Financial Incentives and SMS to Improve African American Women's Glycemic Contro

项目总结（见说明）： 在洛杉矶县社区诊所接受治疗的血糖控制不足（A1 c>8%）的非裔美国糖尿病女性中，我们建议评估干预措施的影响，该干预措施通过结合面对面、电话和短信联系来识别和支持改善糖尿病控制的内在动机，并且对于研究的一个分支，一种行为经济学干预，使用金钱激励来奖励改善血糖控制。随机对照试验（RCT）是一项多因素干预措施，旨在增强改善血糖控制的内在动机，将参与临床的患者随机分为三组：1）家庭护理（“对照”条件），2） 干预，以提高内在动机，降低A1 c通过亲自访问，电话，和定制 通过手机发送的文本消息（“IM/SMS”条件），以及3）添加定期 货币激励，其大小取决于A1 c的降低程度，以及彩票参与， 提高参与糖尿病自我护理的动机，并达到A1 c目标（“IM/SMS+激励”条件）。 我们将评估IM/SMS和IM/SMS+激励干预对血糖控制的影响， 并确定与对照组相比，Ale的改善是否持续6个月 在SMS和货币奖励停止后的额外几个月。我们还将评估 干预措施及其对资源利用的影响。 主要研究结果是A1 c的变化。为了深入了解可能的机制， 干预，我们还将评估干预对自我管理行为，患者 激活，药物治疗方案的变化，医生就诊次数，体重，生活质量，对 卫生保健系统，参与者自我报告的干预经验，以及 干预血压控制。 我们假设，与对照组相比，IM/SMS或IM/SMS+激励组的女性 A1 c水平较低（更有可能达到7.0%的A1 c目标），而 干预措施到位后6个月，定期联系和货币奖励停止。 我们还假设IM/SMS+激励组在12个月时的血糖控制将优于 IM/SMS组，但在干预停止后6个月类似。

PROJECT SUMMARY (See instructions): Among African American women with diabetes who have inadequate glycemic control (A1c>8%) who receive care in community clinics in Los Angeles County, we propose to evaluate the impact of an intervention that identifies and supports intrinsic motivation for improved diabetes control through combined in-person, phone, and SMS contact and also, for one arm of the study, a behavioral economics intervention that uses monetary incentives to reward improved glycemic control. The randomized controlled trial (RCT), a multicomponent intervention to boost intrinsic motivation for improved glycemic control will randomize patients within participating clinics to one of three groups; 1) Usual care (("Control" condition), 2) An intervention to boost intrinsic motivation to lower A1c through in-person visits, telephone calls, and tailored text messages delivered by cell phone ("IM/SMS" condition), and 3) An intervention that adds periodic monetary incentives, whose size depends on the degree of reduction in A1c, and lottery participation to boost motivation to participate in diabetes self care and reach A1c goals ("IM/SMS+lncentives" condition). We will assess the effect ofthe IM/SMS and IM/SMS+lncentives interventions on glycemic control over a 12 month period and determine whether improvements in Ale compared to the control arm are sustained for 6 additional months after the SMS and monetary incentives are discontinued. We will also assess the costs of the interventions and their effect on resource use. The primary study outcome is change in A1c. To gain insights into possible mechanisms forthe impact ofthe intervention, we will also assess the effects of the intervention on self-management behaviors, patient activation, changes in medication regimens, number of physician visits, weight, quality of life, trust in the health care system, participants' self-reported experiences with the intervention, and spillover effects ofthe intervention on blood pressure control. We hypothesize that, compared with the control group, women in the IM/SMS or the IM/SMS+incentive arms will have lower A1c levels (and will be more likely to achieve the target A1c of 7.0%), both while the interventions are in place and 6 months after the regular contact and monetary incentives are discontinued. We also hypothesize that glycemic control will be better at 12 months forthe IM/SMS+lncentive group than the IM/SMS group, but will be similar 6 months after the interventions are discontinued.