Social Network Analysis and Social Support Intervention for Rural Dwelling Older Adults with T2DM

农村2型糖尿病老年人的社会网络分析与社会支持干预

• 批准号: 10541154
• 负责人: Brittany L. Smalls
• 金额: $ 14.78万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10541154
• 关键词: Address; Adherence; Adult; Affect; Age; Aging; Attention; Behavior; Blindness; Blood Pressure; Clinical; Communities; Community Health Aides; Complications of Diabetes Mellitus; Coronary Arteriosclerosis; County; Decision Making; Diabetes Mellitus; Diagnosis; Disease; Education; Effectiveness; Elderly; Environment; Epidemic; Exposure to; Foundations; Geriatrics; Glycosylated hemoglobin A; Health Food; Health Personnel; Health behavior; High Prevalence; Individual; Influentials; Intervention; Interview; Kentucky; Kidney Diseases; Knowledge; Life Expectancy; Maps; Medical Records; Methods; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pathway Analysis; Persons; Play; Population; Positioning Attribute; Poverty; Prevalence; Quality of life; Regimen; Research; Research Personnel; Risk; Role; Rural Appalachia; Rural Community; Self Care; Social Environment; Social Network; Social support; Source; Stress; Stroke; Structure; Surveys; Syndrome; Training; United States National Institutes of Health; aging population; blood lipid; cognitive function; diabetes management; diabetes self-management; disease transmission; empowerment; experience; fall risk; feasibility testing; frailty; glycemic control; health care service; health communication; health literacy; improved; individual patient; innovation; member; negative affect; post intervention; premature; programs; recruit; rural area; rural dwellers; rural residence; sarcopenia; social; social competition; statistics

7. PROJECT SUMMARY/ABSTRACT Approximately 29.1 million (9.3%) adults in the US have type 2 diabetes (T2DM).1 T2DM is associated with significant complications including premature coronary artery disease, kidney disease, stroke, and blindness.1 Estimates show that prevalence of T2DM is 17% higher in rural dwellers compared to their urban counterparts.2 For example, the prevalence of T2DM for adults in Kentucky's rural Appalachian counties is 13.6%,3 compared to the overall state prevalence of 10.6% 3. Appropriate self-care behaviors are necessary for optimal clinical outcomes in T2DM 4-6 and account for 90% of the variance in glycemic control 7. Yet, self-care among T2DM is notoriously poor in general and even worse in rural-dwellers. Without attention to improving self-care in this population, we are facing an epidemic of T2DM complications in rural areas of the US. The impact of living with T2DM in rural communities is compounded in the aging population. The prevalence of T2DM increases with age and an estimated 25% of older adults (≥65 years) have T2DM 8. Older adults living with T2DM have more difficulty than younger people adhering to self-care regimens and social/environment factors account for up to 85% of their self-care nonadherence.6,9-13 Notable social/environment factors include competing social demands, lack of social support (SS), and stress.14-17 Social support plays a particularly significant role in older adults with T2DM. The extent and type of SS available in rural communities can positively or negatively impact self-care in those diagnosed with T2DM. 18-25 To better understand the effects of the social environment in communities where older rural dwelling adults reside and to lay the foundation for interventions, social network analysis (SNA) will be used to determine social support network structures. By using SNA, social support structures can be developed and relationships between individuals within a social network can be evaluated. 26 The overall objective of this study is to improve T2DM self-care regimens in older rural dwelling adults by training influential community members to be community health workers and provide social support strategies within an older adults' existing social network that promotes T2DM self-care. The proposed study seeks to: Aim 1—Use social network analysis to identify key players in a rural community to serve as community health workers for those living with T2DM. Aim 2—Use mixed methods to evaluate the impact of social support on T2DM self-care and clinical outcomes and evaluate social networks in rural dwelling older adults with T2DM. Aim 3—Test the feasibility and preliminary effectiveness of a 6-week intervention administered by community health workers with the support of members of older adults' individual social network.

7.项目总结/摘要 美国约有2910万（9.3%）成人患有2型糖尿病（T2 DM）。1 T2 DM与 严重并发症包括早发冠状动脉疾病、肾脏疾病、中风， 1估计显示，农村居民的T2 DM患病率比城市居民高17%， 2例如，肯塔基州阿巴拉契亚县农村成年人的T2 DM患病率为 13.6%，3相比之下，全州患病率为10.6%3.适当的自我照顾行为是必要的， T2 DM 4-6的最佳临床结局，并占血糖控制方差的90% 7。然而，自我照顾 众所周知，T2 DM患者的总体健康状况较差，在农村居民中甚至更糟。不注意改善 自我保健在这一人群中，我们正面临着T2 DM并发症在美国农村地区的流行。 农村社区T2 DM患者的影响在人口老龄化中更为复杂。的 T2 DM的患病率随年龄增长而增加，估计25%的老年人（≥65岁）患有T2 DM 8。老年 成年T2 DM患者比年轻人更难坚持自我护理方案， 社会/环境因素占其自我护理不依从性的85%。6，9 -13 社会/环境因素包括相互竞争的社会需求、缺乏社会支持和压力。 支持在老年T2 DM患者中起着特别重要的作用。可用SS的范围和类型 农村社区可以积极或消极地影响诊断为T2 DM的患者的自我护理。18-25 为了更好地了解社会环境对老年人居住的社区的影响， 为了为干预措施奠定基础，将使用社会网络分析（SNA）来确定 社会支持网络结构。通过使用SNA，可以建立社会支持结构， 可以评估社交网络内的个体之间的关系。26本研究的总体目标是改善 通过培训有影响力的社区成员， 社区卫生工作者，并在老年人现有的社会网络中提供社会支持策略 促进T2 DM自我护理。 拟议的研究旨在： 目标1-利用社会网络分析确定农村社区的主要参与者，以作为社区 为T2 DM患者提供医疗服务。 目的2-使用混合方法评估社会支持对T2 DM自我护理和临床的影响 结果并评估农村居住的老年T2 DM患者的社交网络。 目标3-测试6周干预的可行性和初步有效性， 社区卫生工作者在老年人个人社会网络成员的支持下。