Improving Diabetes Health in Emerging Adulthood Through an Autonomy Supportive Intervention.

通过自主支持干预改善成年初期的糖尿病健康。

• 批准号: 10337039
• 负责人: April Marie Idalski Carcone
• 金额: $ 52.68万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-06 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10337039
• 关键词: Address; Adolescence; Adolescent; Adult; Aftercare; Age; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Caring; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical Trials; Communication; Competence; Complications of Diabetes Mellitus; Decision Making; Development; Diabetes Mellitus; Engineering; Experimental Designs; Feedback; Feeling; Frequencies; Glycosylated hemoglobin A; Goals; Health; Health Personnel; Health behavior; Health behavior change; Healthcare; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Link; Measures; Mediating; Medical; Mental Depression; Metabolic Control; Modeling; Moods; Motivation; Outcome; Patient Self-Report; Patients; Perception; Process; Provider; Randomized; Randomized Clinical Trials; Research; Research Design; Resources; Risk; Risk Behaviors; Role; Sample Size; Self Determination; Self Efficacy; Self Management; Self-Direction; Site; Social support; System; Target Populations; Testing; Text Messaging; Time; Treatment Efficacy; Visit; Youth; age group; base; behavior change; behavior in diabetes management; behavior test; care providers; clinically significant; design; diabetes management; diabetes self-management; eHealth; effectiveness trial; efficacy evaluation; efficacy testing; emerging adult; emerging adulthood; experimental study; extrinsic motivation; family support; follow-up; glucose monitor; improved; indexing; innovation; intervention effect; intrinsic motivation; joint function; motivational enhancement therapy; multi-component intervention; multiphase optimization strategy; peer support; premature; primary outcome; psychologic; satisfaction; sex; skills; theories; therapy design; tool; young adult

Project Summary This project will use the multiphase optimization strategy (MOST) approach to test the efficacy of an autonomy supportive behavioral intervention to improve metabolic control among older adolescents and emerging adults (16-25) with T1D. Youth this age demonstrate chronic poor metabolic control that persists into adulthood leading to the premature emergence of short- and long-term diabetes complications. Developmentally, adolescence and emerging adulthood is a time when the need for independence and autonomy are particularly salient. This new intervention will leverage youths’ desire for autonomy by designing an intervention to support diabetes self-management autonomy. This intervention is guided by self-determination theory (SDT) which suggests that autonomous (i.e., self-initiated, driven by intrinsic versus extrinsic motivation) diabetes management depends upon three conditions: 1) the perception that one’s behavior is self-directed, 2) feelings of competence, or self-efficacy, and 3) the existence of caring relationships supportive of the behavior. We have identified three intervention components that target the SDT constructs. A question prompt list (QPL) is a simple, inexpensive tool comprised of a list of questions that patients might consider asking their health care provider during a clinic visit. QPLs empower patients to assume a more active role (asking questions and stating concerns) during clinic visits. The Motivation Enhancing System (MES) is an eHealth intervention to increase intrinsic motivation for health behavior change. MES content is based on the Motivational Interviewing (MI) framework and the Information-Motivation-Behavioral Skills (IMB) model of health behavior change which posits that behavior change results from the joint function of three critical components: accurate information about risk behaviors or their replacement health behaviors, motivation to change behavior, and behavioral skills necessary to perform the behavior (self-efficacy). Text message reminders (TXT) are a strategy to encourage youth to complete their diabetes self-care that also lead to gains in self- efficacy and a stronger relationship with diabetes care providers through greater communication and satisfaction. We will test the efficacy of these intervention components toward improving metabolic control in a component selection experiment (N=320). The experiment will use a factorial research design with random assignment to determine which intervention components contribute to a clinically significant improvement (≥0.5%) in HbA1c. The result of this research will be an optimized, multi-component intervention with effect size estimates that will be used to inform a large scale, fully powered effectiveness trial. This theory-driven intervention will be scalable to a variety of chronic illness contexts and the knowledge gained from this research will inform self-determination theory and behavioral interventions targeting this population (for which there currently are none).

项目概要 该项目将使用多阶段优化策略（MOST）方法来测试自治系统的功效 支持性行为干预，以改善老年青少年和新兴成年人的代谢控制 (16-25) 与 T1D。这个年龄段的青少年表现出慢性代谢控制不良，这种情况一直持续到成年 导致短期和长期糖尿病并发症的过早出现。从发展上来说， 青春期和成年初期是特别需要独立和自主的时期 突出。这项新的干预措施将通过设计干预措施来利用年轻人对自主的渴望 支持糖尿病自我管理自主权。这种干预以自决理论（SDT）为指导 这表明自主（即自我发起，由内在动机与外在动机驱动）糖尿病 管理取决于三个条件：1）认为自己的行为是自我导向的，2）感受 能力或自我效能感，以及 3）支持该行为的关怀关系的存在。我们有 确定了针对 SDT 结构的三个干预组成部分。问题提示列表（QPL）是 简单、廉价的工具，由患者可能考虑询问其医疗保健的一系列问题组成 诊所就诊期间的提供者。 QPL 使患者能够发挥更积极的作用（提出问题和 在就诊期间陈述疑虑。动机增强系统 (MES) 是一种电子健康干预措施 增加健康行为改变的内在动力。 MES 内容基于励志 访谈（MI）框架和健康信息-动机-行为技能（IMB）模型 行为改变假设行为改变是三个关键组成部分共同作用的结果： 有关风险行为或其替代健康行为、改变动机的准确信息 行为以及执行该行为所需的行为技能（自我效能）。短信提醒 (TXT) 是一项鼓励青少年完成糖尿病自我护理的策略，这也有助于提高自我护理能力 通过加强沟通和与糖尿病护理提供者建立更牢固的关系 满意。我们将测试这些干预措施在改善代谢控制方面的功效 成分选择实验（N=320）。该实验将使用随机的因子研究设计 分配以确定哪些干预措施有助于临床显着改善 (≥0.5%) 的 HbA1c。这项研究的结果将是一种优化的、有效的多成分干预措施 规模估计将用于为大规模、全功率有效性试验提供信息。这种理论驱动的 干预措施将可扩展到各种慢性病背景以及从中获得的知识 研究将为自决理论和针对这一人群的行为干预提供信息（例如 目前还没有）。