Amy Gorin, an associate professor of clinical psychology in the College of Liberal Arts and Sciences, knows from experience that sometimes a therapist’s non-verbal cues – an inviting atmosphere, an understanding expression – can support a patient as much as her words.With that in mind, Gorin has been taking painstaking care for the past year to impart a virtual clinician with a real, expert clinician’s knack for delivering the right response – verbal or otherwise – at the right time and to replicate the personal interaction that takes place in a trusted therapist’s office.
Gorin, also a principal investigator at UConn’s Center for Health, Intervention, and Prevention (CHIP), is working as part of a multi-disciplinary team based at University of Rochester to translate the proven Look Ahead (LA) behavioral intervention for overweight and obese individuals with Type 2 diabetes into an online format, with a virtual clinician, to extend its reach and implement it as part of routine care.
“There’s certainly a move within the weight-loss community to provide as many online tools as possible, but this project combines a state-of-the-art behavioral program with the latest technology,” Gorin said.
The LA trial, in which Gorin participated as a co-investigator, involved more than 5,000 participants and 16 research institutions and it ran for 12 years. LA encouraged participants to lose at least 7 percent of their body weight and to increase their physical activity to at least 175 minutes per week.
Among the LA trial’s findings, participants in the intensive lifestyle intervention arm of the trial experienced loss of 8.6% of body weight (compared to .7% in the control arm), improvement in glycemic control, and significant reductions in systolic and diastolic blood pressure, among other markers. In addition, the intervention arm had greater reductions in the proportion of patients using medication for diabetes, hypertension, and hyperlipidemia.
“Look Ahead has been proven effective, but it is an intensive face-to-face intervention, requiring extended clinical contact that is difficult, if not impossible, to implement outside of specialty care centers,” Gorin said.
Two key advantages of the virtual Look Ahead program (VLAP), according to Gorin, is that it will be accessible to patients 24/7 via any Internet-connected device and that it will reduce the live practitioner time needed to implement the intervention by as much as 70 percent.
If the VLAP proves as successful as the in-person version of the intervention, the impact could be profound, as approximately 21 million Americans currently have diabetes (95 percent Type 2 diabetes) and an estimated 54 million more Americans have pre-diabetes, Gorin said.
The VLAP will cover all major components of LA, including (1) providing relevant health information and education, (2) assessing individual risk factors and customizing information to each participant’s risk profile, (3) providing a forum for participants to ask and answer questions relating to their health and diabetes management, (4) the creation of an initial treatment plan that is customized to each participant’s needs and goals, and (5) the collection of key metrics related to the participant’s health, motivation, and behavior targeted for change. The VLAP will involve the participants interacting with a virtual health care practitioner regarding healthy lifestyle choices and the key LA goals of 7% weight loss and 175 minutes of moderate level physical activity a week.
The technology will integrate the participant’s health risk information to provide recommendations for treatment or change. The initial virtual encounter will result in health behavior risk information and an initial plan for change that will be provided to a live clinician for approval and periodic monitoring.
The research team recently began piloting VLAP through the employee wellness program at University of Rochester, where grant PI Dr. Geoffrey Williams, an internist and health psychologist, is on the faculty. The team will recruit 40 overweight or obese individuals with Type 2 diabetes into the intervention arm and another 40 participants into a control arm, which likely will involve a brief in-person intervention, Gorin said.
If the pilot proves successful, the team plans to seek additional funding for a larger-scale clinical trial, likely partnering with already-identified insurers in the Rochester area.
As the only team member involved in the original LA trial, Gorin’s main charge has been working closely with Jennifer LaGuardia, Ph.D., a clinical psychologist at Rochester who is a motivational expert and grant co-investigator, to develop the scripts for the VLAP’s avatar, providing appropriate questions and responses to various anticipated answers, and providing input regarding how the avatar and the office environment should look. Gorin will participate in the development of 24 scripts.
Others on the VLAP research team include LaGuardia, who oversees the entire project with Dr. Williams, Scott Rigby, a software developer with a motivational psychology background, and Megan Clarke, a UConn clinical psychology graduate student working with Gorin. This project is funded by the Library of Medicine.