一项关于采用不同信息以提高糖尿病患者参与健康食品计划比例的随机对照试验。
Randomised controlled trial of alternative messages to increase enrolment in a healthy food programme among individuals with diabetes.
作者信息
Gopalan A, Paramanund J, Shaw P A, Patel D, Friedman J, Brophy C, Buttenheim A M, Troxel A B, Asch D A, Volpp K G
机构信息
Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
出版信息
BMJ Open. 2016 Nov 30;6(11):e012009. doi: 10.1136/bmjopen-2016-012009.
OBJECTIVES
We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes.
METHODS
Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician's recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an 'enhanced active choice'(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message.
RESULTS
We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6%) than the diabetes-specific message alone (7.6%, p=0.0016).
CONCLUSIONS
Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes.
TRIAL REGISTRATION NUMBER
NCT02462057.
目的
我们比较了以糖尿病为重点的信息传递策略在增加糖尿病成年人参与健康食品计划方面的有效性。
方法
活力计划是南非健康保险公司Discovery Health的会员可享有的一项多方面的健康福利。最大的活力计划之一是健康食品（HF）计划，这是一项基于激励的计划，旨在通过为健康食品购买提供高达25%的现金返还来鼓励更健康的饮食。我们将2型糖尿病成年人随机分为5组中的1组：（1）对照组，（2）特定糖尿病信息组，（3）从患有糖尿病的HF会员角度撰写的推荐HF的信息组，（4）包含医生推荐HF的信息组，或（5）第2组的特定糖尿病信息与“强化主动选择”（EAC）相结合的组。在EAC中，要求读者立即做出选择（在这种情况下，选择注册或不注册）；突出显示与首选和非首选选项相关的利弊。在首次发送电子邮件信息1个月后评估HF注册情况。
结果
我们随机分配了3906名会员。在排除那些在首次干预电子邮件之前就已注册HF或退出活力计划的人之后，3665名（94%）被纳入改良意向性分析。与对照组相比，所有4个实验组的HF注册率均显著更高（所有比较均p<0.0001）。在比较各实验组时，带有EAC的特定糖尿病信息的注册率（12.6%）显著高于单独的特定糖尿病信息（7.6%，p=0.0016）。
结论
以糖尿病为重点的信息在增加健康食品计划的注册方面是有效的。在信息中添加框架式主动选择显著提高了该人群的注册率。这些发现表明，简单、低成本的干预措施可以提高促进健康计划的注册率，并且也可以在这些计划中进行实际测试。
试验注册号
NCT02462057。
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