Enhancing social support for diabetes self-management among men and women Veterans

背景：克里斯汀·格雷博士，博士，硕士，西雅图高铁研发中心博士后研究员 以退伍军人为中心和价值驱动的医疗创新--卫生部高级研究员 华盛顿大学公共卫生学院的服务。她的研究反映出她致力于 了解和缓解女性退伍军人(WVS)的健康差距。计划中的职业 发展奖(CDA)将为Gray博士提供建立 作为一名独立的退伍军人健康服务研究人员，成功地开发和测试行为健康 针对WVS的干预措施。 研究计划的主要内容：拟议的CDA的目标是开发和试行 虚拟糖尿病自我管理的可行性、可接受性和初步临床改善 针对男性和女性退伍军人及其支持人员的干预措施。干预将是二元的， 包括退伍军人及其支持人员，并将重点加强支持和减少 不支持行为，以改善退伍军人的自我管理行为和疾病结局。 审查结果中的性别差异是该提案的一个关键重点，因为：(1)退伍军人事务部的证据-- 基于综合的研究项目最近发现非药理学领域的性别差异知识存在差距。 糖尿病干预措施，以及(2)VA自我管理干预措施试验很少或没有妇女参与， 排除了性别差异的检查， 该提案的具体目的是：(1)描述男女退伍军人的社会支持资源， 与糖尿病自我管理相关的支持性和非支持性行为的认知，以及促进者 以及通过定性电话访谈参与伙伴自我管理干预的障碍； (2)识别支持人员对退伍军人自我支持和不支持行为的认知 管理和促进者以及通过以下方式参与伙伴自我管理干预的障碍 定性访谈；以及(3)评估A组治疗的可行性、可接受性和初步临床改善。 在单臂飞行员试验中合作进行糖尿病自我管理干预。基于AIMS 1和 2、干预措施将量身定做，以促进招募和留住退伍军人和支助人员 目的3先导研究。将有同等数量的男性和女性退伍军人参加试点，以使 检查性别差异在可行性、可接受性和临床改善方面的差异。由此产生的产品 这将是一项精细化的干预措施，将在一项更大规模的多地点随机对照试验中进行测试。 培训：为了实现CDA和职业目标，格雷博士将寻求额外的培训以加强 她的卫生服务研究技能包括：1)定性方法，2)健康行为改变，3)试验设计。 她还将开始实施科学方面的入门培训。她将参加学校的课程学习 华盛顿大学，地方和国家培训，临床跟踪和其他专业活动，以 实现这些培训目标。 导师：格雷博士在她的培训和研究中得到了一组多样化和合格的导师的支持， 包括糖尿病专家(Karin Nelson博士)、定性方法(Corine Voils博士)；行为随机化 对照试验(Lori Basian博士和Voils博士)和虚拟医疗保健(John Fortney博士)。其他CDA 顾问将在慢性病自我管理干预方面提供指导(米歇尔·海斯勒博士)。 影响：这一CDA将促进格雷博士作为退伍军人健康服务调查员的独立性，致力于 促进WVS的健康。这项研究提出，结合导师和培训，将 提供必要的经验和知识，以培养独立的卫生服务计划 研究重点是开发和测试针对WVS的行为健康干预措施。

BACKGROUND: Dr. Kristen Gray, PhD, MS is a Postdoctoral Fellow at the Seattle HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care and a Senior Fellow in the Department of Health Services in the University of Washington School of Public Health. Her research reflects a commitment to understanding and mitigating health disparities among women Veterans (WVs). The proposed Career Development Award (CDA) will provide Dr. Gray with the additional training and skills needed to build a successful career as an independent VA health services researcher developing and testing behavioral health interventions for WVs. KEY ELEMENTS OF THE RESEARCH PLAN: The goal of the proposed CDA is to develop and pilot test the feasibility, acceptability, and preliminary clinical improvement of a virtual diabetes self-management intervention tailored to men and women Veterans and their support persons. The intervention will be dyadic, including Veterans and their support persons, and will focus on enhancing supportive and reducing unsupportive behaviors in order to improve Veterans' self-management behaviors and disease outcomes. Examination of gender differences in outcomes is a key focus of the proposal because: (1) the VA Evidence- based Synthesis program recently identified a gap in knowledge of gender differences in non-pharmacologic diabetes interventions, and (2) VA trials of self-management interventions have included few or no women, precluding examination of gender differences, The specific aims of the proposal are to: (1) characterize women and men Veterans' social support resources, perceptions of supportive and unsupportive behaviors related to diabetes self-management, and facilitators and barriers to engaging in a partnered self-management intervention through qualitative telephone interviews; (2) identify support person perceptions of supportive and unsupportive behaviors for Veterans' self- management and facilitators and barriers to engaging in a partnered self-management intervention through qualitative interviews; and (3) evaluate feasibility, acceptability, and preliminary clinical improvement of a partnered diabetes self-management intervention in a single-arm pilot trial. Based on findings from Aims 1 and 2, the intervention will be tailored to facilitate recruitment and retention of Veterans and support persons in the Aim 3 pilot study. An equal number of men and women Veterans will be enrolled in the pilot to enable examination of gender differences in feasibility, acceptability, and clinical improvement. The resulting product will be a refined intervention, which will be tested in a larger, multi-site randomized controlled trial. TRAINING: In order to accomplish CDA and career goals, Dr. Gray will seek additional training to strengthen her health services research skills in: 1) qualitative methods, 2) health behavior change, and 3) trial design. She will also begin introductory training in implementation science. She will participate in coursework at the University of Washington, local and national trainings, clinical shadowing, and other professional activities to achieve these training goals. MENTORS: Dr. Gray is supported in her training and research by a diverse and well-qualified set of mentors, including experts in diabetes (Dr. Karin Nelson), qualitative methods (Dr. Corrine Voils); behavioral randomized controlled trials (Drs. Lori Basian and Voils), and virtual health care (Dr. John Fortney). Additional CDA consultants will provide guidance in chronic disease self-management interventions (Dr. Michele Heisler). IMPACT: This CDA will accelerate Dr. Gray's independence as a VA health services investigator dedicated to advancing the health of WVs. The research proposed, in combination with the mentorship and training, will provide the necessary experience and knowledge to cultivate an independent program of health services research focused on developing and testing behavioral health interventions for WVs.