The Northwell Roybal Center for Personalized Trials uses state-of-the-art behavioural theory and personalised approaches to improve the health of older adults
Modifiable health behaviours account for nearly half of deaths in the United States, with the burden of modifiable chronic disease being especially significant among those aged 60 years or older. Despite the importance of modifying health behaviours to improve health and reduce mortality in older adults, large-scale, stable health behaviour change has been difficult to achieve. Well-designed behavioural interventions are critical to supporting consistent health behaviour change.
The Edward R. Roybal Centers
The goal of the National Institute of Health’s (NIH) National Institute on Aging (NIA) is to support innovative research that fosters the health and independence of older adults while studying the conditions that uniquely affect the most vulnerable among America’s ageing population. The Edward R. Roybal Centers for Translational Research in the Behavioural and Social Sciences of Aging are a NIA-supported consortium of 15 Centers created to help achieve this goal. The Roybal Centers conduct research to translate and integrate basic behavioural and social research findings into interventions that improve the lives of older people and increase institutional capacity to adapt to societal ageing.
Northwell Health is proud to be a member of the Roybal Consortium and to support the work of the consortium as the Roybal Coordinating Center, providing strategic leadership and coordination to the Edward R. Roybal Centers for Translational Research on Aging.
The Northwell Center for Personalized Trials
The Northwell Roybal Center for Personalized Trials works to develop behavioural interventions and adequately powered clinical trial results that can be translated into scalable, implementable interventions through innovative mechanisms of behaviour change, behaviour change theories and techniques, and innovative personalised methods. The current focus of our Roybal Center is to: 1) comprehensively and creatively test several Stage I-V behaviour-change interventions to initiate and maintain physical activity in caregivers of those living with AD/ADRD or those with AD/ADRD; 2) contribute to the science of basic behaviour change by testing behaviour change theories, techniques, and mechanisms for promoting physical activity in caregivers and those with AD/ADRD; 3) provide trial and future programme of research support to under-represented investigators; and 4) build an evidence-based, implementable suite of personalised behaviour change interventions and measures of mechanisms of action for promoting physical activity in caregivers and those with AD/ADRD. Related to these goals, our centre is committed to using state-of-the-art behavioural science to guide intervention development.
Behavioural Change Techniques (BCTs) and Mechanisms of Behaviour Change (MoBCs)
At the Northwell Roybal Center, we believe it is critical to identify the most effective components of a behavioural intervention and to understand how and why behavioural interventions can influence health behaviours. To better understand and communicate what the ‘active ingredients’ of behavioural interventions are, we utilise the work of Dr Susan Michie and her colleagues in the Human Behaviour Change Project. These researchers have worked to break down interventions into behavioural ontologies, or a map of existing interventions and how they are related, developing components called Behaviour Change Techniques (BCTs). Each BCT component is distinct and exact, with each BCT being observable, replicable, and an active building block for an intervention. For example, two distinct BCTs are Goal Setting for behaviour (e.g. “I will walk 1,000 more steps per day) and Goal Setting for a health outcome (e.g. “I will lose 5 lbs. of weight”). At the Northwell Roybal Center, we utilise existing BCT ontologies to define our health behaviour interventions, helping other researchers to better understand and replicate our findings.
Connected with this ontology of BCTs, researchers have also been developing the ontology of mechanisms of behaviour change (MoBCs), by which BCTs influence behaviour. Understanding the MoBCs for health interventions is essential for developing effective and scalable health programmes. MoBC models identify the processes that produce behavioural change and help researchers determine which intervention components are responsible for observed effects. This knowledge improves intervention design, facilitates adaptation across settings, and increases the likelihood that effects will persist when programmes are implemented in replication studies or routine practice.
Utilising our focus on BCT interventions with well-defined MoBCs, we have developed several innovative clinical trials aimed at improving the health of older adults.
Innovative personalised clinical trials
Since being established in 2019, our Northwell Roybal Center has conducted eight trials among older adults. These include two trials to develop walking habits among caregivers for individuals with AD/ADRD. These trials utilise two personalised approaches to create individualised physical activity habits. The first trial tries to encourage more movement during one hour of the day selected by each caregiver, while the other trial encourages caregivers to be more active over a four-hour period, reducing the amount of time that they spend sedentary. Prior research has found that both walking more AND sitting less can improve physical and mental health. This is particularly important for caregivers of individuals living with AD/ADRD as their caregiving responsibilities often result in less time spent caring for themselves. Each of these trials utilises behavioural theory, with the intervention comprising the well-established BCTs of Goal Setting for behaviour, Action Planning, Self-Monitoring of behaviour, and Prompts/Cues to influence habitual physical activity via the key MoBC of Cognitive Automaticity. These trials will help us to understand how best to encourage habitual physical activity among caregivers.
In addition to using behaviour theory, our Roybal Center leverages adaptive trial designs to explore health behaviour interventions. Using the Time-to-Event Continual Reassessment Method developed by Dr Ying Kuen Cheung, we have also conducted adaptive behavioural trials to identify the optimal dose (in weeks of intervention length) of a BCT intervention to improve the physical activity and medication adherence of older adults taking statin medication. In addition, we have utilised Personalised N-of-1 trials to explore how Mind-Body interventions can best improve sleep among middle-aged women working in healthcare.
The portfolio of clinical trials conducted by the Northwell Roybal Center is diverse, but all of our research aims to improve the health of older adults using the most current behavioural science and tailored intervention approaches.
To learn more
For more information about our current and past research, please explore our website. To learn more about the clinical trials currently active and those we have completed in the past, feel free to visit our current and past research projects.
In addition, our Roybal Center is always seeking collaborators to conduct innovative physical activity research. In fact, the Roybal Centers provide yearly calls for investigators to submit their research ideas. To find more information and to potentially submit your trial idea, click here.
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Please note, this article will also appear in the 27th edition of our quarterly publication.
