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 有规律的体育锻炼和健康的饮食。这是一个重大的公共卫生问题，因为心脏病是 在美国是主要的死因，但在许多情况下，可以通过更多地参与这些 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 有几个限制。首先，它们昂贵、密集，而且只有相对较少的病人参加(特别是低度病人 少数群体的出席率)。此外，这些课程没有包括积极心理学(PP) 活动，促进与健康行为独立相关的结构(例如，积极的情感) 和更好的心脏健康。最后，它们不是为满足患者的个人偏好和需求而设计的。 短信干预(TMI)可能会解决现有计划的许多缺点。TMIS 是简单、低负担、可定制和高度可访问的，到目前为止，它们在 促进健康行为。简单的PP活动非常适合TMI，而TMI同时提供PP和 健康行为信息可能是改善健康和降低心脏风险的有力途径，因为 心理-行为联合干预似乎比任何一种单独的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 一组固定的消息，一个为每个人深度个性化的灵活程序可以极大地 提高参与度和影响力。我们开发了一种新的自适应TMI，它提供PP和健康 英文和西班牙文的行为短信。根据参与者的遵从性差距和有关 作为先前消息的效用，该程序使用动态的、特定于患者的算法来选择新消息 通过多个特定于消息的属性(例如，PP与关注健康行为)。随着时间的推移，自适应TMI 越来越多地提供与个人特定偏好和需求相匹配的信息内容。 与PA-18-389专注于自我管理的移动健康干预措施一致，我们建议 该自适应12周TMI的随机试点试验(利用来自自适应算法的每日文本消息， 每周两次以目标为重点的消息，以及两次简短的电话签到以提供支持)，以及提供 计步器。TMI将与60例有2+的患者的增强型常规护理(单独使用计步器)进行比较 心脏危险状况(高血压、2型糖尿病、高脂血症)和次佳体力活动以及 节食。R21试验的主要结果是可行性和可接受性，通过短信发送率来衡量 反馈和参与者对消息效用的评分。作为一个关键的次要目标，我们将在组内进行比较 12周和24周时心理、行为和健康相关结果改善的差异。如果 干预是可行的，被广泛接受，并对临床相关结果有希望的效果，我们将 进行一项更大规模的下一步试验，以评估TMI对依从性和心脏病发生的影响。