An adaptive personalized text message intervention for cardiac prevention

用于心脏预防的自适应个性化短信干预

• 批准号: 9979221
• 负责人: Jeff C Huffman
• 金额: $ 25.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-08 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979221
• 关键词: Adaptive Behaviors; Address; Adherence; Affect; Algorithms; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Cardiac; Cardiac health; Caring; Cause of Death; Consumption; Data; Development; Devices; Diet; Event; Feedback; Goals; Habits; Health; Health Promotion; Health Psychology; Health Technology; Health behavior; Health education; Healthy Eating; Heart Diseases; Heart Rate; Hyperlipidemia; Hypertension; Individual; Intervention; Link; Lipids; Measures; Mental Health; Minority; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Measure; Participant; Patients; Personal Satisfaction; Persons; Physical Function; Physical activity; Population; Prevention; Protocols documentation; Psychology; Public Health; Randomized; Reporting; Risk; Risk Factors; Self Management; Source; Strategic Planning; System; Technology; Telephone; Testing; Text Messaging; Theoretical model; Time; United States; Weight; Well in self; Wireless Technology; base; behavior change; behavioral health; behavioral outcome; clinically relevant; compliance behavior; cost; exercise capacity; flexibility; good diet; health difference; health goals; health management; heart disease risk; high risk; improved; indexing; individual patient; innovative technologies; intervention effect; learning algorithm; mHealth; mobile application; mortality; novel; optimism; patient oriented; personalized approach; personalized care; pilot trial; preference; prevent; primary outcome; programs; prospective; psychologic; psychological outcomes; randomized trial; success; tailored messaging; tool; treatment as usual

The majority of patients at risk for heart disease are unable to adhere to key health behaviors, including regular physical activity and healthy eating. This is a major public health problem, as heart disease is the leading cause of death in the U.S., yet could be prevented in many cases through greater participation in these behaviors. Existing programs to promote health behaviors and prevent heart disease can be effective but have several limitations. First, they are costly, intensive, and attended by relatively few patients (with especially low attendance among minorities). In addition, these programs have not included positive psychology (PP) activities, which promote constructs (e.g., positive affect) that are independently linked to healthy behaviors and superior cardiac health. Finally, they are not designed to meet patients’ individual preferences and needs. Text message interventions (TMIs) may address many of the shortcomings of existing programs. TMIs are simple, low-burden, customizable, and highly accessible, and they have thus far shown promise in promoting health behaviors. Simple PP activities are well-suited to TMIs, and a TMI delivering both PP and health behavior messages could be a powerful approach to improving health and reducing cardiac risk, as combined psychological-behavioral interventions appear to have greater effects than either approach alone. A TMI that utilizes an adaptive algorithm to choose messages could be highly effective. As opposed to a single fixed set of messages, a flexible program that is deeply personalized for each individual could greatly improve engagement and impact. We have developed a novel adaptive TMI that delivers PP and health behavior text messages in English and Spanish. Based on a participant’s adherence gaps and feedback about the utility of prior messages, the program uses a dynamic, patient-specific algorithm to select new messages via multiple message-specific attributes (e.g., PP vs. health behavior-focused). Over time, the adaptive TMI increasingly delivers message content that matches the individual’s specific preferences and needs. Consistent with PA-18-389 focused on mHealth interventions for self-management, we propose a randomized pilot trial of this adaptive 12-week TMI (with daily text messages from the adaptive algorithm, twice-weekly goal-focused messages, and two brief phone check-ins to provide support) plus provision of a step counter. The TMI will be compared to enhanced usual care (step counter alone) in 60 patients with 2+ cardiac risk conditions (hypertension, type 2 diabetes, hyperlipidemia) and suboptimal physical activity and diet. The primary outcome of this R21 trial is feasibility and acceptability, measured via rates of text message feedback and participants’ ratings of message utility. As a key secondary aim, we will compare between-group differences in improvements in psychological, behavioral, and health-related outcomes at 12 and 24 weeks. If the intervention is feasible, well-accepted, and has promising effects on clinically relevant outcomes, we will conduct a larger next-step trial to assess the TMI’s impact on adherence and heart disease development.

大多数有心脏病风险的患者无法坚持关键的健康行为，包括 规律的身体活动和健康的饮食。这是一个重大的公共卫生问题，因为心脏病是 是美国的头号死因然而，在许多情况下，通过更多地参与这些活动， 行为。现有的促进健康行为和预防心脏病的计划可能是有效的，但 几个限制。首先，它们是昂贵的，密集的，并且由相对较少的患者参加（特别是低 少数民族）。此外，这些方案还没有包括积极心理学（PP） 活动，促进构建（例如，积极的影响）与健康行为独立相关 和上级心脏健康。最后，它们不是为了满足患者的个人偏好和需求而设计的。 短信干预（TMI）可以解决现有方案的许多缺点。TMIs 简单、低负担、可定制、高度可访问，迄今为止，它们在以下方面表现出了希望： 促进健康行为。简单的PP活动非常适合TMI，而TMI既提供PP， 健康行为信息可能是改善健康和降低心脏病风险的有力方法， 心理-行为综合干预似乎比单独采取任何一种方法都有更大的效果。 利用自适应算法选择消息的TMI可能非常有效。而不是 一个单一的固定的信息集，一个灵活的程序，是深刻的个性化为每个人可以大大 改善参与和影响。我们已经开发出一种新的自适应TMI， 英语和西班牙语的行为短信。根据参与者的依从性差距和反馈， 先前消息的效用，该程序使用动态的患者特定算法来选择新消息 经由多个消息特定属性（例如，PP vs.以健康行为为中心）。随着时间的推移，自适应TMI 越来越多地提供符合个人特定偏好和需求的信息内容。 与PA-18-389一致，我们提出了一个针对自我管理的移动健康干预措施， 该适应性12周TMI的随机试验（每天从适应性算法发送文本消息， 每周两次以目标为重点的信息，两次简短的电话登记以提供支持），并提供 步进计数器将在60例2+患者中比较TMI与增强型常规护理（单独使用计步器） 心脏风险状况（高血压、2型糖尿病、高脂血症）和次优体力活动， 饮食.这项R21试验的主要结果是可行性和可接受性，通过短信率来衡量。 反馈和参与者对信息效用的评价。作为一个关键的次要目的，我们将比较组间 第12周和第24周时心理、行为和健康相关结局改善的差异。如果 干预是可行的，被广泛接受的，并对临床相关结果有很好的影响，我们将 进行更大规模的下一步试验，以评估TMI对依从性和心脏病发展的影响。