Identifying Areas for Family Intervention to Improve Adult Diabetes Self-Care

描述(申请人提供)：对于患有糖尿病的成年人，有规律的自我护理行为(即饮食、锻炼和坚持用药)可以预防疾病相关的并发症和过早死亡。然而，社会经济地位低、健康素养低、家庭压力大的患者不太可能维持自我护理行为，更有可能出现血糖失控。即使在有同等机会和护理的环境中(例如，联邦合格的健康中心-FQHC)，非裔美国人和西班牙裔患者对自我护理行为的遵守程度也低于白人，血糖控制也比白人差，这表明自我护理的行为障碍发挥了关键作用。家庭支持可能是一种尚未开发的资源，有可能减少成年糖尿病患者的种族和社会经济差异。家庭对糖尿病自我护理的支持(例如，提醒患者服用或补充药物，计划健康饮食，与患者一起参加锻炼，在自我护理障碍出现时与患者一起解决问题)增加了患者进行定期自我护理的可能性，并可以改善低收入、低健康素养和高压力患者的临床结果。然而，目前尚不清楚家庭成员行为如何影响患者的自我护理和临床结果，以及种族或共病抑郁如何调节家庭成员行为对患者自我护理行为的影响。为了探索这些问题，首席调查员(PI)将与正在进行的一项关于糖尿病用药依从性的研究合作，并在低收入、种族多样化的2型糖尿病(T2 DM)患者样本中扩展这项研究。拟议的计划将使PI成为一名成功的独立调查者，能够在社区卫生组织中为成人糖尿病患者制定和实施有效的家庭干预措施。PI的近期目标是：(1)熟练运用先进的定量方法，全面探索复杂的关系，为成人糖尿病家庭支持的知识库做出贡献；(2)将定量和定性方法结合起来，了解基于种族的家庭支持作用的差异；(3)获得与FQHC合作并与提供者合作进行临床相关研究的经验。通过拟议的培训计划，PI将成为家庭支持糖尿病自我护理领域的知名研究人员，并将接受将研究成果转化为可在社区卫生保健背景下实施的培训。她将提交一份K01建议，根据拟议研究策略的结果，制定和试行家庭干预措施。为了实现这些目标，国际糖尿病协会制定了一项培训计划，其中包括先进的教学课程工作、参加地方和国家研究会议/会议、指导研究经验(包括在FQHC收集数据)以及积极参与极其支持和创新的研究环境(其中包括NIDDK资助的糖尿病翻译研究中心、临床和翻译科学奖，以及社区参与的研究核心)。 公共卫生相关性：让家庭成员参与成人糖尿病患者的自我护理行为可能会减少健康差距，并减少肥胖和糖尿病相关行为代际模式的可能性。这一F32奖项将使PI获得糖尿病自我护理的家庭支持方面的专业知识，以推进知识库，并为患有糖尿病和低社会经济地位的成年人开发和试点家庭干预。

DESCRIPTION (provided by applicant): For adults with diabetes, regular self-care behaviors (i.e., diet, exercise, and medication adherence) prevent disease-related complications and premature death. However, patients with low socioeconomic status, low health literacy, and high levels of family stress are less likely to maintain self-care behaviors and more likely to have uncontrolled glycemia. Even in settings with equivalent access and care (e.g., federally qualified health centers-FQHCs), African American and Hispanic patients are less adherent to self-care behaviors and have worse glycemic control than Whites, suggesting behavioral barriers to self-care play a critical role. Family support may be an untapped resource with potential to reduce racial and socioeconomic disparities among adults with diabetes. Family support for diabetes self-care (e.g., reminding patients to take or refill medication, planning healthy meals, participating in exercise with the patient, problem-solving with the patient when barriers to self-care arise) increases the likelihood that patients perform regular self-care, and can improve clinical outcomes for patients with low income, low health literacy, and high stress. However, it remains unclear how family member behaviors influence patient self-care and clinical outcomes, and how race or comorbid depression might moderate the effects of family member behaviors on patients' self-care behaviors. To explore these issues, the principal investigator (PI) will partner with and extend an ongoing study of diabetes medication adherence in a low-income, racially diverse sample of patients with type 2 diabetes (T2DM). The proposed plan will prepare the PI for success as an independent investigator who can develop and implement effective family interventions for adults with diabetes in community health organizations. The PI's immediate goals are to (1) develop proficiency with advanced quantitative methods to explore complex relationships cross-sectionally and contribute to the knowledge base on family support for adults with diabetes, (2) combine quantitative and qualitative methods to understand differences in the role of family support based on race, and (3) gain experience partnering with a FQHC and working with providers to conduct clinically relevant research. Through the proposed training plan, the PI will become an established researcher in the area of family support for diabetes self-care, and will gain training in translating research findings to be implementable in community health care contexts. She will submit a K01 proposal to develop and pilot a family intervention in a FQHC based on findings from the proposed research strategy. To meet these goals, the PI has developed a training plan that integrates advanced didactic course work, participation in local and national research meetings/conferences, a mentored research experience (including data collection at a FQHC), and active involvement in an extremely supportive and innovative research environment (which includes an NIDDK- funded Diabetes Center for Translational Research, a Clinical and Translational Science Award, and a Community-Engaged Research Core). PUBLIC HEALTH RELEVANCE: Engaging family members in self-care behaviors of adults with diabetes may reduce health disparities and decrease the likelihood of intergenerational patterns of obesity and diabetes-related behaviors. This F32 award will allow the PI to gain expertise in family support for diabetes self-care to advance the knowledge base, and develop and pilot a family intervention for adults with diabetes and low socioeconomic status.