Minding Goals: An Internet-Assisted Mind-Body Behavior Program for Blood Pressure Control

思维目标：用于血压控制的互联网辅助身心行为计划

• 批准号: 8892706
• 负责人: KATHLEEN M MCTIGUE
• 金额: $ 30.4万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-15 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8892706
• 关键词: 21 year old; Adult; Affect; Attention; Awareness; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body Weight decreased; Caring; Charge; Chronic Disease; Clinical; Clinical Trials; Counseling; Data; Diet; Eating; Education; Educational Intervention; Educational process of instructing; Effectiveness; Enrollment; Ensure; Feedback; Future; Goals; Health; Health Promotion; Hypertension; Hypotension; Internet; Intervention; Joints; Life Style; Measurement; Medicine; Meditation; Mental Health; Methods; Mind; Mind-Body Intervention; Mind-Body Method; Modeling; Nature; Office Visits; Online Systems; Outcome; Outcome Assessment; Participant; Patient Education; Patient Noncompliance; Patient-Centered Care; Patients; Pharmaceutical Preparations; Pharmacists; Physical activity; Population; Preparation; Primary Care Physician; Primary Health Care; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Recommendation; Risk; Risk Factors; Self Management; Sodium-Restricted Diet; Solutions; Son; Stress; Technology; Testing; Time; Training; Update; Weight; Weight maintenance regimen; arm; base; blood pressure reduction; blood pressure regulation; body-mind; cardiovascular risk factor; compliance behavior; design; diet and exercise; disorder risk; evidence base; health information technology; healthy lifestyle; improved; innovation; interest; medication compliance; meetings; mindfulness; mindfulness meditation; mindfulness-based stress reduction; patient oriented; physical conditioning; programs; public health relevance; stress management; tool; trial comparing; virtual

 DESCRIPTION (provided by applicant): Efficacious hypertension therapies are well-documented, yet 40% of treated patients do not meet the blood pressure goals set by the Joint National Committee. This gap between scientific evidence and clinical outcomes in part reflects low patient adherence to lifestyle recommendations (e.g., physical activity, weight and diet), as well as medication non-adherence. Accordingly, growing attention is focused on the need to provide patients with effective self-management support tools. In addition to finding ways to help patients adhere to currently prescribed hypertension care, it is useful to consider the range of treatment options that are offered. Evidence- based reviews have identified stress reduction as an effective tool for reducing blood pressure, yet such approaches are typically not implemented in practice. This omission represents a chance to improve the quality of hypertension care by adding stress management self-management tools. Furthermore, since patients have demonstrated a clear interest in mindfulness, the incorporation of a holistic mind-body intervention is an innovative approach to inherently patient-centered care. Increasing data supports the use of mindfulness for treating health concerns. Its holistic nature may be particularly well-suited to developing and maintaining healthy lifestyles, since lifestyle impacts diverse aspects of physical and psychological health. Yet the potential for mindfulness in health self-management has not been realized. Limited but promising data demonstrate the effectiveness of web-based counseling for behavior modification to improve common chronic disease risk factors. It is an ideal solution to provider time constraints and a potential solutionto patient non-adherence to lifestyle recommendations. Health information technology provides a way to make self-management support affordable, convenient and feasible. We have developed a convenient behavioral self-management support platform, "Goal-oriented Online Access to Lifestyle Support" (GOALS) for primary care patients, which has promoted weight loss and improved blood pressure control among primary care patients with weight-related cardiovascular risk factors. To maximize the ability of patients to achieve blood pressure goals, we propose to add an online mind-body-behavior program to GOALS: "Minding GOALS." We will evaluate the feasibility of using this program for self-management support in coordination with primary care, in a group of 76 patients with uncontrolled hypertension. In preparation for an RCT comparing the online tool to online traditional self-management support, we will assess implementation and determine 1) the availability of eligible and willing subjects using the proposed recruitment methods, 2) the feasibility of delivering the proposed interventions in the population of interest, and 3) the viability of our proposed measurement protocols. We will modify study protocols as needed, identifying and correcting problems, to strengthen the design of the future RCT and help ensure that it contributes meaningfully to the advancement of patient-centered hypertension self-management support.

 描述（由申请人提供）：有效的高血压疗法已有详细记录，但 40% 的治疗患者未达到国家联合委员会设定的血压目标。科学证据与临床结果之间的这种差距部分反映了患者对生活方式建议（例如体力活动、体重和饮食）的依从性较低，以及不依从药物治疗。因此，越来越多的注意力集中在为患者提供有效的自我管理支持工具的需要上。除了找到帮助患者坚持目前规定的高血压护理的方法之外，考虑提供的治疗选择范围也是有用的。基于证据的审查已确定减轻压力是降低血压的有效工具，但此类方法通常并未在实践中实施。这一遗漏代表了通过添加压力管理自我管理工具来提高高血压护理质量的机会。此外，由于患者对正念表现出明显的兴趣，因此结合整体身心干预是一种本质上以患者为中心的护理的创新方法。越来越多的数据支持使用正念来治疗健康问题。它的整体性可能特别适合发展和维持健康的生活方式，因为生活方式影响身体和心理健康的各个方面。然而，正念在健康自我管理中的潜力尚未实现。有限但有希望的数据证明了基于网络的行为矫正咨询对于改善常见慢性病危险因素的有效性。它是解决提供者时间限制的理想解决方案，也是解决患者不遵守生活方式建议的潜在解决方案。卫生信息技术提供了一种使自我管理支持负担得起、方便且可行的方法。我们为初级保健患者开发了便捷的行为自我管理支持平台“以目标为导向的在线生活方式支持”（GOALS），促进了具有体重相关心血管危险因素的初级保健患者的减肥并改善了血压控制。为了最大限度地提高患者实现血压目标的能力，我们建议在目标中添加在线身心行为计划：“Minding GOALS”。我们将评估在 76 名未受控制的高血压患者中使用该计划与初级保健相配合进行自我管理支持的可行性。在准备比较在线工具与在线传统自我管理支持的随机对照试验时，我们将评估实施情况并确定 1) 使用提议的招募方法是否有资格且愿意的受试者，2) 在感兴趣的人群中提供提议的干预措施的可行性，以及 3) 我们提议的测量方案的可行性。我们将根据需要修改研究方案，识别和纠正问题，以加强未来随机对照试验的设计，并帮助确保其对推进以患者为中心的高血压自我管理支持做出有意义的贡献。