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

项目摘要 该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老年青少年和初出茅庐成年人的代谢控制 (16-25)，T1D。这个年龄段的年轻人表现出持续到成年的慢性代谢控制不良 导致糖尿病短期和长期并发症过早出现。从发展上讲， 青春期和成年初期尤其需要独立和自主。 很突出。这一新的干预措施将通过设计一种干预措施来利用年轻人对自主的渴望 支持糖尿病患者自主管理。这种干预是以自决理论(SDT)为指导的 这表明自主性(即，自我启动，由内在动机与外在动机驱动)糖尿病 管理依赖于三个条件：1)认为一个人的行为是自我导向的；2)感觉 能力或自我效能感，以及3)存在支持行为的关怀关系。我们有 确定了针对SDT构建物的三个干预组件。问题提示列表(QPL)是一种 简单、廉价的工具，包括患者可能会考虑询问其医疗保健的一系列问题 在一次诊所访问中提供服务。QPL使患者能够承担更积极的角色(提出问题和 陈述担忧)。动机增强系统(MES)是一种电子健康干预措施 增加健康行为改变的内在动力。MES内容以激励为基础 访谈框架与健康的信息-动机-行为技能(IMB)模型 行为变化假定行为变化是三个关键组成部分共同作用的结果： 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，以及执行行为所必需的行为技能(自我效能)。短信提醒 (TXT)是一项鼓励年轻人完成糖尿病自我护理的战略，这也会导致自我保健 通过加强沟通和加强与糖尿病护理提供者的关系 满足感。我们将测试这些干预成分在改善代谢控制方面的有效性 成分选择实验(N=320)。实验将采用析因研究设计，随机 确定哪些干预组件有助于临床显著改善的任务 (≥0.5%)。这项研究的结果将是一种优化的、多成分的有效干预 规模估计将被用来为大规模、全功率的有效性试验提供信息。这一理论驱动 干预措施将可扩展到各种慢性病背景和从中获得的知识 研究将为针对这一人群的自我决定理论和行为干预提供信息(针对 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).