Investigators are conducting a randomized controlled trial to determine whether an online team-based spaced education (SE) game can improve HbA1c levels among these patients with diabetes (primary aim). Secondary aims include determining the impact of the game on patients' pill possession ratio (PPR) of oral DM meds and their microalbumin/creatinine (M/C) ratio, ACE PPR, and ARB PPR.
Participants will be randomized to one of two cohorts: (1) the intervention cohort will participate in an online team-based game on diabetes self-management education (DSME) and will receive a paper documents on American history, and (2) the 'attention control' cohort will participate in an online team-based game on American history and will receive a paper documents on DSME. Each game would consist of 2 questions per week x 25 weeks = 50 questions total per arm. The questions are delivered via email by the Qstream platform to the participants. Upon clicking on a hyperlink in the email, participants select an answer that is downloaded to a server. They are then provided with the answer to and explanation of the question, along with additional educational materials. Using an adaptive methodology, the spacing and content of the game material will be individualized for each clinician based on their performance. Home-based testing of HbA1c and M/C ratio will be conducted by patients at enrollment, 6 months and 12 months. If successful, this SE game will improve diabetes management among VA patients and improve patient outcomes. Given the growing use of email and the Internet by patients, SE games could be easily expanded to a broad audience of VA patients with varying health problems across the country. With content tailored to meet specific needs, SE games can be utilized as tools to improve patients' clinical outcomes by bolstering their health management behaviors.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
456
Investigators created an online educational game by incorporating game mechanics into an evidence-based form of online education, termed 'spaced education' (SE). Based upon two psychology research findings (the spacing and testing effects), SE has been shown in randomized trials to improves knowledge acquisition, boosts learning retention for up to two years, and durably improves clinical behavior.
Investigators created an online educational game by incorporating game mechanics into an evidence-based form of online education, termed 'spaced education' (SE). Based upon two psychology research findings (the spacing and testing effects), SE has been shown in randomized trials to improves knowledge acquisition, boosts learning retention for up to two years, and durably improves clinical behavior.
Veterans Affairs Boston Healthcare System
Boston, Massachusetts, United States
HbA1c levels
Time frame: Months 1-12
Microalbumenuria levels [microalbumin-creatinine ratio].
Time frame: Months 1-12
Pill possession ratios of oral diabetes medications.
Time frame: Months 1-12
Treatment with angiotensin receptor blockers (ARB drugs) and angiotensin converting enzyme inhibitors (ACE inhibitors).
Time frame: Months 1-12
Pill possession ratios of angiotensin receptor blockers (ARB drugs) and angiotensin converting enzyme inhibitors (ACE inhibitors).
Time frame: Months 1-12
Weight / BMI
Time frame: Months 1-12
Low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol & triglyceride levels,
Time frame: Months 1-12
Systolic and diastolic blood pressure.
Time frame: Months 1-12
Clinic visit frequency.
Time frame: Months 1-12
Initiation or alteration of insulin therapy
Time frame: Months 1-12
Changes in oral diabetes medication regimen.
Time frame: Months 1-12
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Patient-perceived empowerment to manage their diabetes.
Questionnaire
Time frame: Months 1-12
Baseline knowledge levels of patients assessed via their initial responses to SE game questions -- DSME SE game cohort only.
Time frame: Months 1-6
Analysis of SE game performance differences by patient-related variables (age, gender, geographic location, baseline HbA1c, etc.) -- DSME SE game cohort only.
Time frame: Months 1-6
Patient-perceived acceptability of SE game interventions.
Questionnaire
Time frame: Months 1-6
Patient-perceived barriers and facilitators to the SE game intervention.
Questionnaire
Time frame: Months 1-6
Patient's perceptions of the optimal parameters for the SE game intervention.
Questionnaire
Time frame: Months 1-6