮食生活方式的改变被认为是源于其能力， 解决内容和资源量身定制的退伍军人的需求，从而通过其 团体内的联系这项研究的目标是招募100名肥胖的糖尿病前期退伍军人参加小学 布鲁斯W的护理诊所。卡特迈阿密VAMC。纳入标准与糖尿病前期肥胖相关 标准包括HbA 1C 5.7-6.4%和空腹血糖100-125 mg/dL（或口服葡萄糖耐量试验 140-199 mg/dL;排除标准包括目前正在减肥饮食或存在糖尿病 糖尿病。干预将是单组、纵向、重复测量设计。关键成果 将在基线和三个月时从参与者中获得的测量结果包括身体活动 （用加速计测量，该加速计将在七天内每分钟对身体活动进行采样），饮食 摄入量，身体活动自我效能（锻炼信念），饮食自我效能（饮食信念），进行身体活动的意图 活动，并打算坚持饮食。此外，健康素养，客观计算能力， 将在基线时收集图形读写能力。在基线访视期间，测量血压、脉搏、体重、身高， 和腹围测量，参与者还将获得一个 加速度计及其使用说明。参与者将在一周后返回，届时， 将收集加速计数据。他们将接受第二次两小时的MHV THF培训， 然后开始按照指示每周使用MHV功能，研究人员每周发送安全消息 团队在为期三个月的访问中，参与者将完成干预后文书，并再次收到 一个加速度计，并将被要求返回设备一个星期后，当加速度计数据将 将进行半结构化离职面谈。这项试点研究预计将 证明使用MHV的THF在这些参与者参与的满意度方面的效用， THF，并提高他们的自我效能和坚持体力活动和饮食的意图，以及他们的 实际坚持体育活动和饮食。预计还将产生关于以下方面作用的宝贵数据： 计算能力，健康和图形素养的能力，有效地使用THF，以及建议 重新设计此功能，以更好地满足更大样本的MHV用户的认知能力。