Habit Formation in an Occupational Therapy Self-Management Intervention: The Resilient, - PowerPoint Presentation

Slide1

Habit Formation in an Occupational Therapy Self-Management Intervention: The Resilient, Empowered, Active Living (REAL Diabetes) Study

Beth Pyatak, PhD, OTR/L, CDE

Chan Division of Occupational Science and Occupational Therapy

University of Southern CaliforniaSlide2

What is occupational therapy (OT)?

Facilitates participation in everyday activities

(occupations)

Addresses disconnects between the activities we:Want, need, or are expected to doAnd what we actually DO in our everyday livesSlide3

Habits in Occupational Therapy

Performance patterns

are the

habits, routines, roles, and rituals used in the process of engaging in occupations or activities that can support or hinder occupational performance. Habits refers to specific, automatic behaviors; they may be useful, dominating, or impoverished. Routines are established sequences of occupations or activities that provide a structure for daily life; routines also can promote or damage health.

American Occupational Therapy Association.

OT Practice

Framework: Domain and Process (3rd Edition). Am J

Occup

Ther

. 2014;68(Supplement_1):S1-S48. Slide4

Habits in occupational therapy

OT has important potential role in chronic disease care through its emphasis on

modifying personal habits

relevant to disease managementDespite strong theoretical and conceptual understanding of habit, OT lacks empirical research connecting habit theory to OT treatment and outcomesSlide5

Habits in occupational therapy

“The

role of

OT in chronic disease management has been described as facilitating patients' consistent, habitual, and correct performance of health management tasks through the integration of these tasks into daily routines. The emphasis on developing consistent diabetes self-care habits and routines forms the overarching focus of the intervention.” (Pyatak et al., 2017, p. 10)Slide6

Diabetes self-management

D

iabetes

is the “quintessential self-managed chronic disease” (Wiley et al., 2014)Seven key self-care behaviors:Healthy eatingPhysical activityTaking medicationsSelf-monitoring

Problem solving

Healthy coping

Risk reductionSlide7

Types of diabetes

Type 1 diabetes (T1D)

5-10% of diabetes cases

Increasing incidenceGenetic/environmental risk factors; behavior does not play roleCannot be delayed/ preventedAutoimmune disorder leading to insulin deficiency

Only treatment is intensive insulin therapy

type 2 diabetes (T2D)

90-95% of diabetes cases

Increasing incidence

Genetic/behavioral risk factors

Progressive; may be delayed or prevented

Disorder of insulin resistance

Initial treatment with oral medication, then once-daily insulin, then intensive insulin therapy

Youth-onset T2D

Less responsive to treatment than T2D

Earlier initiation of intensive insulin therapy

Earlier onset of complications

Poorer prognosis (disability/mortality) than T1D or T2DSlide8

diabetes Self-management

monitoring

blood

glucose (SMBG)6-10x daily for people on intensive insulin regimen (83% of REAL participants)1-2x daily for other medication regimensUpon waking, before meals, before bed, when symptoms of high or low blood glucose present

Taking medications

Intensive insulin regimen: many doses daily; variable

Fixed insulin regimen: 1-4 doses daily; consistent

Oral medications: varies, typically 1-2x daily before morning/ evening meal

Healthy eating

Reducing sugary beverage intake

Substituting “junk” food with healthier meal/ snack choices

Accurate/consistent serving sizes/ carbohydrate countsSlide9

Diabetes self-managementSlide10

REAL Diabetes

Study:

Resilient, Empowered, Active Living with DiabetesSlide11

REAL Intervention Conceptual model

diabetes distress

q

uality of life

d

epressive symptoms

secondary outcomesSlide12

REAL Study Participants

Variable

Participants

Age (years)22.6 (±3.5)Gender (% female)63%

Race/Ethnicity -

% Hispanic/Latino

% African American

% White

78%

10%

10%

Neighborhood income below FPL

23.8%

Diabetes type (% T1D)

75%

Diabetes duration (years)

9.7 (±5.8)

A1C

(goal for most

adults with diabetes: <7%)

10.8 (±1.9)

Medication adherence

(days/week as recommended)

5.9

(±1.8)

SMBG adherence

(days/week as recommended)

3.3

(±2.7)

Diabetes distress

(>8 clinically significant)

9.6

(±5.7)

Pyatak

EA

et al.

Contemp

Clin

Trials. 2017;54:8-17.Slide13

Study Flow

Excluded (n=160

)

Completed

testing

(

n=35)

A1C testing only

(n=3)

Lost to follow-up (n=3)

OT intervention group (n=41

)

Received

tx

(≥4 sessions)

(

n=31)

Average 8.7 ± 5.2 sessions

Completed

testing (n=37)

A1C testing only (n=0)

Lost

to follow-up testing (n=3

)

Attention control group

(n=40)

Received

attn

control

(

≥

4)

(

n=33)

Average 8.4 ± 3.9 phone calls

Allocation

Follow-Up

Randomized (n=81)

Enrollment

Screened for

eligibility (n=241)Slide14

REAL Study Outcomes

p=0.01

p=0.04Slide15

REAL Study Outcomes

p=0.05

SRBAI: Self-Reported Behavioral Automaticity Index

p=0.32Slide16

Intervention process: goalsSlide17

Intervention Process: ActivitiesSlide18

Habit in the REAL Intervention

Self-monitoring

Environmental

cuesScaffolded cues (e.g. text message reminders)Naturalistic cues (e.g. sticky notes, changing environment)Chaining with existing habits Substituting alternate behaviorsSlide19

“[Client] identified before-dinner [blood sugar] checks as a new habit to target. She identified the following ideas to support the new habit loop (she plans to implement the starred ideas this week): 

*ask her boyfriend to remind her

*Leave her diabetes bag out at the dinner table

*Leave a post-it at work*Leave a post-it in phone caseCheck after work before leaving the officeMake a phone alarmSlide20

“[

Client] identified evening meals/snacking as a problem and requested that we complete the 'how to create a habit' worksheet. Problem-solved potential cues and rewards. [Client] created an environmental cue and decided to also post his son's picture on the sign to remind him of the long-term reward of injecting bolus insulin with evening meals and snacks

.”Slide21

next steps and questions

Larger-scale study incorporating:

Long-term

follow-upRefine conceptual model; test mediating pathwaysBetter measures for medication adherence, blood glucose self-monitoring habits?Refining interventionFor example: Recommending 2-3 behavior change goals, preferably all actions or all inactionsHabit strategies for medication adherence?