Targeting Family Behaviors to Improve Diabetes Management among Adults with Type 2 Diabetes

针对家庭行为改善 2 型糖尿病成人的糖尿病管理

• 批准号: 8949600
• 负责人: Lindsay S. Mayberry
• 金额: $ 9.87万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2016-04-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8949600
• 关键词: Address; Adherence; Adult; Award; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Blood Glucose Self-Monitoring; Car Phone; Caring; Chronic Disease; Clinic; Clinical Sciences; Collaborations; Communication; Communities; Control Groups; Counseling; Crossover Design; Data Analyses; Decision Making; Development; Development Plans; Diabetes Mellitus; Diet; Disease; Educational process of instructing; Educational workshop; Enrollment; Environment; Evaluation; Exercise; Family; Family health status; Family member; Frequencies; Funding; Future; Goals; Health; Health Services Research; Health Technology; Health behavior; Health behavior outcomes; Health education; Healthcare; Intervention; Lead; Literature; Longevity; Mentored Research Scientist Development Award; Mentors; Meta-Analysis; Minority Groups; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcomes Research; Participant; Patient risk; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Pharmaceutical Preparations; Populations at Risk; Preparation; Principal Investigator; Qualifying; Quality of life; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Infrastructure; Research Personnel; Research Training; Resources; Risk; Self Care; Self Care outcome; Self Efficacy; Self Management; Social Environment; Socioeconomic Status; Target Populations; Technology; Telephone; Testing; Text; Time; Training; Translational Research; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Universities; Utah; Voice; base; behavior change; behavior in diabetes management; biobehavior; career; career development; compliance behavior; cost; diabetes management; diet and exercise; experience; glycemic control; high risk; improved; intervention effect; longitudinal analysis; low socioeconomic status; mHealth; medication compliance; meetings; mortality; patient population; premature; prevent; programs; public health relevance; skills; success; symposium; theories; usability

 DESCRIPTION (provided by applicant): For adults with type 2 diabetes mellitus (T2DM), successful self-management requires daily self-care behaviors, which can be made easier or more difficult by family members' behaviors. Family members who perform diabetes-specific supportive behaviors (e.g., reminding patients to take medications, exercising with the patient) often also perform behaviors that make adults' self-care more difficult (e.g., sabotaging the patients' self-care attempts or nagging/arguing about self-care). Targeting family members' disease-specific behaviors may be effective for improving patients' adherence. However, few family interventions for adults with T2DM have been successful in improving patients' outcomes, and family interventions are often time-intensive and poorly attended by patients at highest risk of non-adherence (minority groups with low socioeconomic status; SES). It remains unclear whether intervention content can equip adult patients with the necessary skills to identify and manage supportive and obstructive diabetes-specific family behaviors. Furthermore, longitudinal evidence is conspicuously absent; we do not yet know if the relationships between family members' diabetes- specific behaviors and patients' diabetes management (i.e., adherence to self-care behaviors and glycemic control) are unidirectional or reciprocal over time. During this K01 award, the principal investigator (The candidate) will address these gaps in the extant literature while participating in a mentored training experience that will prepare her for success as an independent investigator who identifies sustainable approaches to family interventions that improve the health and well-being of adults with T2DM and their family members in at-risk populations. Specific training goals include developing expertise in: family-focused intervention content for adults' diabetes management, behavioral randomized controlled trials (RCTs), delivering intervention content via mobile phone technology, and longitudinal analysis. The proposed plan integrates didactic coursework and training, a mentored research experience (including hands- on experience with an NIDDK R01-funded behavioral RCT), participation in local and national meetings/seminars/workshops/conferences, and active involvement in a robust and extremely supportive research environment. This environment includes NIDDK-funded Center for Diabetes Translational Research and Diabetes Research & Training Center, a NIH Clinical & Translational Science Award, a Center for Health Services Research, a Center for Health Behavior and Health Education, AHRQ-funded programming in patient-centered outcomes research, and the Meharry-Vanderbilt Community Engaged Research Core which facilitates the active engagement of patients and community clinics in research. In addition, one of the candidate's co- mentors is the director of the multi-disciplinary Consortium for Life-span BioBehavioral Family Health Research at the University of Utah, and will provide the candidate will access to associated resources and relevant collaborations. The proposed research includes three specific aims. Aim 1: The candidate will build on findings from her research with the target population (i.e., a racially/ethnically diverse, low SES patient population) to develop family- focused intervention content to equip patients with skills to ask for needed supportive behaviors from family members and to redirect and/or disengage from obstructive family behaviors. Intervention content will be delivered exclusively via basic mobile phone technology (i.e., text messages and voice communications) to enhance reach, participation, and retention. Adult T2DM patients and an adult family member will be recruited for three iterative rounds of usability testing to refine the intervention prior to evaluation. The intervention will be evaluate in a 3-month trial nested within her mentor's larger RCT. Aim 2: The candidate will analyze the extent to which changes in patients' diabetes self-efficacy, self-care behaviors, and glycemic control were occasioned by changes in family members' diabetes-specific behaviors (i.e., the targeted mechanism), and will evaluate the acceptability of delivering intervention content to family members via text messages. Aim 3: Finally, the candidate will analyze the longitudinal relationships between patient-reported diabetes-specific family behaviors and patients' self-care and outcomes, assessed at regular intervals over a 12-month period. This career development plan presents a natural extension of the candidate's research and training to date, and leverages findings from her NIDDK-funded F32 to inform the development of family interventions for adults with T2DM. Upon completion of this plan, the candidate will have expertise in developing and delivering family-focused behavioral intervention in a low SES patient population via technology and in using longitudinal data analysis to evaluate effects of intervention content on health behaviors and outcomes. In combination with findings from the specific aims, this unique expertise will accelerate the candidate's independent research career as an expert in family interventions for adults with T2DM, and will help her reach her ultimate goals of developing and evaluating scalable family interventions to improve health and quality of life for adults with T2DM and their family members.

