CVD RISK MANAGEMENT IN DIABETIC BLACKS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。患有2型糖尿病的非裔美国人患心脏病的几率很高。心脏病的危险因素，如高血糖、血压和胆固醇，可以通过医疗管理和改变生活方式行为来控制。治疗糖尿病和改变生活方式是很困难的。解决问题是一种自我管理工具，被认为对糖尿病的有效自我护理和克服障碍，使生活方式的改变对预防或控制心脏病至关重要。但是，培训解决问题和健康管理决策的方法尚未很好地建立起来。本研究将测试一种新的问卷，用于测量与健康相关的问题解决能力，以及一种新的问题解决培训，应用于非裔美国人2型糖尿病患者糖尿病和心脏病风险因素的自我管理。具体目标是：1)评估有效与无效健康问题解决能力问卷（健康问题解决量表）的效度和信度；2)开发一种新的干预措施，向无效问题解决者教授健康问题解决技能；3)在心脏病高风险和无效健康问题解决技能的参与者样本中开展一项试点研究。测试简短的健康问题解决训练与强化的健康问题解决训练是否能提高解决问题的能力、健康行为和心脏病风险因素。参与者是患有2型糖尿病的城市非裔美国人。本研究将分为健康问题解决量表开发（研究1）和健康问题解决干预（研究2）两部分。研究1的资格标准包括低心血管疾病风险概况（在本研究计划中定义为血压、胆固醇和血糖的最佳控制），或高心血管疾病风险概况（定义为高血压、和/或高胆固醇和/或高血糖）。参与者将完成健康问题解决量表和其他问题解决和行为测试。在完成健康问题解决量表问卷验证研究后，60名符合高心血管疾病风险标准并在健康问题解决量表中得分为一系列无效问题解决的参与者将被纳入研究2，即问题解决培训研究。参与者将像抛硬币一样被随机分配到最小干预组或强化干预组。最小干预组将接受心脏病风险教育课程+简短的健康问题解决培训（每周2次小组会议和1次电话随访）。强化干预组将接受心脏病风险教育课程+强化健康问题解决培训（每周9次小组会议和1次电话随访）。在基线和干预组结束后6个月，参与者将评估他们的血糖（HbA1c）、胆固醇和血压。此外，他们将完成关于问题解决、自我管理依从性、知识、健康行为、心血管疾病风险管理目标进展和生活质量的问卷调查。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. African Americans with type 2 diabetes suffer high rates of heart disease. Risk factors for heart disease, such as high blood sugar, blood pressure, and cholesterol, can be controlled through medical management and changes in lifestyle behaviors. Taking care of diabetes and changing lifestyle behaviors can be difficult. Problem solving is one self-management tool deemed important for effective self-care of diabetes and for overcoming barriers to making the lifestyle changes essential for preventing or managing heart disease. But, methods for training problem solving and decision making for managing health have not been well established. This study will test a new questionnaire for measuring health-related problem-solving abilities and a new problem-solving training applied to self-management of diabetes and heart disease risk factors in African Americans with type 2 diabetes. The specific aims are: 1) to assess the validity and reliability of a questionnaire of effective vs. ineffective health-related problem-solving ability (Health Problem-Solving Scale), 2) to develop a new intervention to teach health-related problem-solving skills to ineffective problem solvers, and 3) to conduct a pilot study with a sample of participants who have a high risk for heart disease AND ineffective health-related problem-solving skills, to test whether a brief vs. an intensive health problem-solving training improves problem solving ability, health behaviors, and heart disease risk factors. Participants are urban African Americans with type 2 diabetes. The research will be conducted in two parts, Health Problem-Solving Scale development (Study 1) and Health Problem-Solving Intervention (Study 2). Eligibility criteria for Study 1 include Low CVD Risk Profile (defined in this research proposal as optimal control of blood pressure, cholesterol, and blood sugar), or a High CVD Risk Profile (defined as high blood pressure, and/or high cholesterol, and/or high blood sugar). Participants will complete the Health Problem-Solving Scale and additional tests of problem solving and behavior. Upon completion of the Health Problem-Solving Scale questionnaire validation study, 60 participants who meet criteria for high CVD risk, and who score with a range of ineffective problem solving on the Health Problem-Solving Scale, will be participants in Study 2, the problem-solving training study. Participants will be randomly assigned, like flipping a coin, into either a Minimal Intervention group or an Intensive Intervention group. The Minimal Intervention group will receive Heart Disease Risk Education class + Brief Health Problem-Solving Training (2 weekly group sessions and 1 telephone follow-up). The Intensive Intervention Group will receive the Heart Disease Risk Education class + Intensive Health Problem-Solving Training (9 weekly group sessions and 1 telephone follow-up). At baseline and at 6 months after the intervention groups have ended, participants will have their blood sugar (HbA1c), cholesterol, and blood pressure assessed. In addition, they will complete questionnaires about problem solving, self-management adherence, knowledge, health behaviors, progress toward CVD risk management goals, and quality of life.