Behavioral Economics for Activity Motivation in Adolescents and Young Adults with Prediabetes and Type 2 Diabetes

项目总结/摘要 肥胖的青少年和年轻成人（AYA）与2型糖尿病（T2 D）相比， 糖尿病同龄人，尽管身体活动的许多疾病相关的好处。因为面对面的身体活动 针对肥胖AYA的干预措施实施起来具有挑战性，并且具有高流失率，因此迫切需要 设计有针对性的身体活动干预措施，对患有糖尿病前期的肥胖AYA有效且可扩展 和T2 D。根据NIDDK的优先事项，拟议研究的长期目标是开发一种 干预措施，降低糖尿病前期和T2 D青年的疾病进展风险。申请人将 充分利用费城儿童医院和大学丰富的科学环境 宾夕法尼亚州实现她的研究和培训目标，由专家多学科导师的支持 咨询团队。这个K23将支持PI在混合方法研究，行为经济学， 移动健康，身体活动干预，生物行为临床试验设计和分析。的目标 拟议的研究是开发一种有效的移动的健康（mHealth）干预措施， 在患有糖尿病前期或T2 D的AYA中进行剧烈的体力活动（MVPA），利用行为 经济学和利用一个高效的框架来确定有效的干预措施。要求1 将确定参与日常MVPA的态度、信念和规范，以及障碍和促进因素 通过对患有糖尿病前期或T2 D的AYA进行半结构化访谈。在目标2中，以理论为基础， 将通过调整遵守情况来开发用于促进MVPA的医疗信息短信- 推广PI导师开发的短信银行，与患者利益相关者一起使用焦点小组， 目标1的见解。目标3将确定有效增加MVPA的干预组件设置， 将包括一项为期12周的析因试验（活动动机的行为经济学），包括4个干预部分 针对MVPA的理论中介：1）针对计划行为理论概念的短信， 态度和规范，与简单的提醒; 2）斜升与固定步数目标，目标感知 行为控制; 3）预先分配的财务激励和未实现目标的损失与获得的目标损失 厌恶;以及4）每日与每周目标，以双曲线贴现为目标（偏好较小-较早超过 更大的奖励）。主要结局是MVPA的变化。次要结局包括步数/天， 达到60分钟MVPA/天的比例、体重指数、血红蛋白A1 c以及空腹胰岛素和血脂。 PI和导师假设有效的组件设置将包括短信定位 态度/规范、倾斜目标、损失框架激励和日常目标。通过这个K23，PI将准备 成功竞争R 01级资金，进行优化干预的随机对照试验， 帮助她开始了自己的职业生涯，成为一名独立的医学科学家，在健康行为改变方面拥有专业知识， 患有糖尿病前期和T2 D的AYA。

Project Summary/Abstract Obese adolescents and young adults (AYA) with type 2 diabetes (T2D) are significantly less active than non- diabetic peers, despite the many disease-related benefits of physical activity. Because in-person physical activity interventions for obese AYA are challenging to implement and have high attrition rates, there is an urgent need to engineer targeted physical activity interventions that are effective and scalable for obese AYA with prediabetes and T2D. Aligned with NIDDK priorities, the long-term objective of the proposed research is to develop an intervention that reduces the risk of disease progression in youth with prediabetes and T2D. The applicant will take full advantage of the rich scientific environment of the Children’s Hospital of Philadelphia and University of Pennsylvania to achieve her research and training goals, supported by an expert multidisciplinary mentorship and advisory team. This K23 will support the PI’s training in mixed methods research, behavioral economics, mHealth, physical activity interventions, and biobehavioral clinical trial design and analysis. The goal of the proposed research is to develop an effective mobile health (mHealth) intervention to increase moderate to vigorous physical activity (MVPA) in AYA with prediabetes or T2D, harnessing insights from behavioral economics and leveraging a highly efficient framework to determine effective intervention components. Aim 1 will determine attitudes, beliefs, and norms about, as well as barriers and facilitators to, engaging in daily MVPA by conducting semi-structured interviews of AYA with prediabetes or T2D. In Aim 2, theory-based and empirically-informed text messages to promote MVPA will be developed through adaptation of adherence- promoting text message banks developed by the PI’s mentors, using focus groups with patient stakeholders and insights from Aim 1. Aim 3 will determine intervention component settings that effectively increase MVPA and will consist of a 12-week factorial trial (Behavioral Economics for Activity Motivation) of 4 intervention components targeting theoretical mediators of MVPA: 1) text messages targeting Theory of Planned Behavior concepts of attitudes and norms, vs. simple reminders; 2) ramping-up vs. fixed step count goals, targeting perceived behavioral control; 3) financial incentives allocated up-front and lost for unmet goals vs. earned, targeting loss aversion; and 4) daily vs. weekly goals, targeting hyperbolic discounting (preference for smaller-sooner over larger-later rewards). The primary outcome is change in MVPA. Secondary outcomes include steps/day, proportion achieving 60 minutes MVPA/day, body mass index, hemoglobin A1c, and fasting insulin and lipids. The PI and mentors hypothesize that effective component settings will include text messages targeting attitudes/norms, ramped goal, loss-framed incentives and daily goals. Through this K23, the PI will be poised to compete successfully for R01-level funding to conduct a randomized controlled trial of the optimized intervention, helping to launch her career as an independent physician-scientist with expertise in health behavior change in AYA with prediabetes and T2D.