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

项目摘要/摘要 心血管疾病是美洲土著人(Nas)的主要死亡原因。伦比部落 北卡罗来纳州罗伯逊县的社区在心血管疾病方面存在严重差异 发病率和死亡率。高血压(HTN)大大增加了相关的发病率和死亡风险 心血管疾病。美国HTN指南推动的生活方式调整包括可修改的自我 护理行为，如与较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，激励体力活动 行为将是纳伦比部落社区心血管健康促进努力的关键。 一种有希望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、可扩展的工具，有助于参与HTN自我护理行为，同时令人愉快 使用方便。SCDG干预集成了来自活动跟踪器的HTN参与者的行为数据 激活游戏进度、奖励和反馈的传感器。这项研究的主要目标是测试一种文化上的 改良式SCDG干预(N-SCDG)改善伦蜂日常体育活动自理行为 患有HTN的部落成年人，并研究在社区维持N-SCDG影响的方法 水平。对于目标1，我们将使用以社区为基础的参与式方法来从文化上适应SCDG干预 我们已经为移动智能手机开发了这项技术，以促进持续的身体活动和自我照顾 患有HTN的NA成人的行为。对于目标2，使用随机对照临床试验，我们将比较 N-SCDG干预与仅传感器对照对HTN自身参与的主要结果的影响 体力活动的护理行为与HTN自理知识、自理的二次结局 行为、自我效能、收缩和舒张压、心脏住院和生活质量 基线、3个月和6个月。对于我们的样本，我们将从部落中招募18岁或以上的成年人 罗伯逊郡的附属心脏诊所。我们将随机将220名参与者分配到N-SCDG 干预组，参与者将收到跟踪身体活动的传感器，并将玩N- 移动智能手机上的SCDG，或将接收传感器的控制组，这是一款跟踪身体状况的应用程序 活动，标准化的HTN书面教材。对于目标3，我们将评估 N-SCDG通过对研究参与者和 社区领导人和培训Lumbee社区成员以维持和传播N-SCDG 社区HTN管理能力建设干预。该项目将产生洞察力和 指导可扩展且易于使用的数字游戏解决方案，以激励HTN自理行为和 改善患有HTN的NA患者的健康状况。

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.