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

项目摘要 本项目将使用多阶段优化策略（MOST）方法来测试自治的有效性 支持性行为干预改善大龄青少年和新生儿的代谢控制 （16 - 25）T1D。这个年龄段的年轻人表现出慢性代谢控制不良，并持续到成年 导致短期和长期糖尿病并发症的过早出现。从发育上来说， 青春期和成年期是一个需要独立和自主的时期， 很明显这项新的干预措施将通过设计一种干预措施， 支持糖尿病自我管理自治。这种干预是由自我决定理论（SDT）指导的 这表明自主（即，自我发起，由内在与外在动机驱动）糖尿病 管理取决于三个条件：1）一个人的行为是自我指导的感觉，2）感觉 能力，或自我效能，和3）存在的关怀关系支持的行为。我们有 确定了针对SDT结构的三个干预组件。问题提示列表（Question Prompt List，QPL） 一个简单、便宜的工具，包括一系列问题，患者可能会考虑向他们的医疗保健机构提出这些问题。 在诊所访问期间提供者。QPL使患者能够承担更积极的角色（提出问题和 在诊所访问期间表示关注。动机增强系统（MES）是一种电子健康干预措施， 增加改变健康行为内在动机。MES内容基于动机 访谈（MI）框架和健康的信息-动机-行为技能（IMB）模型 行为改变，认为行为改变是三个关键因素共同作用的结果： 关于危险行为或其替代健康行为的准确信息，改变的动机 行为，以及执行行为所需的行为技能（自我效能）。短信提醒 (TXT)是一种鼓励年轻人完成糖尿病自我护理的策略， 通过更好的沟通，提高疗效，并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成分对改善代谢控制的有效性， 组分筛选实验（N = 320）。实验将采用析因研究设计， 分配以确定哪些干预成分有助于临床显著改善 （≥ 0.5%）。本研究的结果将是一个优化的，多成分的干预与效果 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疾病背景， 研究将为针对这一人群的自决理论和行为干预提供信息（ 目前还没有）。

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).