Leveraging mHealth Messaging to Promote Adherence, Capability, and Motivation in Teens with CKD

项目总结/摘要 高血压是慢性肾脏病（CKD）进展的危险因素，但只有77%的青少年患有高血压。 尽管有证据表明坚持服用降压药可减缓疾病进展，但CKD仍坚持服用降压药。 移动的健康（mHealth）应用程序显示出提高依从性的希望，但大多数应用程序并不是在 健康促进框架，只发送药物提醒，使用不可靠的结果措施，和/或 对坚持的影响很小。不依从是一个公共卫生问题， 沟通策略，超越提醒，提高mHealth的功效。高效健康 信息修改感知、态度和技能，以促进行为改变;不适当的框架 消息（例如，使用恐惧呼吁）可能对健康行为产生意想不到的负面影响（即，减少 坚持）。对于患有CKD的青少年，构建移动健康信息以激励持续的依从性可能是 预防疾病进展的关键因素;然而，很少有实证研究来指导使用 这种方法。COM-B模型指出，能力、机会和动机相互作用地影响健康 行为，包括坚持。我们对128名CKD青少年的初步数据显示， 和依从性与抗高血压药物的依从性有关。mHealth提醒可以 概念化为坚持的机会。为了传播更有效的移动健康信息， 研究是必要的。因此，我们建议（1）制定移动健康信息，以纳入有效的框架 战略和目标能力，机会和动机，坚持通过迭代过程， 初步评价CKD青少年（N=10）和儿科肾病学家（N=7）的信息，（2） 使用一项在CKD青少年（年龄11-21岁; N=40）中开展的初步随机对照试验（RCT）， 我们的COM-B信息干预与仅通过以下方式接收药物提醒的主动对照组相比 现有的移动健康应用程序，以及（3）定性评估青少年使用我们的COM-B的体验 研究后访谈中的信息（N=20），以完善疗效试验的信息。我们希望我们的通信B 信息将被≥85%的青少年评定为有效、可接受、适当和可理解， 对于儿科肾病学家，干预组将具有更高的随机化后依从性和能力， 坚持的动机比积极控制组，并且，<10%的青少年在干预组将报告 这些信息降低了他们服药的欲望探索性时间序列分析将调查 干预组在随机化后依从性的改善速度是否比 积极的控制组。这项研究的结果可能会提高我们有效构建移动健康信息的能力 有助于长期改善CKD青少年的药物依从性， 患有其他慢性疾病，需要每日服药的儿童。如果我们的信息干预有更大的效果， 在依从性方面优于活性对照条件，将保证进行充分把握度的疗效试验。

PROJECT SUMMARY/ABSTRACT Hypertension is a risk factor for chronic kidney disease (CKD) progression but only 77% of adolescents with CKD are adherent to antihypertensive medications despite evidence that adherence slows disease progression. Mobile health (mHealth) applications show promise for improving adherence but most are not designed within health-promotion frameworks, only send medication reminders, use unreliable outcome measures, and/or have small effects on adherence. Nonadherence is a public health problem that may benefit from using health communication strategies to advance beyond reminders and improve mHealth efficacy. Highly effective health messages modify perceptions, attitudes, and skills to facilitate behavioral change; inappropriately framed messages (e.g., use of fear appeals) may have unintended, negative effects on health behaviors (i.e., reduce adherence). For adolescents with CKD, framing mHealth messages to motivate sustained adherence may be a key factor in preventing disease progression; however, there has been little empirical study to guide the use of this approach. The COM-B model states that capability, opportunity, and motivation interactively modify health behaviors, including adherence. Our preliminary data with 128 adolescents with CKD showed that motivation and capability to adhere are associated with antihypertensive medication adherence. mHealth reminders can be conceptualized as adherence opportunities. To disseminate more efficacious mHealth messages, formative research is needed. Hence, we propose (1) formulating mHealth messages to incorporate effective framing strategies and to target capability, opportunity, and motivation to adhere through an iterative process and preliminarily evaluating the messages with adolescents with CKD (N=10) and pediatric nephrologists (N=7), (2) using a pilot randomized controlled trial (RCT) with adolescents with CKD (ages 11-21 years; N=40) to evaluate our COM-B message intervention versus an active control group that only receives medication reminders through an existing mHealth application, and (3) qualitatively assessing adolescents' experiences with our COM-B messages in post-study interviews (N=20) to refine messages for an efficacy trial. We expect that our COM-B messages will be rated as efficacious, acceptable, appropriate, and understandable by ≥85% of adolescents and pediatric nephrologists, the intervention group will have higher post-randomization adherence and capability and motivation to adhere than the active control group, and, <10% of adolescents in the intervention group will report that the messages reduced their desire to take their medication. Exploratory time series analyses will investigate whether the intervention group exhibits a faster rate of improvement in adherence post-randomization compared to the active control group. Results of this study may improve our ability to efficaciously frame mHealth messages that facilitate long-term improvements in medication adherence for adolescents with CKD and, potentially, children with other chronic illnesses requiring daily medications. If our messaging intervention has greater effects on adherence than the active control condition, a fully-powered efficacy trial would be warranted.