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

糖尿病相关的痛苦，糖尿病患者（DM）生活的负面情绪影响，是一个强大的预测， 心理社会功能、治疗依从性和血糖控制。实践指南和共识 发言呼吁采取创新办法，解决与糖尿病有关的困扰。尽管有自我- 管理和心理社会干预，以减少DM相关的困扰，这些干预措施是 由于时间、资金、动机和资源意识方面的限制，未得到充分利用。的干预措施 利用传统的医疗保健和基于社区的健康促进计划（例如，DM自我- 管理教育（DSME）计划）可以提高退伍军人与DM的能力， 广泛和可访问的资源范围。确保患有DM的退伍军人获得足够的自我护理支持 需要干预措施，（1）照顾医疗保健和糖尿病相关的痛苦和（2）改善 退伍军人的访问和参与DSME和传统的医疗/精神护理。整合VA和 社区卫生服务和DSME资源是创新的，并提供了很大的机会，以提高 退伍军人成果和建立VA社区伙伴关系。退伍军人和社区的参与 组织在发展和提供保健响应2016年HSR&D的高度优先领域的健康 护理系统的变化，并与2017年VA副部长的更多选择的优先事项保持一致 （提供社区和VA资源）、效率（社区和VA协调）和时间性 （电话传递）。 这种社区-VA伙伴关系和为期三个月的退伍军人同伴指导干预（iNSPiRED）旨在 通过促进糖尿病退伍军人的心理健康和糖尿病自我管理行为， 获得和使用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，消除使用服务的认知和实际障碍， 通过鼓励参与退伍军人事务部和更大社区的健康促进和医疗保健服务。 第二个目标是加强和整合VHA与社区的伙伴关系，这是主要目标的组成部分。 退伍军人支持组织（VSO）。 这是一项对退伍军人进行为期3个月的同伴导航干预的单盲、平行组随机试验 患有糖尿病和糖尿病相关的抑郁水平升高。我们将招募退伍军人与DM相关的痛苦，通过 退伍军人事务部内外与社区机构、VSO合作的现有求助渠道， 和休斯顿VAMC合格的退伍军人将被随机分配到iNSPiRED干预（同行 导航和指导）与常规护理（书面资源材料和鼓励继续遵循- 医疗保健提供者）。与关注DM的整体情绪影响一致， 结果是DM相关的痛苦（DM痛苦量表）。在以前的研究中，DDS表现出很强的 与心理症状、自我管理行为和血糖客观指标的关系 控制次要结局包括焦虑症状（广泛性焦虑障碍量表）， 抑郁症状（患者健康问卷-8）、DM自我管理行为（DM自我管理行为） 管理规模），自我报告的使用和新的使用VA或社区资源。除了 参与者层面的结果，我们还将通过混合方法评估利益相关者的结果 过程评价我们的目标是衡量利益相关者参与活动对 脆弱性评估-社区伙伴关系的发展和可持续性、信任和沟通以及能力建设。 将在基线、干预后和6个月时评估主要和次要终点。 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 实施糖尿病和其他慢性病干预的专科护理。

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..