Developing, Refining, and Testing a Mobile Health Question Prompt List in Gastroesophageal Reflux Disease

项目摘要 高达42%的患有胃食道反流病(GERD)的美国人经历了无法控制的慢性 降低与健康相关的生活质量并增加长期并发症风险的症状。我的龙- 长期目标是改善食道疾病患者的健康结果。这项提案旨在改进 GERD患者的健康结果，通过利用患者的积极性和激励行为变化 移动健康(MHealth)问题提示列表(QPL)干预框架。患者激活 强调患者在管理其医疗保健方面的知识、技能和信心，并预测患者的 健康成功的水平。然而，几乎一半的GERD患者表现出较低的患者激活分数。 患者活跃度低导致对药物治疗的依从性较差。值得注意的是，几乎没有研究 专注于开发一种干预措施，以提高GERD患者的积极性和激励行为改变。 新出现的证据表明，有效的医患沟通干预措施，例如针对特定疾病的干预 QPLs，增加病人的活跃度。本提案的目标是应用以用户为中心的5步设计 开发、改进和测试基于QPL的GERD患者专用移动应用程序的思维模式 “食道-Q。”中心假设是食道-Qs将是可用的，并有可能被利用 激活患者并激励行为改变。我们的具体目标包括：1)开发设计 食道-通过移情、定义患者面临的问题和思考产生解决方案来回答问题；2) 通过原型和可用性测试来改进食道Qs的设计；以及3)收集关于 食道Qs在一项随机对照先导研究中估计干预效果的大小。我们会 使用定性和定量方法的创新组合来实现这些目标 为应用程序开发提供信息的实施科学。这项拟议的研究意义重大，因为它已经 潜在地利用患者的活力并激励行为改变，这可以转化为改善健康 结果。它还具有重要意义，因为它将开发一个可扩展的平台来开发mHealth 其他食道疾病的QPL。这项工作的最接近预期结果是开发出一种可用的 食道-Qs，并收集关于患者活动随时间、药物治疗的差异的初步数据 食道Qs和GERD标准之间的依从性、健康相关生活质量和GERD症状严重程度 关心。这项职业发展奖的试点数据将成为R01资助的临床试验的基础 在大量不同的人群中严格测试食道Qs的疗效。

Project Summary Up to 42% of Americans with gastroesophageal reflux disease (GERD) experience uncontrolled, chronic symptoms that reduce health-related quality of life and heighten the risk of long-term complications. My long- term goal is to improve health outcomes for patients with esophageal disorders. This proposal aims to improve health outcomes for patients with GERD, by harnessing patient activation and motivating behavioral change as a framework for a mobile health (mHealth) Question Prompt List (QPL) intervention. Patient activation emphasizes patients’ knowledge, skills, and confidence in managing their health care and predicts patients’ level of health success. However, almost half of patients with GERD demonstrate low patient activation scores. Low patient activation leads to poor adherence to medical therapy. Remarkably, very little research has focused on developing an intervention to improve patient activation and motivate behavior change in GERD. Emerging evidence suggests effective patient-physician communication interventions, such as disease-specific QPLs, increase patient activation. The objective of this proposal is to apply a 5-step user-centered Design Thinking model to develop, refine, and test a mobile app based QPL specific for GERD patients titled “Esophagus-Qs.” The central hypothesis is that Esophagus-Qs will be usable and has potential to harness patient activation and motivate behavior change. Our specific aims include: 1) Develop the design of Esophagus-Qs by empathizing, defining the problems patients face, and ideating to generate solutions; 2) Refine the design of Esophagus-Qs by prototyping and testing usability; and 3) Collect preliminary data on Esophagus-Qs in a randomized controlled pilot study to estimate the effect size of the intervention. We will pursue these aims using an innovative combination of qualitative and quantitative methodologies and implementation science to inform app development. The proposed research is significant, because it has potential to harness patient activation and motivate behavior change, that can translate into improved health outcomes. It is also significant because it will develop a platform that can be extended to develop mHealth QPLs in other esophageal disorders. The proximate expected outcome of this work is to develop a usable Esophagus-Qs and collect preliminary data on differences in patient activation over time, medication adherence, health-related quality of life, and GERD symptom severity between Esophagus-Qs and standard of care. Pilot data from this career development award will be the foundation for an R01-funded clinical trial to rigorously test the efficacy of Esophagus-Qs among a large, diverse population.