 描述(申请人提供)：对于患有2型糖尿病(T2 DM)的成年人，成功的自我管理需要日常的自我照顾行为，这可能会因家庭成员的行为而变得更容易或更难。执行特定于糖尿病的支持性行为(例如，提醒患者服用药物、与患者一起锻炼)的家庭成员通常也会执行使成年人的自我护理更加困难的行为(例如，破坏患者的自我护理尝试或唠叨/争论自我护理)。针对家庭成员的疾病特定行为可能会有效地提高患者的依从性。然而，对成年T2 DM患者的家庭干预很少能成功地改善患者的预后，而且家庭干预往往是时间密集型的，而且不遵守的风险最高的患者(社会经济地位低的少数群体；SES)得到的照顾很少。目前尚不清楚干预内容是否能使成年患者具备必要的技能，以识别和管理支持性和阻塞性糖尿病特有的家庭行为。此外，明显缺乏纵向证据；我们还不知道家庭成员的糖尿病特有行为与患者的糖尿病管理(即坚持自我护理行为和血糖控制)之间的关系是单向的还是随着时间的推移是互惠的。在K01奖项期间，首席研究员(候选人)将在参加指导培训经验的同时，解决现有文献中的这些差距，为她作为一名独立调查员的成功做好准备，确定家庭干预的可持续方法，以改善高危人群中成年T2 DM患者及其家庭成员的健康和福祉。具体的培训目标包括培养以下方面的专业知识：成人糖尿病管理的以家庭为中心的干预内容、行为随机对照试验(RCT)、通过移动电话技术提供干预内容以及纵向分析。拟议的计划包括教学课程和培训、指导研究经验(包括由NIDDK R01资助的行为RCT的实践经验)、参与地方和国家会议/研讨会/讲习班/会议，以及积极参与强大和极其支持的研究环境。这一环境包括NIDDK资助的糖尿病转化研究和培训中心，NIH临床和转化科学奖，医疗服务研究中心，健康行为和健康教育中心，AHRQ资助的以患者为中心的结果研究规划，以及促进患者和社区诊所积极参与研究的Meharry-Vanderbilt社区参与研究核心。此外，候选人的一位共同导师是犹他大学生命周期生物行为家庭健康研究多学科联盟的主任，并将为候选人提供访问相关资源和相关合作的机会。拟议的研究包括三个具体目标。目标1：候选人将基于她对目标人群(即种族/民族多样化、低SES患者群体)的研究结果，开发以家庭为重点的干预内容，使患者具备要求家庭成员提供必要支持行为的技能，并重新定向和/或脱离阻挠家庭行为。干预内容将专门通过基本移动电话技术(即短信和语音通信)提供，以增强覆盖、参与和保留。成年T2 DM患者和一名成年家庭成员将被招募进行三轮反复的可用性测试，以在评估之前完善干预措施。这项干预措施将在为期3个月的试验中进行评估，试验嵌套在她导师更大的随机对照试验中。目的2：候选人将分析糖尿病患者的自我效能、自我护理行为和血糖控制的变化在多大程度上是由家庭成员的糖尿病特有行为(即目标机制)的变化引起的，并将评估通过短信向家庭成员传递干预内容的可接受性。目的3：最后，候选人将分析患者报告的糖尿病特有的家庭行为与患者的自我护理和结果之间的纵向关系，并在12个月的时间内定期进行评估。这份职业发展计划代表了应聘者迄今为止研究和培训的自然延伸，并利用她由NIDDK资助的F32的研究结果来为成人T2 DM家庭干预的发展提供信息。该计划完成后，应聘者将拥有通过技术在低SES患者群体中开发和提供以家庭为中心的行为干预的专业知识，并使用纵向数据分析来评估干预内容对健康行为和结果的影响。与特定目标的发现相结合，这一独特的专业知识将加速候选人作为成人T2 DM家庭干预专家的独立研究生涯，并将帮助她实现开发和评估可扩展的家庭干预措施的最终目标，以改善成年T2 DM患者及其家庭成员的健康和生活质量。