Real-World Assessment of Daily Functioning in Veterans with Type 2 Diabetes

患有 2 型糖尿病的退伍军人日常功能的真实世界评估

• 批准号: 10413728
• 负责人: Jennalee S Wooldridge
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10413728
• 关键词: Accelerometer; Accounting; Address; Assessment tool; Attenuated; Behavior; Behavioral Medicine; Blood Glucose; Caring; Characteristics; Clinical; Clinical Trials; Data; Data Collection; Depressed mood; Development; Diabetes Mellitus; Ecological momentary assessment; Enrollment; Environment; Foundations; Future; Goals; Health Care Visit; Impairment; Individual; Informal Social Control; Intervention; Life; Measures; Medical; Mentors; Methods; Modeling; Monitor; Moods; Nature; Non-Insulin-Dependent Diabetes Mellitus; Pain; Participant; Pathway Analysis; Patients; Persons; Physical activity; Post-Traumatic Stress Disorders; Quality of life; Reporting; Research; Research Personnel; Risk; Sampling; Self Management; Social Environment; Social Functioning; Social Interaction; Social support; Source; Statistical Data Interpretation; Stress; Surveys; Symptoms; Technology; Testing; Time; Training; Veterans; Visit; associated symptom; base; blood glucose regulation; career; clinical application; clinical decision-making; contextual factors; cost; daily functioning; design; diabetes self-management; functional disability; improved; innovation; mHealth; medical appointment; medication compliance; psychologic; recruit; social; theories

Type 2 diabetes (T2D) is associated with considerable functional impairment and reduced quality of life. Consistent daily engagement in self-management behaviors, such as physical activity, medication adherence, and monitoring blood glucose is required to maintain daily functioning, quality of life, and glucose control. However, most Veterans do not meet daily self-management targets, particularly physical activity. This is problematic as physical activity is a cornerstone of T2D self-management and represents a fundamental component of functioning. Self-management occurs in the context of patients’ own environments. Thus, assessments at healthcare visits likely miss significant amounts of variability in self-management behaviors as well as daily fluctuations in comorbid symptoms and social contextual factors that influence self-management. The conceptual model guiding the proposal is based on temporal self-regulation theory and posits that because T2D is generally asymptomatic, consequences of poor self-management and benefits of consistent self-management are not salient in the moment. For Veterans with T2D, comorbid symptoms such as mood, pain, and stress are common time-varying momentary barriers to self-management that may particularly impact physical activity. Social context is another well-established set of factors related to self-management among people with T2D. Most research on barriers and facilitators of T2D self-management is cross-sectional and assumes comorbid symptoms and contextual factors are static. Current research does not address the time-varying nature in which these comorbid symptoms and social contextual factors impact physical activity and other self-management behaviors within individuals. Thus, the overarching aim of the current proposal is to understand daily, time-varying factors (comorbid symptoms, social context) that are particularly relevant to Veterans and that influence physical activity, T2D self-management, daily functioning, and quality of life. We will enroll 95 (5 test participants and 90 for the analytic sample) Veterans with T2D and will use ecological momentary assessment (EMA), a method of real-time data collection. Participants will receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which Veterans will report on comorbid symptoms (mood, stress, pain, PTSD), social support, social interactions, physical activity and other self- management behaviors, randomly, during pre-programmed intervals in their natural environment over a 14-day sampling period. Accelerometry will also assess physical activity. With these data, we will address 4 aims: Aim 1) Use EMA to examine within-person time-varying relationships among daily comorbid symptoms (depressed mood, stress, pain, PTSD) and within-day time spent doing physical activities; Aim 2) Use EMA to examine within-person social contextual factors (social support, social interactions) and daily time spent doing physical activities; Exploratory Aim 1) Explore relationships among other within-person time-varying factors, social contextual factors, between-person demographic and T2D specific characteristics, and T2D self-management behaviors that may impact daily functioning and quality of life; and Exploratory Aim 2) Leverage intensive longitudinal data to explore temporal relationships among study variables using network analysis. The successful completion of this CDA will provide the applicant with the necessary training and data to pursue a VA Merit to further examine the complexity of real-world barriers and facilitators of T2D self- management. Results from the current study will help to develop both assessment tools and clinical interventions. Assessment tools developed from the present study can inform clinical decision making that takes into account barriers to self-management that occur outside of medical appointments. Clinical applications include tailored, adaptive technology-supported interventions that provide the right type and amount of support, at the right time by adapting to an individual’s changing internal and contextual state.

2型糖尿病（T2D）与相当大的功能障碍和生活质量降低有关。 持续的日常自我管理行为，如身体活动，药物依从性， 并且需要监测血糖以维持日常功能、生活质量和血糖控制。 然而，大多数退伍军人没有达到日常自我管理的目标，特别是身体活动。这是 身体活动是T2D自我管理的基石， 功能的组成部分。自我管理发生在患者自身环境的背景下。因此，在本发明中， 在医疗保健访问的评估可能会错过自我管理行为的显著差异， 以及影响自我管理的共病症状和社会背景因素的日常波动。 指导该建议的概念模型基于时间自我调节理论，并假定， 因为T2D通常是无症状的，自我管理不良的后果和一致的益处 自我管理在当下并不突出。对于患有T2D的退伍军人，共病症状如情绪， 疼痛和压力是自我管理的常见时变暂时障碍， 影响身体活动。社会环境是另一个与自我管理相关的既定因素 在T2D患者中。大多数关于T2D自我管理的障碍和促进因素的研究都是横断面的 并假设共病症状和背景因素是静态的。目前的研究并不涉及 这些共病症状和社会背景因素影响体力活动的时变性质 以及其他个人自我管理行为。因此，本提案的总体目标是 了解日常的，随时间变化的因素（共病症状，社会背景），特别是相关的 退伍军人和影响身体活动，T2D自我管理，日常功能和生活质量。 我们将招募95名（5名测试参与者和90名分析样本）T2D退伍军人，并将使用 生态瞬时评估（EMA），一种实时数据收集方法。参与者将获得5 瞬时EMA调查和每天1次每日EMA调查，其中退伍军人将报告共病 症状（情绪，压力，疼痛，创伤后应激障碍），社会支持，社会互动，身体活动和其他自我- 管理行为，随机，在预先编程的时间间隔，在他们的自然环境超过14天 采样周期加速度计还将评估身体活动。有了这些数据，我们将实现4个目标： 1)使用EMA检查日常共病症状（抑郁）之间的人内时变关系 情绪，压力，疼痛，创伤后应激障碍）和一天内花在体力活动上的时间;目的2）使用EMA检查 人内社会环境因素（社会支持，社会互动）和每天花在身体上的时间 活动;探索性目标1）探索其他人内时变因素、社会 情境因素、人与人之间的人口统计学和T2D具体特征以及T2D自我管理 可能影响日常功能和生活质量的行为;以及探索性目标2）利用强化 纵向数据，探讨研究变量之间的时间关系，使用网络分析。 成功完成本CDA将为申请人提供必要的培训和数据， 追求VA优点，以进一步研究T2D自我的现实世界的障碍和促进因素的复杂性， 管理目前研究的结果将有助于开发评估工具和临床 干预措施。本研究开发的评估工具可以为临床决策提供信息， 考虑到在医疗预约之外发生的自我管理障碍。临床 应用程序包括量身定制的，适应性技术支持的干预措施，提供正确的类型， 通过适应个人不断变化的内部和环境状态，在适当的时候提供支持。