Resilience-Based Diabetes Self-Management Among African Americans

描述（由申请人提供）：2型糖尿病影响超过2400万人，非裔美国人受到这种疾病的影响不成比例。糖尿病是一种对心理和行为都要求很高的慢性疾病。糖尿病患者通常比非糖尿病患者承受更大的压力，由于对血糖调节的生理影响和对糖尿病自我护理行为的依从性降低，情绪压力使糖尿病恶化。最佳的长期糖尿病护理需要一个情绪和精神健康的病人——也就是说，一个有弹性的病人。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，而不是提高心理社会素质，从而建立弹性和蓬勃的反应，使患者能够选择健康的生活方式并控制病情。本研究采用压力、应对和自我调节理论的交易模型来解决疾病的身体和情感因素，将文化上有竞争力的弹性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弹性的糖尿病自我管理教育（RB-DSME）干预和我们的RB-DSME参与者工作手册和辅导员指导手册，基于目标社区的关键个人的焦点小组；2)确定在社区教堂为诊断为2型糖尿病的非裔美国人提供RB-DSME的可行性，使用改进的参与者工作手册和促进者手册；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，在研究开始后3个月和6个月检查干预的有效性。三个实验组和三个对照组，每个组包括8周的课程和2个后续的双周支持小组会议，将由一名注册糖尿病教育者（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有显著的提高，但实验组的参与者在心理健康、糖尿病自我管理行为、肥胖、2型糖尿病和心血管疾病的生理指标方面都比对照组有显著的改善。我们的长期目标是让患有2型糖尿病的非裔美国人能够接触到我们的弹性课程，这些课程由护士或营养师cde在广泛的社区环境中提供，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。

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.