A sensor-controlled digital game-based approach to improve self-care behaviors among adults diagnosed with hypertension in a Native American community

项目总结/摘要 心血管疾病是美洲原住民（NAs）的主要死因。伦比部落 北卡罗来纳州罗伯逊县的一个社区患有与心血管疾病相关的严重差异， 发病率和死亡率。高血压（HTN）严重增加了与高血压相关的发病率和死亡率 to cardiovascular心血管disease疾病.美国HTN指南提倡的生活方式改变包括可改变的自我- 护理行为，如与降低血压相关的定期体力活动，减少 心血管风险和有益的心脏结构重塑。因此，激励身体活动 行为将是NA Lumbee部落社区心血管健康促进工作的关键。 一种有前途的方法是使用传感器控制的数字游戏（SCDG），它提供负担得起的， 便携式，可扩展的工具，以促进参与HTN自我护理行为，同时是愉快的， 容易使用. SCDG干预整合了HTN参与者的行为数据， 传感器来激活游戏进度、奖励和反馈。这项研究的主要目的是测试一个文化 适应性SCDG干预（N-SCDG）改善Lumbee患者日常体力活动自我护理行为 与HTN的部落成年人，并检查维持N-SCDG在社区的影响的方法 水平对于目标1，我们将使用基于社区的参与式方法，在文化上调整SCDG干预措施 我们已经为移动的智能手机开发了一种方法， 在患有HTN的NA成年人中的行为。对于目标2，使用随机对照临床试验，我们将比较 N-SCDG干预与仅传感器控制的HTN自我参与的主要结局， 体力活动的护理行为和HTN自我护理知识，自我护理的次要结果 行为、自我效能、收缩压和舒张压、心脏病住院和生活质量 基线和3个月和6个月时。对于我们的样本，我们将从部落招募18岁或以上的成年人， 在罗伯逊县的附属心脏诊所我们将220名受试者随机分配至N-SCDG组 干预组，参与者将收到跟踪身体活动的传感器，并将播放N- 移动的智能手机上的SCDG，或将接收传感器的控制组，一个跟踪物理 活动和标准化的HTN书面教材。就目标3而言，我们会评估 N-SCDG通过与研究参与者的定性访谈在Lumbee部落社区进行干预， 社区领导人和培训Lumbee社区成员，以维持和传播N-SCDG * 采取干预措施，建设社区管理高血压和营养不良的能力。该项目将产生洞察力， 指导可扩展和易于使用的数字游戏解决方案，以激励HTN自我保健行为， 改善患有HTN的NA个体的健康结果。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease is the leading cause of death among Native Americans (NAs). The Lumbee tribal community in Robeson county in North Carolina suffer from severe disparities related to cardiovascular disease incidence and mortality. Hypertension (HTN) strongly elevates the morbidity and mortality risks related to cardiovascular disease. Lifestyle modifications promoted by U.S. HTN guidelines includes modifiable self- care behaviors such as regular physical activity which is associated with lower blood pressure, reduced cardiovascular risk, and beneficial cardiac structural remodeling. Therefore, motivating physical activity behaviors would be key to cardiovascular health promotion efforts among the NA Lumbee tribal community. One promising approach is the use of sensor-controlled digital games (SCDGs), which offer affordable, portable, and scalable tools to facilitate engagement in HTN self-care behaviors while being enjoyable and easy to use. The SCDG intervention integrates HTN participants’ behavioral data from an activity tracker sensor to activate game progress, rewards, and feedback. The primary goal of this study is to test a culturally adapted SCDG intervention (N-SCDG) for improving daily physical activity self-care behaviors among Lumbee tribal adults with HTN and examine approaches for sustaining the impact of the N-SCDG at the community level. For Aim 1, we will use community based participatory approach to culturally adapt a SCDG intervention that we have already developed for mobile smartphones to motivate sustained physical activity self-care behaviors among NA adults with HTN. For Aim 2, using a randomized controlled clinical trial, we will compare the N-SCDG intervention versus a sensor-only control for the primary outcome of engagement in the HTN self- care behavior of physical activity and the secondary outcomes of HTN self-care knowledge, self-care behaviors, self-efficacy, systolic and diastolic blood pressure, cardiac hospitalization, and quality of life at baseline and at 3 and 6 months. For our sample, we will recruit adults aged 18 years or older from tribal affiliated cardiac clinics in Robeson county. We will randomize 220 participants to either the N-SCDG intervention group, in which participants will receive sensors that track physical activity and will play the N- SCDG on a mobile smartphone, or a control group that will receive sensors, an app that tracks physical activity, and standardized written HTN educational materials. For Aim 3, we will evaluate the sustainability of N-SCDG intervention in the Lumbee tribal community through qualitative interviews with study participants and community leaders and train Lumbee community members to sustain and disseminate the N-SCDG intervention for building community capacity for HTN management. This project will generate insight and guidance for scalable and easy-to-use digital gaming solutions to motivate HTN self-care behaviors and improve health outcomes among NA individuals with HTN.