Randomized Trial of CVD Education and Problem-Solving Training in Urban Diabetics

城市糖尿病患者心血管疾病教育和问题解决训练的随机试验

• 批准号: 8073975
• 负责人: FELICIA HILL-BRIGGS
• 金额: $ 77.27万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073975
• 关键词: Address; Adult; African American; Behavior; Behavior Therapy; Behavioral; Behavioral Medicine; Blood Glucose; Blood Pressure; Blood Vessels; Body mass index; Cardiovascular Diseases; Characteristics; Cholesterol; Clinical; Community Health Education; Comorbidity; Complications of Diabetes Mellitus; Cost Effectiveness Analysis; Costs and Benefits; Counseling; Data; Decision Making; Development; Diabetes Mellitus; Dyslipidemias; Education; Educational Intervention; Effectiveness; Effectiveness of Interventions; Environment; Evidence based intervention; Glycosylated hemoglobin A; Goals; Health; Health Communication; Hyperglycemia; Hypertension; Individual; Intervention; K-Series Research Career Programs; Knowledge; Learning; Life; Lipids; Maps; Medical; Mentored Research Scientist Development Award; Methods; Minority; Modality; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Education; Patients; Physical activity; Population; Prevention; Principal Investigator; Problem Solving; Randomized; Recommendation; Recruitment Activity; Research; Research Personnel; Resources; Risk; Risk Factors; Self Care; Self Management; Testing; Training; Training Programs; Translating; Use Effectiveness; Visit; Weight; arm; base; behavior change; blood lipid; burden of illness; cardiovascular disorder education; cardiovascular disorder epidemiology; cardiovascular disorder prevention; cardiovascular disorder risk; career development; clinical practice; compare effectiveness; cost effectiveness; diabetes education; diabetic; experience; four-arm study; functional health literacy; health literacy; high risk; improved; literacy; post intervention; programs; randomized trial; skills; tool; treatment as usual

DESCRIPTION (provided by applicant): African Americans with type 2 diabetes suffer excess disease burden, but cardiovascular disease (CVD) risk factors such as hyperglycemia, hypertension, and dyslipidemia are modifiable with medical management and lifestyle modification. Patient diabetes education and counseling for behavior change are recommended standards of practice to facilitate effective self-management of these risk factors. However, for patients with low literacy or health literacy, accessibility and impact of educational and behavioral interventions are limited. Pilot research suggests that: a) literacy demand and behavioral activation characteristics of patient education modules can be adapted to facilitate learning in urban patients with low literacy, and b) combining literacy- adapted education with problem-solving training facilitates understanding and use of health information for performing self-management in the context of daily life (functional health literacy). Optimal modalities for delivery of a combined patient diabetes education and problem-solving training, and cost-effectiveness of this intervention model, however, are not known. The proposed study will address these needs by testing effectiveness and cost-effectiveness of literacy-adapted diabetes and CVD education and problem-solving training interventions in urban African Americans with type 2 diabetes and high CVD risk profile (suboptimal blood sugar, blood pressure, and/or lipids). The specific aims of the study are: a) to complete development of a package of literacy-adapted diabetes and CVD patient education materials by developing two video/DVDs addressing self-management recommendations appropriate to the needs, resources, and environment of the population; b) to randomize urban African-American adults with type 2 diabetes and a high CVD risk profile into one of four study arms: Usual Care (Arm 1), Literacy-Adapted Education and Problem-Solving Training Self- Study (Arm 2), Literacy-Adapted Education and Group Problem-Solving Training (Arm 3), and Literacy-Adapted Education and Individual Problem-Solving Training (Arm 4); c) to conduct baseline, 3-month post-intervention, and 6-month post-intervention assessment visits to analyze and compare effectiveness of the literacy-adapted education and problem-solving interventions, as compared to Usual Care, in improving the skills of knowledge, problem-solving and health literacy, behaviors of patient activation and diabetes self-management, and clinical outcomes of A1C, blood pressure and lipids; and d) to perform a cost-effectiveness analysis of each intervention arm as compared to Usual Care. If proven effective, this research will yield low literacy diabetes and CVD patient education and self-management intervention tools for dissemination to high-risk urban minority populations. Moreover, the cost-effectiveness analysis will provide evidence to support decision- making regarding implementation of the models to achieve cardiovascular disease patient self-management goals in clinical practice. PUBLIC HEALTH RELEVANCE: Education and counseling for behavior change are recommended to help people with type 2 diabetes improve high blood sugar, blood pressure, and cholesterol. But, for people who have low literacy or health literacy, understanding and using traditional educational programs is difficult. This study will provide low literacy diabetes and cardiovascular disease education and self-management training tools for use with high-risk urban minority populations and provide evidence to evaluate the costs and benefits of using the literacy-adapted education and problem-solving training programs in clinical practice.

描述（由申请人提供）：患有2型糖尿病的非洲裔美国人遭受过度的疾病负担，但心血管疾病（CVD）风险因素，如高血糖症，高血压和血脂异常，可以通过药物管理和生活方式改变来改变。患者糖尿病教育和行为改变咨询是推荐的实践标准，以促进这些风险因素的有效自我管理。然而，对于低识字率或健康素养的患者，教育和行为干预的可及性和影响是有限的。试点研究表明：a）患者教育模块的识字需求和行为激活特征可以被调整以促进识字率低的城市患者的学习，和B）将识字适应教育与解决问题的培训相结合，促进理解和使用健康信息，以在日常生活的背景下进行自我管理（功能性健康识字）。然而，目前尚不清楚提供患者糖尿病教育和解决问题培训相结合的最佳模式，以及这种干预模式的成本效益。这项拟议的研究将通过测试适应糖尿病和心血管疾病教育的有效性和成本效益以及在患有2型糖尿病和高心血管疾病风险特征（血糖，血压和/或血脂）的城市非洲裔美国人中解决问题的培训干预措施来解决这些需求。本研究的具体目的是：a）通过开发两个视频/DVD，解决适合人群需求、资源和环境的自我管理建议，完成一套适应读写能力的糖尿病和心血管疾病患者教育材料的开发; B）将患有2型糖尿病和心血管疾病高风险特征的城市非洲裔美国成年人随机分为四个研究组之一：家庭护理（第1组）、识字适应教育和问题解决训练自学（第2组）、识字适应教育和小组问题解决训练（第3组）和识字适应教育和个人问题解决训练（第4组）; c）进行基线，干预后3个月，和6个月的干预后评估访问，以分析和比较扫盲教育和解决问题的干预措施的有效性，与家庭护理相比，提高知识技能、解决问题和健康素养、患者激活和糖尿病自我管理行为以及A1 C、血压和血脂的临床结果;以及d）与家庭护理相比，对每个干预组进行成本效益分析。如果证明有效，这项研究将产生低识字糖尿病和心血管病患者的教育和自我管理干预工具，传播到高风险的城市少数民族人口。此外，成本效益分析将提供证据，以支持有关在临床实践中实施模型以实现心血管疾病患者自我管理目标的决策。公共卫生关系：建议对行为改变进行教育和咨询，以帮助2型糖尿病患者改善高血糖、血压和胆固醇。但是，对于识字率或健康素养低的人来说，理解和使用传统的教育计划是困难的。本研究将提供低识字率糖尿病和心血管疾病教育和自我管理培训工具，用于高风险的城市少数民族人群，并提供证据，以评估在临床实践中使用识字适应教育和解决问题的培训计划的成本和效益。