Integrating Behavioral Economics and Self-Determination Theory to Advance Patient Engagement in Diabetes Prevention

整合行为经济学和自我决定理论，促进患者参与糖尿病预防

• 批准号: 10254315
• 负责人: JEFFREY KULLGREN
• 金额: $ 61.77万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254315
• 关键词: Address; Adult; Behavior; Behavioral; Caring; Chronic Disease; Collaborations; Consolidated Framework for Implementation Research; Control Groups; Data; Diabetes prevention; Effectiveness; Enrollment; Evidence based intervention; Glycosylated hemoglobin A; Health; Health Insurance; Health Promotion; Health system; Healthcare; Healthcare Systems; Incentives; Individual; Intervention; Interview; Lead; Link; Measures; Mediator of activation protein; Medicine; Metformin; Michigan; Modeling; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Participant; Patients; Prediabetes syndrome; Prevention; Prevention strategy; Program Evaluation; Randomized; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Rewards; Risk; Risk Factors; Role; Self Determination; Surveys; Testing; Time; Universities; Weight; Workplace; base; behavior change; behavioral economics; community organizations; compare effectiveness; diabetes prevention program; eHealth; effective intervention; evidence base; financial incentive; health care model; health plan; implementation framework; implementation intervention; incentive program; innovation; insight; insurance claims; novel; novel strategies; patient engagement; prevent; primary outcome; program costs; programs; screening; secondary outcome; tailored messaging; theories; waist circumference

The estimated 84 million US adults with prediabetes can significantly reduce their risk of developing type 2 diabetes mellitus (T2DM) by engaging in a Diabetes Prevention Program (DPP) or using metformin. Although these evidence-based interventions are widely available, few patients who would benefit use them. An opportune time to increase engagement of patients with prediabetes in strategies to prevent T2DM is after they are detected through a screening. One scalable and sustainable way to increase patient engagement after screenings would be to offer patients financial incentives for participating in a DPP or using metformin. Such financial incentives could be made more effective by integrating insights from behavioral economics with principles of self-determination theory (SDT). This integration could be achieved by adding to incentives automated tailored messages that link incentives and T2DM prevention to people's roles, values, and strengths. Our team of experts in T2DM prevention, behavioral economics, and SDT will conduct a 12-month pragmatic randomized controlled trial in which we will randomize 380 patients with prediabetes to 1 of 4 groups: (1) financial incentives plus tailored messages based on SDT principles; (2) financial incentives alone; (3) tailored messages based on SDT principles alone; or (4) an enhanced control group. Aim 1: Compare the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles in decreasing hemoglobin A1c, weight, and waist circumference and in increasing participation in a DPP or use of metformin. We will assess changes in the primary outcome of hemoglobin A1c and in secondary outcomes of weight and waist circumference at 6 and 12 months. We will use health insurance claims data to measure the secondary outcome of participation in a DPP or use of metformin. Aim 2: Identify mediators and moderators of the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. To measure these, we will survey participants at baseline, 6, and 12 months. Aim 3: Evaluate facilitators of and barriers to scalability, acceptability, and sustainability of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. We will interview patients, workplace health promotion staff, and health system staff to conduct a comprehensive evaluation of program implementation and sustainability using an integration of the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. If effective, this novel approach that leverages insights from behavioral economics and SDT could serve as a model for how health care systems and community organizations can partner to help at-risk patients prevent T2DM as well as modify other behavioral risk factors for chronic disease and poor health.

估计有8400万美国成年人患有前驱糖尿病，可以显著降低他们患2型糖尿病的风险。 通过参与糖尿病预防计划（DPP）或使用二甲双胍治疗糖尿病（T2 DM）。虽然 这些基于证据的干预措施是广泛可用的，很少有患者会受益于使用它们。一个 增加前驱糖尿病患者参与预防T2 DM策略的适当时机是在他们 都是通过筛选检测出来的一种可扩展和可持续的方式，以提高患者的参与度， 筛查将为患者提供参与DPP或使用二甲双胍的经济激励。等 通过将行为经济学的见解与 自决理论（SDT）。这种融合可以通过增加激励措施来实现 自动定制的信息，将激励措施和T2 DM预防与人们的角色、价值观和 长处.我们的T2 DM预防、行为经济学和SDT专家团队将进行为期12个月的 一项实用的随机对照试验，我们将380例糖尿病前期患者随机分为4组， 小组：（1）财政奖励加上基于特殊和差别待遇原则的专门信息;（2）仅财政奖励; (3)仅基于SDT原则的定制消息;或（4）增强的控制组。目标1：比较 财政激励措施的有效性，加上基于特殊和差别待遇原则、财政 基于SDT原则的奖励和定制信息，以降低血红蛋白A1 c，体重， 腰围和增加DPP或二甲双胍使用的参与。我们将评估 血红蛋白A1 c的主要结局以及体重和腰围的次要结局的变化 6个月和12个月时的周长。我们将使用健康保险索赔数据来衡量次要的 参与DPP或使用二甲双胍的结局。目标2：确定 财政激励措施的有效性，加上基于特殊和差别待遇原则、财政 激励措施和基于特殊和差别待遇原则的定制信息。为了衡量这些，我们将调查参与者 在基线、6个月和12个月时。目标3：评估可扩展性、可接受性和可扩展性的促进因素和障碍， 财政激励措施的可持续性，加上基于特殊和差别待遇原则、财政 激励措施和基于特殊和差别待遇原则的定制信息。我们会询问病人工作场所的健康状况 推广人员和卫生系统工作人员对方案实施情况进行全面评估 和可持续性，使用范围，有效性，采用，实施和 实施研究框架的维护和综合框架。如果有效，这部小说 一种利用行为经济学和SDT的见解的方法可以作为一种模式， 护理系统和社区组织可以合作帮助高危患者预防T2 DM， 其他慢性病和健康不良的行为风险因素。