BACKGROUND/RATIONALE:
Cardiovascular disease is the leading cause of hospitalization, morbidity, and mortality among veterans. Many of the contributing risk factors are health behaviors that occur outside of the health care system and within their everyday lives of veterans such as physical activity, obesity, smoking, and medication adherence. Connected health is a model for using mobile technologies to remotely monitor health outcomes and deploy interventions to change behavior. While connected health devices may help to facilitate the monitoring of behaviors within veterans' everyday lives, they alone may not drive behavior change toward improved health. Insights from behavioral economics can help to design engagements strategies around connected health devices that leverage the fact the individuals tend to be more present-biased, put undue weight on small probabilities, and are heavily influenced by emotions such as regret and loss aversion. The Veterans Health Administration (VHA) is a leader in pioneering connected health technologies to improve the care and health of veterans as exemplified by the VA Center for Connected Health. However, little is known about veterans' experiences and outcomes with these technologies. Without the appropriate design, veterans' use of connected health devices may be subject to multiple challenges and potentially unintended consequences. Given VHA's significant investment in these technologies, the potentially significant impact on veterans nationally, and the alignment with the VHA's Blueprint for Excellence, it is imperative that these approaches are rigorously tested


OBJECTIVE(S):
To address these issues, I will aim to focus on following research objectives: 1) Understand veterans' perspectives of needs, barriers, and opportunities with connected health devices; 2) Evaluate veteran's experiences with Way to Health, a technology platform already being used at the CMCVAMC in Philadelphia to integrate connected health devices and enable automated deployment of behavioral economic interventions; 3) Use Way to Health to test social and financial incentive-based connected health approaches to increase physical activity among veterans to inform an investigator-initiated research proposal.

METHODS:
My first study will use a mixed-methods approach to identify veterans' experiences with mobile and connected health technologies, conduct an 8-week pilot using a connected device for physical activity, and conduct semi-structured interviews to evaluate experiences. These findings will inform my second study, a 20-week randomized clinical trial testing combinations of social and financial incentives to increase physical activity. This work will inform an investigator initiated research proposal for a larger, multisite clinical trial. Insights from this work will be applicable to other health behaviors such as those related to smoking, obesity, and medication adherence.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
My pilot study is one of the first to evaluate veterans' perceptions and experience with connected health devices, specifically using wearable devices to increase physical activity. The findings demonstrate promise for using these technologies if they can be combined with effective behavior change strategies. These insights have informed the design of the clinical trial which will begin enrolling Veterans in early 2019.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX001922-01A2
Link: https://reporter.nih.gov/project-details/9189574

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PUBLICATIONS:

None at this time.

DRA: Diabetes and Other Endocrine Disorders
DRE: Prevention, Technology Development and Assessment, Treatment - Preclinical
Keywords: none
MeSH Terms: none