Primary Care-Based Physical Activity for Diabetic Latinas

描述(由申请人提供)：在这个K01培训模块中，我计划获得必要的培训，通过行为干预在初级保健环境中从事II型糖尿病的一级和二级预防工作，重点是服务不足的人群。在过去的两年里，我接受了流行病学方面的基础培训和研究经验，并利用现有的数据集研究了健康行为与慢性疾病之间的关系，包括心血管疾病和糖尿病。我还观察了身体活动干预措施在健康成年人中的设计、适应和实施。我最近指导了一项针对拉丁裔男性的体力活动干预的小型示范试验(N=10)，结果显示12周后活动量显著增加。在K01培训期间，我计划在设计和实施针对初级保健环境中特定人群的体力活动干预的随机对照试验方面获得进一步的经验，并获得关于病理生理学、相关生物标记物和II型糖尿病治疗的全面培训。此外，我计划在评估以初级保健为基础的干预措施的成本和成本效益方面建立基本技能。我将通过课程作业、培训研讨会、诊所观察、会议和与导师的一对一培训练习来实现这些目标。这些培训目标将由一支极其合格的指导团队监督和支持，该团队在体力活动干预、糖尿病流行病学和临床治疗以及成本效益方面具有丰富的经验，此外还将拥有全面的指导研究员、住院医生和初级教员的经验。这次培训将给我必要的技能来设计和实施糖尿病初级保健中具有成本效益的行为干预措施，我认为这是一个对公共健康至关重要的领域。该研究计划的目标是实施一种在文化和语言上适应的基于网络的体力活动干预措施，专门为在初级保健环境中患有II型糖尿病的拉丁裔人设计。预计拉丁裔在未来几十年将经历糖尿病患病率的最大增长，本世纪出生的拉丁裔的预计患病率将超过50%，但很少有专门为这一高危群体设计的干预措施，他们报告了许多文化、语言、 以及参与自我管理干预的社会经济障碍。拟议的干预措施将基于主要导师为拉丁裔开发的网络交付干预措施，该干预措施基于跨理论模型和社会认知理论。过去的试验表明，这种干预措施在非糖尿病人群中有效，但从未在临床人群或初级保健环境中进行过测试。在目前的提案中，这一干预措施将针对糖尿病人群进行修改，并将与加州大学圣迭戈分校家庭医学诊所合作，在初级保健环境中作为糖尿病管理计划实施。进行一项小型随机对照试验(N=80)，我们将实现四个具体目标：1)测试基于文化适应的基于网络的个性化体力活动干预在增加每周中强度体力活动分钟数方面的有效性；2)测试 除了药物使用之外，干预对糖尿病的临床标记物，如血糖和糖化血红蛋白的影响，3)评估干预增加体力活动的成本，以便在将干预作为糖尿病管理计划时提供初步的成本-效果分析，以及4)评估行为改变的维持和临床标记物的变化。拟议的干预结合了过去糖尿病管理试验中显示的特征，以有效地增加体力活动行为，包括目标设定、自我监控、 个人量身定做的反馈和社区支持，还解决了拉丁裔经常提到的障碍，如缺乏交通工具、语言障碍和缺乏支持，因此 有很大潜力增加拉丁裔糖尿病患者的体力活动。此外，基于网络的形式减少了工作人员和参与者的负担，增加了参与者的参与度，鉴于近年来拉丁裔使用互联网的人数大幅增加，这是适当的。最后，基于网络的形式可以在初级保健中广泛传播，使其成为在高危人群中促进重要疾病管理行为的潜在低成本、高覆盖范围的方法。

DESCRIPTION (provided by applicant): In this K01 training module, I plan to acquire necessary training to pursue a career in primary and secondary prevention of type II diabetes in primary care settings through behavioral interventions, with a focus on underserved populations. For the past two years, I have received foundational training and research experience in epidemiology, and have used existing datasets to study the associations between health behaviors and chronic diseases, including cardiovascular disease and diabetes. I have also observed the design, adaptation, and implementation of physical activity interventions in healthy adults. I recently directed a small demonstration trial (N=10) of a physical activity intervention adapted for Latino men, which showed significant increases in activity after 12 weeks. In the K01 training period, I plan to gain further experience in designing and implementing randomized controlled trials of physical activity interventions for specific populations in primary care settigs, and to gain thorough training in the pathophysiology, relevant biomarkers, and treatment of type II diabetes. Furthermore, I plan to build a basic skillset in assessments of cost and cost- effectiveness of primary care-based interventions. I will accomplish these goals through a combination of coursework, training seminars, clinic observation, and meetings and one-on-one training exercises with mentors. These training goals will be overseen and supported by an extremely qualified mentoring team with extensive experience in physical activity interventions, diabetes epidemiology and clinical treatment, and cost- effectiveness, in addition to thorough experience mentoring fellows, residents, and junior faculty. This training will give me the skills necessary to design and implement cost-effective behavioral interventions in primary care for diabetes, an area I feel is critical to public health. The goal of the research plan is to implemen a culturally and linguistically adapted web-based physical activity intervention designed specifically for Latinas with type II diabetes in a primary care setting. Latinas are projected to experience the largest increases in diabetes prevalence in the coming decades, with projected prevalence rates exceeding 50% for Latinas born in this century, yet few interventions have been designed specifically for this high-risk group which reports a number of cultural, linguistic, and socioeconomic barriers to participating in self-management interventions. The proposed intervention will be based on a web-delivered intervention developed for Latinas by the primary mentor, which is based on the Transtheoretical Model and Social Cognitive Theory. Past trials have shown efficacy of the intervention in non-diabetic populations, yet it has never been tested with clinical populations or in a primary care setting. In the current proposal, this intervention ill be modified for a diabetic population and, in collaboration with the UCSD Family Medicine Clinic, will be implemented in a primary care setting as a diabetes management program. Conducting a small randomized controlled trial (N=80), we will accomplish four specific aims: 1) to test the efficacy of the culturally adapted web-based individually tailored physical activity intervention in increasing weekly minutes of moderate-to-vigorous physical activity, 2) to test the effect of the intervention on clinical markers of diabetes, such as glucose and HbA1c, in addition to medication use, 3) to assess the cost of the intervention in increasing physical activity in order to provide preliminary cost-effectiveness analyses in using the intervention as a diabetes management program, and 4) to assess maintenance of behavior change and change in clinical markers. The proposed intervention incorporates features shown in past diabetes management trials to effectively increase physical activity behavior, including goal setting, self-monitoring, individually tailored feedback, and community support, and also addresses barriers commonly cited by Latinas, such as lack of transportation, linguistic barriers, and lack of support, thus it has great potential to increase physical activity in diabetic Latinas. Furthermore, the web-based format reduces staff and participant burden and increases participant engagement, and is appropriate given the large increases in Internet use among Latinos in recent years. Finally, the web-based format could allow for widespread dissemination in primary care, making it a potentially low cost, high reach approach for promoting an important disease management behavior in an at-risk population.