Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial
Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial
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DOI：
10.1093/jpepsy/jsx144
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发表时间：
2019-01-01
影响因子：
3.6
通讯作者：
Moltz, Kathleen
中科院分区：
文献类型：
--
作者：
Ellis, Deborah A.;Carcone, April Idalski;Moltz, Kathleen
目的 调整针对 1 型糖尿病控制不佳的青少年糖尿病管理的循证干预措施，供社区卫生工作者 (CHW) 在社区环境中使用，并对新干预措施 REACH 控制 (RFC) 进行试点测试。该研究是大学研究人员和联邦合格健康中心合作进行的。方法在试点有效性试验中，根据参与者入组、治疗剂量和消费者满意度评估 RFC 的可行性和可接受性。还评估了 RFC 对青少年依从性、健康结果和生活质量的影响。该试验采用平行组设计。家庭被随机分配接受 6 个月的 RFC 加标准医疗护理 (n=26) 或仅标准护理 (SC) (n=24)。数据是在基线和 7 个月后测试时收集的。使用混合方法来分析数据。 结果 定性分析表明，护理人员对 RFC 和社区卫生工作者提供的家庭干预持积极态度。此外，接受 RFC 的青少年的糖化血红蛋白 (HbA1c) (0.7%) 具有统计显着性 (p = .05) 和临床意义的改善，并报告从基线到随访的生活质量显着改善 (p = .001)。青少年的标准医疗护理没有发现显着变化。然而，虽然提供的主要干预课程的剂量是可以接受的，但用于技能练习的后续课程的剂量较低。 结论 结果为 RFC 在为高风险、低收入家庭提供服务的社区环境中改善健康状况和生活质量时的可接受性和有效性提供了初步支持。看来有必要在全面的有效性试验中进行额外的测试。
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. MethodsIn a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n=26) or standard care (SC) only (n=24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data.Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low.Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.