Improving Diabetes Health in Emerging Adulthood Through an Autonomy Supportive Intervention.

通过自主支持干预改善成年初期的糖尿病健康。

• 批准号: 9888400
• 负责人: April Marie Idalski Carcone
• 金额: $ 50.81万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-06 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9888400
• 关键词: Address; Adolescence; Adolescent; Adult; Aftercare; Age; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Caring; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical Trials; Communication; Competence; Complications of Diabetes Mellitus; Decision Making; Development; Diabetes Mellitus; Engineering; Experimental Designs; Feedback; Feeling; Frequencies; Glycosylated hemoglobin A; Goals; Health; Health Personnel; Health behavior; Health behavior change; Healthcare; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Link; Measures; Mediating; Medical; Mental Depression; Metabolic Control; Modeling; Moods; Motivation; Outcome; Patient Self-Report; Patients; Perception; Process; Provider; Randomized; Randomized Clinical Trials; Research; Research Design; Resources; Risk; Risk Behaviors; Role; Sample Size; Self Determination; Self Efficacy; Self Management; Self-Direction; Site; System; Target Populations; Testing; Text Messaging; Time; Treatment Efficacy; Visit; Youth; age group; base; behavior change; behavior in diabetes management; behavior test; care providers; clinically significant; design; diabetes management; diabetes self-management; eHealth; effectiveness trial; efficacy testing; emerging adult; emerging adulthood; experimental study; extrinsic motivation; family support; follow-up; glucose monitor; improved; indexing; innovation; intervention effect; intrinsic motivation; joint function; motivational enhancement therapy; multi-component intervention; multiphase optimization strategy; peer support; premature; primary outcome; psychologic; satisfaction; sex; skills; social; theories; therapy design; tool; young adult

Project Summary This project will use the multiphase optimization strategy (MOST) approach to test the efficacy of an autonomy supportive behavioral intervention to improve metabolic control among older adolescents and emerging adults (16-25) with T1D. Youth this age demonstrate chronic poor metabolic control that persists into adulthood leading to the premature emergence of short- and long-term diabetes complications. Developmentally, adolescence and emerging adulthood is a time when the need for independence and autonomy are particularly salient. This new intervention will leverage youths’ desire for autonomy by designing an intervention to support diabetes self-management autonomy. This intervention is guided by self-determination theory (SDT) which suggests that autonomous (i.e., self-initiated, driven by intrinsic versus extrinsic motivation) diabetes management depends upon three conditions: 1) the perception that one’s behavior is self-directed, 2) feelings of competence, or self-efficacy, and 3) the existence of caring relationships supportive of the behavior. We have identified three intervention components that target the SDT constructs. A question prompt list (QPL) is a simple, inexpensive tool comprised of a list of questions that patients might consider asking their health care provider during a clinic visit. QPLs empower patients to assume a more active role (asking questions and stating concerns) during clinic visits. The Motivation Enhancing System (MES) is an eHealth intervention to increase intrinsic motivation for health behavior change. MES content is based on the Motivational Interviewing (MI) framework and the Information-Motivation-Behavioral Skills (IMB) model of health behavior change which posits that behavior change results from the joint function of three critical components: accurate information about risk behaviors or their replacement health behaviors, motivation to change behavior, and behavioral skills necessary to perform the behavior (self-efficacy). Text message reminders (TXT) are a strategy to encourage youth to complete their diabetes self-care that also lead to gains in self- efficacy and a stronger relationship with diabetes care providers through greater communication and satisfaction. We will test the efficacy of these intervention components toward improving metabolic control in a component selection experiment (N=320). The experiment will use a factorial research design with random assignment to determine which intervention components contribute to a clinically significant improvement (≥0.5%) in HbA1c. The result of this research will be an optimized, multi-component intervention with effect size estimates that will be used to inform a large scale, fully powered effectiveness trial. This theory-driven intervention will be scalable to a variety of chronic illness contexts and the knowledge gained from this research will inform self-determination theory and behavioral interventions targeting this population (for which there currently are none).

项目摘要 该项目将使用多相优化策略（大多数）方法来测试自主权的效率 支持行为干预以改善老年青少年和新兴成年人的代谢控制 （16-25）与T1D。这个年龄的年轻人表明，长期存在的代谢性控制持续到成年 导致短期和长期糖尿病并发症的过早出现。发展， 青少年和新兴的成年是尤其是独立和自主权的时期 突出。这种新的干预措施将通过设计干预措施来利用青年对自治的渴望 支持糖尿病仅仅是管理自治。这种干预措施由自决理论（SDT）指导 这表明自主（即由内在动机与外在动机驱动的自我启动）糖尿病 管理层取决于三个条件：1）对自己行为是自我指导的看法，2） 能力或自我效能感，以及3）关怀关系的存在支持行为。我们有 确定了针对SDT构建体的三个干预组件。问题提示列表（qpl）是 简单，廉价的工具完成了一系列问题清单，患者可能会考虑询问其医疗保健 提供者在诊所访问期间。 QPLS授权患者扮演更积极的角色（提出问题和 说明问题）在诊所就诊期间。动机增强系统（MES）是一种eHealth的干预措施 增加对健康行为改变的内在动机。 MES内容基于激励性 采访（MI）框架和信息动机行为技能（IMB）健康模型 提出行为改变的行为变化是由于三个关键组成部分的联合功能而导致的： 有关风险行为或其替代健康行为的准确信息，改变动机 行为所必需的行为和行为技巧（自我效能）。短信提醒 （TXT）是一种鼓励青年完成糖尿病自我保健的策略，这也会导致自我的收益 通过更大的沟通和 满意。我们将测试这些干预成分的效率，以改善A中的代谢控制 组件选择实验（n = 320）。该实验将使用随机的阶乘研究设计 分配以确定哪些干预组件有助于临床上显着改善 （≥0.5％）在HBA1C中。这项研究的结果将是一项优化的多组分干预措施，有效 尺寸估计值将用于为大规模的，全功能的有效性试验提供信息。这个理论驱动的 干预将可扩展到各种慢性疾病环境以及从中获得的知识 研究将为针对这一人群的自决理论和行为干预提供信息（对于 目前没有）。