Using Peer Navigators to increase access to VA and community resources for Veterans with diabetes-related distress

与糖尿病相关的痛苦，即与糖尿病生活在一起的负面情绪影响，是一个强有力的预测因子 心理社会功能、治疗依从性和血糖控制。实践指南和共识 声明呼吁采取创新的方法来解决糖尿病相关的痛苦。尽管有自我保护的能力 减少糖尿病相关痛苦的管理和心理社会干预，这些干预措施是 由于时间、资金、动机和资源意识的限制，未得到充分利用。干预措施 利用传统医疗保健和以社区为基础的健康促进计划(例如，DM自我 管理教育(DSME)计划)可能会增强患有DM的退伍军人与 广泛和可获得的资源范围。确保患有糖尿病的退伍军人得到足够的自我护理支持 需要进行以下干预：(1)兼顾医疗护理和糖尿病相关的痛苦；(2)改善 退伍军人接触和参与DSME和传统医疗/心理护理。集成退伍军人管理局和 社区卫生服务和DSME资源是创新的，并提供了增强 退伍军人的成果和建立退伍军人事务部社区伙伴关系。退伍军人和社区的参与 开发和提供护理服务的组织应对2016年HSR&D高优先级卫生领域 护理系统变化并与2017年退伍军人事务部副部长的更大选择优先事项保持一致 (提供社区和退伍军人管理局资源)、效率(社区和退伍军人管理局协调)和及时性 (电话递送)。 这种社区与退伍军人管理局的合作伙伴关系和为期三个月的资深同伴辅导干预(灵感)旨在 促进退伍军人糖尿病患者的心理健康和糖尿病自我管理行为 获取和使用医疗保健和健康促进资源。干预的重点是减少 通过聘请资深同行作为教练和领航员来使用服务的认知和实践障碍，以及 通过鼓励退伍军人事务部和更广泛的社区参与健康促进和医疗服务。 第二个目标是加强和整合志愿人员协会与社区的伙伴关系，这是主要目标不可或缺的一部分。 基于组织和退伍军人支持组织(VSO‘s)。 这是一项为期3个月的退伍军人同伴导航干预的单盲、平行分组随机试验 糖尿病和糖尿病相关痛苦水平的升高。我们将通过以下途径招募患有糖尿病相关痛苦的退伍军人 退伍军人事务部内外现有的求助渠道与社区机构、VSO‘s、 以及休斯顿VAMC。符合条件的退伍军人将被随机分配到灵感干预(PEER) 导航和指导)与常规护理(书面资源材料和鼓励继续跟踪- 与医疗保健提供者合作)。与重点一致的是糖尿病对整体情绪的影响，主要 结果是糖尿病相关苦恼(DM苦恼量表)。在之前的研究中，DDS已经显示出很强的 血糖与心理症状、自我管理行为及客观测量的关系 控制力。次要结果包括焦虑症状(广泛性焦虑障碍量表)， 抑郁症状(患者健康问卷-8)、糖尿病自我管理行为(DM自我管理行为) 管理规模)，以及对退伍军人管理局或社区资源的自我报告使用和新使用。除了……之外 参与者级别的结果，我们还将通过混合方法评估利益相关者的结果 流程评估。我们的目标将是衡量利益相关者参与活动对 发展和可持续发展退伍军人事务部-社区伙伴关系、信任和沟通以及能力建设。 主要和次要终点的评估将在基线、干预后和6个月进行。 如果该项目达到预期目标，我们将与VHA社区参与办公室和VHA合作 专科护理实施对糖尿病等慢性病的干预

Diabetes-related distress, the negative emotional impact of living with diabetes (DM), is a powerful predictor of psychosocial functioning, treatment adherence, and glycemic control. Practice guidelines and consensus statements call for innovative approaches to address DM-related distress. Despite availability of self- management and psychosocial interventions to reduce DM related distress, these interventions are underutilized due to constraints in time, finances, motivation, and resource-awareness. Interventions that leverage traditional medical care and community-based health promotion programs (e.g., DM self- management education (DSME) programs) may enhance the ability of Veterans with DM to engage with a broad and accessible range of resources. Ensuring that Veterans with DM receive adequate self-care support requires interventions that (1) attend to both medical care and diabetes-related distress and (2) improve Veterans' access and engagement with DSME and traditional medical/mental care. Integrating VA and community health services and DSME resources is innovative and affords great opportunities to enhance Veteran outcomes and build VA community partnerships. Engagement of Veterans and community organizations in developing and delivering care responds to the 2016 HSR&D high-priority domain of Health Care Systems Change and aligns with the 2017 VA Under Secretary's priorities of Greater Choice (offering community and VA resources), Efficiency (community and VA coordination), and Timeliness (telephone delivery). This community-VA partnership and three-month Veteran peer coaching intervention (iNSPiRED) aims to enhance psychological well-being and diabetes self-management behavior in Veterans with DM by facilitating access to and use of healthcare and health promotion resources. The intervention focuses on reducing cognitive and practical barriers to use of services by engaging Veteran peers as coaches and navigators, and by encouraging engagement in health promotion and healthcare services in the VA and the greater community. A secondary goal, integral to the main goal, is to strengthen and integrate VHA partnerships with community- based organizations and Veteran Support Organizations (VSO's). This is a single-blind, parallel group randomized trial of a 3-month peer navigation intervention for Veterans with DM and elevated levels of DM-related distress. We will recruit Veterans with DM-related distress through existing help-seeking channels within and outside of the VA in partnership with community agencies, VSO's, and the Houston VAMC. Eligible Veterans will be assigned at random to the iNSPiRED intervention (peer navigation and coaching) versus usual care (written resource materials and encouragement to continue follow- up with healthcare providers). Consistent with the focus on the overall emotional impact of DM, the PRIMARY OUTCOME is DM-related distress (DM Distress Scale). In previous studies the DDS has shown strong relationships with psychological symptoms, self-management behaviors, and objective measures of glycemic control. SECONDARY OUTCOMES include anxiety symptoms (Generalized Anxiety Disorder Scale), depression symptoms (Patient Health Questionnaire-8), DM self-management behaviors (DM Self- Management Scale), and self-reported use and new use of VA or community resources. In addition to participant-level outcomes, we will also assess STAKEHOLDER OUTCOMES through a mixed methods process evaluation. Our objective will be to measure the impact of stakeholder engagement activities on development and sustainability of VA-community partnerships, trust and communication, and capacity building. Assessment of primary and secondary endpoints will occur at baseline, post-intervention, and at 6 months. If this project meets intended goals, we will partner with VHA Office of Community Engagement and VHA Specialty Care to implement the intervention for DM and other chronic diseases..