Resilience-Based Diabetes Self-Management Among African Americans

描述(申请人提供)：2型糖尿病影响着2400多万人，非裔美国人对这种疾病的负担不成比例。糖尿病是一种心理和行为要求都很高的慢性病。糖尿病患者通常比非糖尿病患者承受更大的压力，情绪压力会对血糖调节产生生理影响，并减少对糖尿病自我护理行为的遵守，从而使糖尿病病情恶化。最佳的长期糖尿病护理需要一个情绪和精神健康的患者--也就是一个有弹性的患者。然而，大多数研究都集中在风险因素和对糖尿病管理指南的遵守上，而不是增强心理社会素质，以建立弹性和兴旺的反应，使患者能够做出健康的生活方式选择并控制病情。这项研究使用压力和应对的交易模型和自我调节理论来解决疾病的身体和情感因素，将具有文化能力的复原力课程与糖尿病自我管理教育相结合。目的是：1)进一步完善我们的基于复原力的糖尿病自我管理教育(RB-DSME)干预措施和我们的RB-DSME参与者工作簿和促进者指导手册，基于目标社区的关键个人的焦点小组；2)确定在社区教堂为被诊断为2型糖尿病的非裔美国人提供RB-DSME的可行性；以及3)通过比较接受RB-DSME干预的实验组和接受标准糖尿病自我管理教育(DSME)的对照组，在研究后3个月和6个月检查干预的有效性。三个试验组和三个对照组，每个小组包括八个每周一次的课程和两个后续的双周支持小组会议，将由一名认证的糖尿病教育者(CDE)授课，每组有1-2名导师。我们的工作假设是，实验组和对照组的参与者在糖尿病知识方面都会有显著的改善，但实验组的参与者在心理健康、糖尿病自我管理行为以及肥胖症、2型糖尿病和心血管疾病的生理标记物方面的改善会比对照组更大。我们的长期目标是使我们的复原力课程由护士或营养师CDE在广泛的社区环境中教授给患有2型糖尿病的非裔美国人，使个人能够更有效地应对压力并管理他们的2型糖尿病，以避免其严重后果。 公共卫生相关性：2010年健康人强调，当前的糖尿病方案在产生和维持糖尿病患者行为变化方面的能力有限。迫切需要提供糖尿病自我管理技能与复原力和应对策略相结合的干预措施，以便患者能够更有效地管理他们的压力，从而减轻与这种疾病相关的生理负担。帮助患有2型糖尿病的非裔美国人增强他们的韧性，可能会使他们提高对健康生活方式选择的长期坚守，从而减少肥胖，延缓2型糖尿病的进展。

DESCRIPTION (provided by applicant): Type 2 diabetes affects more than 24 million people, and African Americans are disproportionately burdened by this disease. Diabetes is a psychologically and behaviorally demanding chronic disease. Individuals with diabetes typically experience greater stress than non-diseased individuals, and emotional stress worsens diabetes due to physiological effects on blood glucose regulation and reduction in adherence to diabetes self-care behaviors. Optimal long-term diabetes care requires an emotionally and mentally healthy patient - that is, a resilient patient. Most research, however, has focused on risk factors and adherence to diabetes management guidelines rather than enhancing psychosocial qualities that build resilient and thriving responses, enabling the patient to make healthy lifestyle choices and control the condition. This study uses the transactional model of stress and coping and self-regulation theory to address physical and emotional components of the disease, integrating a culturally competent resilience curriculum with diabetes self-management education. Aims are to: 1) further refine our resilience-based diabetes self-management education (RB-DSME) intervention and our RB-DSME participant workbook and facilitator instruction manual based on focus groups with key individuals from the target community; 2) determine the feasibility of offering the RB-DSME in community churches for African Americans diagnosed with type 2 diabetes using the refined participant workbook and facilitator manual; and 3) examine the intervention's effectiveness at 3 and 6 months post-study entry by comparing an experimental group who receive the RB-DSME intervention and a comparison group who receive standard diabetes self-management education (DSME). Three experimental and three comparison groups, each including eight weekly class sessions plus two follow-up bi-weekly support group meetings, will be taught by a certified diabetes educator (CDE) with 1-2 mentors in each group. Our working hypothesis is that both experimental and comparison group participants will show significant improvements in diabetes knowledge, but experimental group participants will show significantly greater improvements in psychological well-being, diabetes self-management behaviors, and physiological markers of obesity, type 2 diabetes, and CVD than the comparison group. Our long-term goal is to make our resilience curriculum accessible to African Americans with type 2 diabetes delivered by nurse or dietitian CDEs in broad community settings, enabling individuals to more effectively cope with stress and manage their type 2 diabetes in order to avoid its serious consequences. PUBLIC HEALTH RELEVANCE: Healthy People 2010 emphasizes that current diabetes programs are limited in their ability to produce and sustain changes in the behaviors of persons with diabetes. There is a critical need for interventions that provide diabetes self-management skills integrated with resilience and coping strategies so that patients can more effectively manage their stress, and thereby reduce the physiological burdens associated with this disease. Helping African Americans with type 2 diabetes to enhance their resilience may enable them to improve their long-term adherence to healthy lifestyle choices, thereby decreasing obesity and delaying the progression of type 2 diabetes.