Diabetes-Specific Family Functioning among Adults: Types, Predictors, and Outcomes

项目摘要 许多患有2型糖尿病（T2D）的成年人难以进行推荐的自我护理活动， 因此，实现最佳血糖控制（A1c）。社会和家庭环境直接或间接地影响患者的生活质量。 通过促进或阻碍自我护理的行动以及通过以下方式启动和维持自我护理行为的动机和能力 对心理健康和糖尿病困扰的影响。关于家庭参与成年人教育的重要性的证据 糖尿病等慢性疾病的管理正在积累，但对成年T2D患者的干预措施已经 方法不一致，效果好坏参半。这可能是因为人们对家庭如何沟通知之甚少。 并响应成年人有效管理T2D的努力，特别是在未婚或未婚的成年人中。一 需要一个适用于整个家庭结构的糖尿病特异性家庭功能的综合框架， 制定和调整干预措施，并改进干预后评价。因此，本项目的目标 在成人T2D患者中建立糖尿病特异性家庭功能的框架，并提供有用的工具， 确定可能从家庭干预中受益的患者，并制定干预措施。调查结果将打开， 指导关于谁从某些干预内容及其提供中受益的新的调查路线（家庭或个人）。 需要一种类型学方法来确定糖尿病特异性家庭功能的概况或"类型"， 家庭在几个相互关联的方面表现出不同的功能模式，这些模式无法通过 一维分析成人T2D患者将完成一项调查，评估糖尿病特定家族的多个方面 在线、通过电话或亲自使用英语或西班牙语进行工作。将采用多种方法招募参与者， 获得关于种族/民族、社会经济地位、地理区域和家庭结构的多样化样本。数据 将集中起来，以满足两个具体目标。目标1：（a）确定和验证糖尿病特异性的经验类型学 家庭功能，然后（B）检查预测类型成员的患者和家庭特征（例如，百分 非裔美国人患者和每种类型中已婚患者的百分比）以及类型和患者 心理健康，坚持自我护理，A1c。这些知识将指导相关的发展。 针对最常见和最有害的类型进行干预。目标2：制定一个简短的评估， 分类到aim 1中确定的类型，同时最小化项目的数量。这一简短的评估可以用于 未来的干预研究，以定制和进行亚组分析的类型。该项目启动了一系列调查， 将通过将重点从家庭结构转移到家庭需求， 提供一个系统的和医疗驱动的干预剪裁方法。

PROJECT SUMMARY Many adults with type 2 diabetes (T2D) have difficulty performing recommended self-care activities and, therefore, achieving optimal glycemic control (A1c). Social and family contexts directly and indirectly impact patients’ motivation and ability to initiate and sustain self-care behaviors via actions that facilitate or impede self-care and via effects on psychological well-being and diabetes distress. Evidence on the importance of family involvement in adults’ management of chronic diseases like diabetes is accumulating, but interventions for adults with T2D have been inconsistent in approach with mixed effects. This may be because little is known about how families communicate about and respond to adults’ efforts to manage T2D effectively, especially among adults who are not married or partnered. A comprehensive framework of diabetes-specific family functioning applicable across family structures is needed to guide intervention development and tailoring, and to improve post-intervention evaluations. Therefore, the goals of this project are to develop a framework of diabetes-specific family functioning among adults with T2D and provide a useful tool for identifying patients likely to benefit from family interventions and for tailoring interventions. Findings will open and guide new lines of inquiry regarding who benefits from certain intervention content and its delivery (family or individual). A typological approach is needed to identify profiles or “types” of diabetes-specific family functioning because families exhibit different patterns of functioning across several interrelated dimensions that cannot be captured by unidimensional analyses. Adults with T2D will complete a survey assessing multiple aspects of diabetes-specific family functioning online, by phone, or in person in English or Spanish. Participants will be recruited using multiple methods to obtain a sample diverse with respect to race/ethnicity, socioeconomic status, geographic region, and family structure. Data will be aggregated to meet two specific aims. Aim 1: (a) identify and validate an empirical typology of diabetes-specific family functioning, and then (b) examine patient and family characteristics predicting type membership (e.g., percent African American patients and percent married patients in each type) and associations between types and patients’ psychological well-being, adherence to self-care, and A1c. This knowledge will guide development of relevant interventions for the most common and most detrimental types. Aim 2: develop a brief assessment which optimizes classification to types identified in aim1 while minimizing the number of items. This brief assessment can be used in future intervention research to tailor and conduct subgroup analyses by type. This project initiates a line of inquiry that will improve family interventions among adults by shifting the focus from family structure to family needs, and by providing a systematic and empirically-driven approach to intervention tailoring.