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

背景：Kristen Gray博士，博士，硕士，是西雅图HSR&D中心的博士后研究员， 以退伍军人为中心和价值驱动的护理创新和卫生部高级研究员 服务于华盛顿大学公共卫生学院。她的研究反映了她对 了解和减轻女性退伍军人之间的健康差距。建议职业 发展奖（CDA）将为格雷博士提供建立一个 成功的职业生涯作为一个独立的VA健康服务研究员开发和测试行为健康 干预WVs。 研究的关键要素：拟议的CDA的目标是开发和试点测试 虚拟糖尿病自我管理的可行性、可接受性和初步临床改进 针对男女退伍军人及其支助人员的干预措施。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 不支持的行为，以改善退伍军人的自我管理行为和疾病的结果。 检查结果中的性别差异是该提案的一个重点，因为：（1）VA证据- 最近，一个基于综合的项目发现，在非药物治疗中， 糖尿病干预，和（2）自我管理干预的VA试验包括很少或没有女性， 排除了对性别差异的研究， 该提案的具体目标是：（1）确定男女退伍军人社会支助资源的特点， 与糖尿病自我管理相关的支持性和不支持性行为的看法，以及促进者 以及通过定性电话访谈参与合作自我管理干预的障碍; (2)确定支持者对退伍军人自我支持和不支持行为的看法， 管理和促进者和障碍，以参与合作的自我管理干预， 定性访谈;和（3）评估可行性，可接受性，和初步的临床改善， 在一项单臂试点试验中合作进行糖尿病自我管理干预。根据目标1和 2.干预措施将量身定制，以促进退伍军人和支持人员的招募和保留， 目标3试点研究。同样数量的男女退伍军人将参加试点， 检查可行性、可接受性和临床改善方面的性别差异。所得产物 这将是一个完善的干预措施，将在一个更大的，多地点的随机对照试验。 培训：为了完成CDA和职业目标，Gray博士将寻求额外的培训，以加强 她的卫生服务研究技能：1）定性方法，2）健康行为改变，和3）试验设计。 她还将开始实施科学的入门培训。她将参加课程在 华盛顿大学、地方和国家培训、临床跟踪和其他专业活动， 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批多元化和合格的导师的支持， 包括糖尿病专家（Karin纳尔逊博士），定性方法（Corrine Voils博士）;行为随机 对照试验（洛里·巴西安和沃尔斯博士）和虚拟医疗保健（约翰·福特尼博士）。其他CDA 顾问将提供慢性病自我管理干预的指导（Michele Heisler博士）。 影响：该CDA将加速Gray博士作为VA卫生服务调查员的独立性， 促进WVs的健康。拟议的研究与指导和培训相结合，将 提供必要的经验和知识，以培养一个独立的卫生服务计划 研究的重点是开发和测试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.