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The Daily Activity Study of Health (DASH): A pilot randomized controlled trial to enhance physical activity in sedentary older adults

In this article, authors describe the design of a randomized control trial aimed to use self-affirmation manipulation and gain-framed health messaging to effectively reduce sedentary behavior in older adults. Sedentary behavior has been proven to increase the risk for multiple chronic diseases, early mortality, and accelerated cognitive decline in older adults. Interventions to reduce sedentary behavior are needed to improve health outcomes and reduce the burden on healthcare systems. In this trial, authors propose recruiting 80 healthy but sedentary older adults between the ages of 60 and 95 years old. Participants will be randomly assigned to one of two groups: 1) an intervention group, which received self-affirmation followed by gain-framed health messages daily or 2) a control group, which received daily loss-framed health messages only. Accelerometers (movement monitors that have the ability to capture intensity of physical activity) will be deployed a week before, during, and the last week of intervention to examine potential changes in sedentary time and physical activity engagement. In addition, participants will undergo various tests before and after the intervention. Ultimately, this article proposes a trial that has the potential to assess the effectiveness of a novel behavioral intervention at reducing sedentarism in older adults, while also examining the neurobehavioral mechanisms underlying any such changes.

Targeting self-control as a behavior change mechanism to increase physical activity: Study protocol of a randomized controlled trial.

In this article, authors describe the design of a randomized control trial aimed to test self-control as a behavior change mechanism for physical activity, investigating whether a smartphone-based self-control intervention can increase physical activity among sedentary middle-aged adults. Despite the highly publicized beneficial effects of physical activity, 51.1% of middle-aged US adults do not achieve the recommended minimum of aerobic physical activity needed to maintain health. A sedentary lifestyle can be attributed in part to a lack of self-control, and there is some evidence that self-control strategies can be improved with targeted interventions. For this trial, authors propose two experimental conditions: a self-control treatment group and a control group. Both groups will track their daily physical activity using a Fitbit step counter for eight weeks. Additionally, the self-control intervention group will receive a 7-week smartphone-based self-control intervention to learn strategies on how to potentiate desirable impulses or weaken undesirable ones. If this self-control intervention proves effective, this digital approach will represent a low-threshold and cost-effective approach to increasing physical activity. Ultimately, authors emphasize that this study has the potential to make a valuable contribution to advance our understanding of the underlying processes and mechanisms that lead to increased and sustained physical activity in middle-aged adults.

REinforcement learning to improve non-adherence for diabetes treatments by Optimising Response and Customising Engagement (REINFORCE): study protocol of a pragmatic randomised trial

In this study protocol of a randomized control trial, authors describe the testing of a reinforcement learning-based text messaging program on adherence to medication for patients with type 2 diabetes. Authors propose the randomization of 60 patients with suboptimal diabetes control treated with oral diabetes medications. One group will receive reinforcement learning intervention texts and the other group will receive none. The text messages will be designed to be individual and adapted using a reinforcement learning prediction algorithm based on daily adherence measurements from the pill bottles. Ultimately, authors plan to evaluate the effect of personalizing the framing of text messages for patients to support medication adherence and provide insight into how this could be adapted at scale to improve other self-management interventions.

Randomised controlled trial targeting habit formation to improve medication adherence to daily oral medications in patients with gout

In this study protocol of a randomized control trial, authors describe their plan to test an adaptive intervention in order to achieve medication adherence for patients with gout. Gout is a debilitating form of arthritis that requires daily medication to prevent flares. This treatment is costly and requires patients to adhere to certain medication schedules. Habit formation theory is a promising strategy to improve patient adherence. The cue-reward-repetition principle posits that habits are formed by repeatedly completing an activity after the same cue and having the action rewarded every time. Overtime, cues become increasingly important whereas rewards become less salient because the action becomes automatic. In this trial, authors propose to separate participants into three groups – two intervention groups and a control group. In the intervention groups, participants will select a daily activity to link to their medication-taking (cue) and a charity to which money will be donated every time they take their medication (reward). Participants in one group will receive reminder texts and participants in the other will receive none. Authors emphasize that this study has the potential to evaluate the impact of an individually-tailored habit formation intervention to improve adherence to daily medications for patients who suffer from gout. If this intervention is effective, this strategy could be tested and scaled to other diseases, clinical environments, and health behaviors.

A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment.

In this large field experiment, authors test 19 nudges delivered to patients via text message, assessing whether or not they could boost adoption of the influenza vaccine. Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. Ultimately, the authors found that text messages sent prior to a primary care visit boosted vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e.: not surprising, casual, or interactive). The authors conclude that this successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

Nudging: Progress to date and future directions.

In this paper, authors assess past empirical research on “nudging.” A nudge can be any small intervention in complex decision-making situations, aimed to help people overcome cognitive errors and select certain beneficial alternatives, without limiting someone’s ability to make difference choices. Nudges influence behavior by changing the environment in which decisions are made, without restricting the menu of options and without altering financial incentives. In simpler terms, a nudge refers to indirect encouragement – not a direct instruction or enforcement. In this paper, authors assess research on nudging and provide recommendations for future work in this area by discussing examples of successful and unsuccessful nudges. In addition, they analyze 174 articles that estimate nudge treatment effects. Ultimately, authors emphasize that that many different types of nudges succeed in changing behavior in a wide range of domains. They highlight the need for future research to pay greater attention to (1) determining which types of nudges tend to be most impactful; (2) using field and laboratory research approaches as complementary methods; (3) measuring long-run effects of nudges; (4) considering effects of nudges on non-targeted outcomes; and (5) examining interaction effects among nudges and other interventions.

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