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

描述（由申请人提供）：对于成年糖尿病患者，定期的自我保健行为（即饮食，运动和药物依从性）可以预防疾病相关并发症和过早死亡。然而，社会经济地位低、健康素养低、家庭压力高的患者维持自我保健行为的可能性较小，血糖不受控制的可能性更大。即使在同等条件下（例如，联邦合格的健康中心- fqhcs），非裔美国人和西班牙裔患者对自我保健行为的坚持程度较低，血糖控制也比白人差，这表明自我保健的行为障碍起着关键作用。家庭支持可能是一种未开发的资源，有可能减少成人糖尿病患者的种族和社会经济差异。家庭对糖尿病自我保健的支持（例如，提醒患者服用或补充药物，计划健康膳食，与患者一起参加运动，在出现自我保健障碍时与患者一起解决问题）增加了患者定期进行自我保健的可能性，并可以改善低收入、健康素养低和压力大的患者的临床结果。然而，尚不清楚家庭成员行为如何影响患者的自我保健和临床结果，以及种族或共病抑郁症如何调节家庭成员行为对患者自我保健行为的影响。为了探索这些问题，首席研究员（PI）将与一项正在进行的研究合作，并在低收入、种族多样化的2型糖尿病（T2DM）患者样本中扩展糖尿病药物依从性的研究。拟议的计划将为PI作为独立调查员的成功做好准备，使其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)熟练掌握先进的定量方法，以探索复杂的关系，并为成人糖尿病患者的家庭支持知识库做出贡献；(2)结合定量和定性方法，了解基于种族的家庭支持作用的差异；(3)获得与FQHC合作的经验，并与提供者合作开展临床相关研究。通过拟议的培训计划，PI将成为家庭支持糖尿病自我保健领域的知名研究人员，并将获得将研究成果转化为可在社区保健环境中实施的培训。她将提交一份K01提案，根据拟议研究策略的结果，在FQHC中开发和试点家庭干预措施。为了实现这些目标，PI制定了一项培训计划，将先进的教学课程、参与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）以及积极参与极具支持性和创新性的研究环境（包括NIDDK资助的糖尿病转化研究中心、临床和转化科学奖以及社区参与的研究核心）结合起来。

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.