Motivation Psychology-based Smart Engagement System (MOSES)

July 10, 2020 updated by: Baltimore Research & Education Foundation, Inc.

Motivation Psychology-based Smart Engagement System for Improved Older Adult Chronic Disease Management

In 2010, 25.8 million people in the US, or 8.3% of the population were reported to have diabetes. Type 2 diabetes mellitus (T2DM) is especially prevalent among older adults: 26.9% of people 65 years or older have diabetes with 50% being pre-diabetic. Diabetes is the leading cause of blindness, kidney disease and lower-limb amputation among older adults, and is also a major risk factor for cardiovascular disease.

Fortunately, diabetes and its related complications are very amenable to lifestyle changes. Engagement with healthcare providers can significantly affects behavior and disease management of practices of individuals as does social engagement. The use of mobile technology and better engagement with providers and peer support networks may support diabetes self-care management. Individual patient personality attributes may affect the success of technology interventions.

In this study, the investigators propose to design and test a motivation psychology-based smart engagement system (MOSES), which is a software application on a digital tablet device. The pre-loaded tablets will be provided to adults with T2DM (age 60+ with high glucose). The software will allow the patients to record diabetes self-care activities (exercise, glucose, nutrition, medication adherence), pursue goals, support communication between the patient and a health coach, support communication between peer patients, and visualize health status more easily by patients and providers. This research program will enroll 88 patients (4 intervention groups of 12 persons each and a 40-person control group) in a 90-day pilot study to test and refine the design of the application and its effectiveness in supporting care plan goals.

Primary Aim 1: Design, implement, and optimize a motivation psychology-based smart engagement system (MOSES) for older adults with diabetes.

Secondary Aim 2: Determine if providing older adult diabetic patients to care managers and peers via a digital tablet-based software application leads to improved diabetes management as measured by blood glucose control.

Secondary Aim 3: Refine the personality attributes used to tailor the interaction with the application.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

The investigators propose to conduct a 90-day pilot study to establish the effects and value of MOSES in the management of diabetes. The pilot study will provide initial data to answer the following research questions: (1) What are the effects of MOSES technology on older adults' diabetes self-care? (2) What type of social engagement intervention is more effective for what aspects of diabetes care? (3) What personality characteristics predict older adults' diabetes self-care?; (4) What personality characteristics moderate the effectiveness of mobile device (esp. tablet-based) social engagement interventions on older adults' diabetic care? (5) What model can be developed from our data to predict probability of effective response to interventions tailored to individual patients, e.g. by message type for clinical, usage and personality attributes?

Subjects Older adults are the target population for this study. Adult volunteers age 60 and above with an HbA1C of >7.9% and having the capacity to provide informed consent will be eligible to participate. Participants will be randomized to usual care or to an intervention group (described below). Once enrolled in the study and randomized to either the intervention or the control group, the Research Certified Diabetes Educator (CDE) will review all participants' clinical data and assist with providing feedback messages to the participants regarding their self-care progress. The Research CDE will alert physicians to any clinical data that would warrant a change in clinical management (e.g. hyper or hypoglycemia).

Manipulations

There are four manipulations in the experiment: (1) patient recording i.e. using the tablet and app to track and review progress (this increases mindfulness, engagement, activation, and informedness, thereby leading to healthier behaviors than the control condition), (2) patient recording with physician involvement via Health-feed communication messages (in addition to the benefits listed above, this provides expert feedback from a trusted source on actions, helps with goal setting, provides motivational reinforcement of positive behavior and sanction against negative, etc.), (3) patient recording with peer interaction i.e. using Health-feed messages, Community Views and Health Tournaments (in addition to the benefits listed for (1), peer effects have been observed in a variety of different settings such as educational attainment). People tend to emulate the behavior of peers, setting in motion a cycle of group conformism. People may also be motivated by a desire to compete in a peer setting, and (4) patient recording with peer interaction AND physician involvement. This final group will permit analysis of the interaction effects of the two forms of social engagement. Thus, the experiment will be done with the following groups:

  • Group A: the control group, usual care, (n=40)
  • Group B: individual patients using app w/o provider support (n=12)
  • Group C: individual patients using app w/ provider support (n=12)
  • Group D: peer patient teams using app w/o provider support (n=12; 4 teams)
  • Group E: peer patient teams using app with provider support (n=12; 4 teams)

Groups will be assigned to achieve age, gender and HbA1C matching at baseline. For groups with provider engagement (E), the provider (endocrinologist/CDE) will provide initial advice to the subjects, as well as continuous monitoring. The study will require a dedicated diabetes educator, who will spend 2 hours a day to keep in touch with the subjects, including reviewing the activity logs, sending reminder and motivational messages, as well as moderating the discussions in the peer engagement group. The CDE will triage the text messages from subjects and trigger the physician engagement when necessary. The study CDE will review participant data routinely and will maintain communication with the study team on a timely basis.

During the experiments, adverse events will be closely monitored by the physician and CDE, as well as through subject self-reports. The MOSES app has a built-in function to highlight potential adverse effects in the activity list and physician to-do list. The investigators will also conduct a weekly review of subject activity log.

Study Type

Interventional

Enrollment (Anticipated)

88

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Maryland
      • Baltimore, Maryland, United States, 21201
        • Baltimore VA Maryland Health Care System

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

60 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Veterans 60 years of age and older with an HbA1c of >7.9%
  • Recieving routine medical care within the University of Maryland Medical Center Midtown Campus (UMMCMC) who are 60 years of age and older with HbA1c of >7.9%

Exclusion Criteria:

  • Unable to provide informed consent
  • Blindness
  • Deaf
  • Type I DM
  • Active Serious Mental Illness
  • Homelessness

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Standard of Care Group - A
The control group
Active Comparator: MOSES - Group B
Individual patients using application and pedometer without healthcare provider support
Behavioral: MOSES
MOSES is an integrated system between a patient, peer patients, and healthcare providers.
Other Names:
  • Motivation Psychology-based Smart Engagement System
Active Comparator: MOSES - Group C
Individual patients using application and pedometer with healthcare provider support
Behavioral: MOSES
MOSES is an integrated system between a patient, peer patients, and healthcare providers.
Other Names:
  • Motivation Psychology-based Smart Engagement System
Active Comparator: MOSES - Group D
Peer patient teams using application and pedometer without healthcare provider support
Behavioral: MOSES
MOSES is an integrated system between a patient, peer patients, and healthcare providers.
Other Names:
  • Motivation Psychology-based Smart Engagement System
Active Comparator: MOSES - Group E
Peer patient teams using application and pedometer with healthcare provider support
Behavioral: MOSES
MOSES is an integrated system between a patient, peer patients, and healthcare providers.
Other Names:
  • Motivation Psychology-based Smart Engagement System

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Improvement in hemoglobin A1c
Time Frame: 3 months
3 months

Secondary Outcome Measures

Outcome Measure
Time Frame
Adherence to diabetes care plan
Time Frame: 3 months
3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Baltimore Research & Education Foundation, Inc.

Collaborators

University of Maryland, College Park

Investigators

  • Principal Investigator: Nanette Steinle, MD, Baltimore VA Maryland Health Care System

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

June 1, 2014

Primary Completion (Anticipated)

May 1, 2022

Study Completion (Anticipated)

June 1, 2022

Study Registration Dates

First Submitted

April 29, 2014

First Submitted That Met QC Criteria

April 29, 2014

First Posted (Estimate)

April 30, 2014

Study Record Updates

Last Update Posted (Actual)

July 14, 2020

Last Update Submitted That Met QC Criteria

July 10, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • CHIDS-MOSES

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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