Background 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 Objectives 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 a 4-week pilot using Way to Health, a connected device, and social incentive intervention to increase physical activity, and conduct semi-structured interviews to evaluate trial 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. Anticipated Impact on Veterans' Health Approaches that effectively combine insights from behavioral economics with connected health devices and lead to improvements in behaviors within the everyday lives of veterans can have a significant impact on the health of veterans. Insights from this work could be leveraged to address other cardiovascular disease risk factors such as hypertension, diabetes, obesity, and smoking, which could lead to additional improvements in the health of veterans on a national scale.
I will design and test connected health approaches to improve the health of veterans. My first study will used a mixed-methods approach beginning with surveys to explore relationships among veterans' sociodemographic characteristics, experiences with mobile technologies, and social support. Veterans will use Way to Health, a technology platform previously used at the CMCVAMC in Philadelphia, to setup a connected health device to monitor physical activity. Veterans will be paired in teams of two persons and asked to use the device for 4 weeks along with a social incentive intervention to increase physical activity. Veterans will participate in a follow-up semi-structured interview to describe their experiences. Findings from Study 1 will inform the design of Study 2, a randomized trial using connected health devices to test combinations of social and financial incentives to increase physical activity. Veterans will complete baseline surveys, form teams of two persons to use the device for the 12-week intervention and 8-week follow-up, then complete surveys on their experience.
