Diabetes Self-Management & Support LIVE (Learning in Virtual Environments)

糖尿病自我管理

• 批准号: 9276766
• 负责人: Constance Margaret Johnson
• 金额: $ 51.63万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9276766
• 关键词: Adult; Affect; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body mass index; Caring; Cause of Death; Chronic Disease; Communication; Communities; Diabetes Mellitus; Diet; Dietary Fats; Distress; Economics; Education; Environment; Family; Feasibility Studies; Feedback; Glucose; Health; Health Professional; Health behavior; Healthcare; Immersion Investigative Technique; Individual; Intake; Internet; Intervention; Knowledge; Lead; Learning; Learning Skill; Life; Lipids; Literature; Location; Long-Term Effects; Measures; Mediating; Mediator of activation protein; Metabolic; Metabolic Control; Modeling; Moderate Exercise; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Education; Patients; Physical activity; Population; Provider; Randomized Controlled Trials; Reporting; Resources; Sampling; Self Efficacy; Self Management; Social Interaction; Social Network; Social support; Technology; Testing; Time; Training Support; Translations; Transportation; base; behavior change; behavioral outcome; biobehavior; community center; cost; cost effective; design; diabetes education; diabetes management; diet and exercise; driving force; experience; fruits and vegetables; group intervention; health care availability; health care service utilization; health literacy; improved; innovation; mortality; peer; programs; psychosocial; public health relevance; social; social learning; virtual; virtual reality; waist circumference

DESCRIPTION (provided by applicant): Interventions to assist patients in chronic illness self-management are needed to: eliminate barriers to healthcare; accommodate limited health literacy; provide sustainable, cost-effective patient education and support; and move beyond ineffective, non-interactive health behavior interventions. Advances in communication technology such as the Web 2.0 are a means to fill these needs. Virtual environments (VE) promote social interaction and learning via application and feedback, leading to superior learning and skill set transfer. We propose to test a theoretically grounded, technologically-based, bio-behavioral intervention using a VE to facilitate self-management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2D) (NIDDK, 2009). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains a leading cause of death in the U.S. Individuals with T2D provide a majority of their own care, making diabetes self-management (DSM) (e.g. diet, exercise) integral to control. Tailored DSM interventions utilizing patient-provider interaction have had encouraging short-term effects. However, this frequent interaction is unattainable and costly. Internet interventions have the potential to capture the dynamics of patient-provider interaction, but to date remain "flat" with asynchronous communication. VEs are a potential solution to capture patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. Preliminary findings from our R21 (R21LM010727-01) showed that a virtual diabetes community with real-time interaction among adults with T2D, and with healthcare professionals is feasible and has the potential to influence metabolic control and psychosocial mediators. Thus we are proposing a randomized controlled trial to determine whether the effects of participation in a VE that incorporates real-time diabetes self-management training and support will be associated with positive changes in health behaviors. The LIVE community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our primary aim is to (1) determine the effects of providing DSMT/S in a VE on diet and physical activity behavior change in adults with T2D compared to traditional DSMT/S over 12 months. Our secondary aims are: (2) to determine the effects on metabolic outcomes; (3) to assess whether level of engagement and social network formation in LIVE differentially impacts behavioral outcomes; and (4) to examine the potential mediating effects of changes in self-efficacy; diabetes knowledge, diabetes-related distress and social support on behavior change and metabolic outcomes. Should LIVE prove effective in improved self-management of diabetes, similar interventions could be applied to other prevalent chronic diseases. Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of DSMT/S.

描述（由申请人提供）：需要采取干预措施来帮助患者进行慢性病自我管理，以： 消除医疗保健障碍；适应有限的健康素养；提供可持续、具有成本效益的患者教育和支持；超越无效、非互动的健康行为干预措施。 Web 2.0 等通信技术的进步是满足这些需求的一种手段。虚拟环境 (VE) 通过应用和反馈促进社交互动和学习，从而实现卓越的学习和技能转移。我们建议使用 VE 来测试一种有理论依据、以技术为基础的生物行为干预措施，以促进糖尿病的自我管理。糖尿病影响着 2360 万美国成年人，其中大多数患有 2 型糖尿病 (T2D)（NIDDK，2009）。众所周知，代谢控制可以降低糖尿病的发病率和死亡率，但它仍然是美国的一个主要原因。T2D 患者大部分需要自行护理，因此糖尿病自我管理 (DSM)（例如饮食、运动）对于控制来说是不可或缺的。利用患者与提供者互动的定制 DSM 干预措施产生了令人鼓舞的短期效果。然而，这种频繁的互动是无法实现的，而且成本高昂。互联网干预有可能捕捉患者与提供者互动的动态，但迄今为止，异步通信仍然“平坦”。 VE 是一种潜在的解决方案，可以在沉浸式环境中通过交互、同步通信、知识应用和社交网络来捕获患者与提供者之间的动态。我们的 R21 (R21LM010727-01) 的初步研究结果表明，在成人 T2D 患者之间以及与医疗保健专业人员之间进行实时互动的虚拟糖尿病社区是可行的，并且有可能影响代谢控制和社会心理调节因素。因此，我们提议进行一项随机对照试验，以确定参与包含实时糖尿病自我管理培训和支持的 VE 的效果是否与健康行为的积极变化相关。 LIVE社区将由社区中心、健身房、杂货店和其他场所组成，每个场所都允许互动知识应用。基于此设计，我们的主要目标是 (1) 确定在 12 个月内，与传统 DSMT/S 相比，在 VE 中提供 DSMT/S 对 T2D 成人饮食和身体活动行为变化的影响。我们的次要目标是：（2）确定对代谢结果的影响； (3) 评估 LIVE 中的参与程度和社交网络形成是否对行为结果产生不同的影响； (4) 检查自我效能变化的潜在中介效应；糖尿病知识、糖尿病相关的困扰以及对行为改变和代谢结果的社会支持。如果 LIVE 能够有效改善糖尿病的自我管理，那么类似的干预措施也可以应用于其他流行的慢性疾病。 LIVE 等创新计划有潜力以易于传播的替代护理模式改善医疗保健的可及性，从而有可能扩大 DSMT/S 的覆盖范围。