Comparative Effectiveness of Adding Family Supporter Training and Engagement to a CHW-Led Intervention to Improve Behavioral Management of Multiple Risk Factors for Diabetes Complications

在社区卫生工作者主导的干预措施中增加家庭支持者培训和参与以改善糖尿病并发症多种危​​险因素的行为管理的比较效果

• 批准号: 10379070
• 负责人: Ann-Marie Rosland
• 金额: $ 67.36万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-25 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379070
• 关键词: Adherence; Adult; Amputation; Behavior; Behavioral; Blindness; Blood Glucose; Blood Pressure; Cardiac; Caring; Cholesterol; Chronic; Chronically Ill; Communication; Communities; Community Health Aides; Complex; Complications of Diabetes Mellitus; Diabetes Mellitus; Education; Effectiveness; Family; Family health status; Family member; Federally Qualified Health Center; Focus Groups; Friends; Glycosylated hemoglobin A; Goals; Health; Health Care Visit; Health Personnel; Health behavior; Health behavior change; Health behavior outcomes; Healthcare; Individual; Intervention; Kidney Failure; Low income; Mediator of activation protein; Medical center; Minority; Modeling; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Education; Patients; Persons; Preparation; Primary Health Care; Protocols documentation; Provider; Public Health; Quality of life; Randomized; Research; Resource-limited setting; Resources; Risk; Risk Factors; Role; Self Efficacy; Self Management; Social support; Stroke; Structure; Techniques; Testing; Time; Training; Training Programs; behavioral outcome; blood pressure control; communication behavior; comparative effectiveness; compare effectiveness; diabetes management; diabetes risk; diabetes self-management; ethnic minority; evidence base; falls; family support; follow-up; high risk; improved; individual patient; innovation; medication compliance; novel; novel strategies; patient engagement; patient oriented; peer support; primary outcome; programs; racial minority; secondary outcome; skills; social health determinants; tool

Challenges to controlling blood glucose, blood pressure, and cholesterol levels put 16 million U.S. adults at high risk of disabling diabetes complications. Diabetes self-management (DSM) interventions have struggled to deliver relevant, effective, and sustainable support for at-risk adults with diabetes to improve multiple key DSM behaviors, become more activated participants in healthcare, and reduce diabetes complications. One largely untapped resource for this support is patients' family and friends. 75% of adults with diabetes reach out to an unpaid family member or friend (a family supporter) for ongoing help with diabetes management. However, diabetes management interventions to date lack structured and tested approaches to directly engage patients' supportive family members in promoting and sustaining patient activation and improved diabetes management. The objective of this study is to compare the effectiveness of a novel strategy – Family Partners for Health Action (FAM-ACT) – to individual patient- focused diabetes self-management education (DSME) and care management. FAM-ACT directly engages family supporters of at-risk adults with diabetes by providing them the core skills to allow them to effectively support health behavior change, medication adherence, and active engagement with patient's healthcare providers. A fundamental focus of FAM-ACT is providing family with the ability to give autonomy supportive and need-responsive help to patients. Community Health Workers (CHWs) will deliver FAM-ACT to low-income patients and their family supporters, plus take the novel step of helping family supporters integrate their efforts with those of patients' primary care teams. The specific aims of this study are to 1) Compare the effect of FAM-ACT on patients' diabetes health outcomes to standard, individually-focused, CHW-led DSME and Care Management (DSME+CM), 2) Compare the effect of FAM-ACT on patient health behaviors and perceived support to standard, individually-focused DSME+CM, and 3) Examine whether health and health behavior gains made in FAM-ACT are better sustained after the intervention period than those made in DSME+CM. 240 patient + family member pairs will be randomized to FAM-ACT or DSME+CM for 12 months. Main diabetes health outcomes will include change from baseline to 12 months in UKPDS 5-Year cardiac risk score, HbA1c, and systolic blood pressure. Main patient behavioral outcomes will include diabetes self-management behaviors, and perceived social support and autonomy supportiveness from family. Sustainability will be assessed at 18 months, after a period of 6 months without CHW intervention. We expect this study to produce an innovative, evidence-based protocol and tool set that leverages family support to help patients optimize and sustain management of multiple diabetes complication risk factors over time. This project is innovative because it provides family supporters with underlying support, communication, and health behavior facilitation techniques that can be applied to improving and sustaining multiple healthy behaviors underlying diabetes management, combines the potential additional effectiveness and sustainability of effective family support with the demonstrated effectiveness of CHWs, and integrates family support with patient-centered medical care.

控制血糖、血压和胆固醇水平的挑战使1600万美国成年人 糖尿病并发症致残的风险很高。糖尿病自我管理（DSM）干预措施 努力为糖尿病高危成人提供相关、有效和可持续的支持， 多个关键的DSM行为，成为医疗保健的积极参与者，并减少糖尿病 并发症这种支持的一个基本上未开发的资源是病人的家人和朋友。75%的 成年糖尿病患者向无偿的家庭成员或朋友（家庭支持者）寻求持续的帮助 糖尿病管理。然而，迄今为止，糖尿病管理干预措施缺乏结构化， 经过测试的方法，直接让患者的支持性家庭成员参与促进和维持 患者激活和改善糖尿病管理。本研究的目的是比较 一项新的战略-“家庭健康伙伴行动”-对个别病人的有效性， 重点糖尿病自我管理教育（DSME）和护理管理。FAM-ACT直接参与 糖尿病高危成人的家庭支持者，为他们提供核心技能，使他们能够 有效地支持健康行为改变、药物依从性以及积极参与患者的 医疗保健提供者。FAM-ACT的一个基本重点是为家庭提供给予的能力， 自主性支持和需求响应帮助病人。社区卫生工作者（CHW） 向低收入患者及其家庭支持者提供FAM-ACT，并采取新的步骤， 家庭支持者将他们的努力与病人的初级保健小组的努力结合起来。的具体目标 本研究的目的是：1）比较FAM-ACT对糖尿病患者健康结局的影响， 以个人为重点，CHW领导的DSME和护理管理（DSME+CM），2）比较 FAM-ACT对患者健康行为和对标准的感知支持， DSME+CM，以及3）检查在FAM-ACT中获得的健康和健康行为是否更好 持续干预期后比DSME+CM。240名患者+家庭成员 配对将随机分配至FAM-ACT或DSME+CM组，持续12个月。主要糖尿病健康结果 将包括UKPDS 5年心脏风险评分、HbA 1c和收缩压从基线至12个月的变化 血压.主要患者行为结局将包括糖尿病自我管理行为，以及 感受到的家庭社会支持和自主性。可持续性将在18 个月，在没有CHW干预的6个月后。我们希望这项研究能产生一个 创新的循证方案和工具集，利用家庭支持帮助患者优化 并随着时间的推移持续管理多种糖尿病并发症风险因素。这个项目是 创新，因为它为家庭支持者提供了基本的支持，沟通和健康 行为促进技术，可用于改善和维持多种健康 糖尿病管理的基础行为，结合了潜在的额外有效性， 有效的家庭支持的可持续性与社区卫生工作者的有效性相结合， 以病人为中心的医疗护理的家庭支持。