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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。

基本信息

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
项目类别：
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

项目摘要

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).

项目总结