REACH-Es: Adapting a digital health tool to improve diabetes medication adherence among Latino adults

REACH-E：采用数字健康工具来提高拉丁裔成年人糖尿病药物的依从性

• 批准号: 10641103
• 负责人: Jacqueline Anne Seiglie
• 金额: $ 19.65万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641103
• 关键词: Address; Adherence; Adult; Behavior Therapy; Biometry; Clinical; Clinical Trials; Communication; Complications of Diabetes Mellitus; Conduct Clinical Trials; Data; Diabetes Mellitus; Disparity; Education; Educational Materials; Endocrinologist; Epidemiology; Evidence based intervention; Feedback; Focus Groups; Glycosylated hemoglobin A; Goals; Health Technology; High Prevalence; Individual; Insulin; Intervention; Interview; Language; Latin America; Latino; Latino Population; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Participant; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Physicians; Population; Prevalence; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Research Training; Self Care; Self Efficacy; Strategic Planning; System; Testing; Text Messaging; Therapeutic; Time; Training; United States; Work; behavioral adherence; career; clinically relevant; comparison control; cost; diabetes management; diabetes self-management; digital health; disparity reduction; effectiveness/implementation trial; ethnic minority; ethnic minority population; health communication; improved; improved outcome; innovation; interest; intervention refinement; live text; mHealth; medication compliance; medication nonadherence; patient engagement; patient oriented; patient portal; response; retention rate; secondary outcome; social disparities; standard of care; therapy development; tool; two way texting; usability

PROJECT SUMMARY Background: Latino adults have a disproportionate burden of type 2 diabetes and diabetes-related complications. Diabetes medication non-adherence is an important modifiable contributor to suboptimal glycemic management among Latino adults, who are nearly twice as likely to report non-adherence to diabetes medications as non-Hispanic White individuals. Besides language barriers, additional commonly reported barriers that contribute to non-adherence in this population include negative perceptions about insulin use and misunderstanding ongoing need for diabetes medications once HbA1c has improved. Mobile health (mHealth) technology can reduce medication adherence barriers and improve adherence behavior, but mHealth tools that address commonly reported barriers to diabetes medication adherence among Latino adults are lacking. Candidate: I am an endocrinologist born and raised in Latin America; my long-term career goal is to develop scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes. Training: I have received outstanding research training in epidemiology but to achieve my long-term career goal I require additional training in: 1) adaptation of evidence-based interventions, 2) mixed methods, and 3) conduct of clinical trials in mHealth. Mentors: My training and research plans will be overseen by Primary Mentor Dr. Deborah Wexler (type 2 diabetes clinical trials/intervention adaptation) and Co-Mentor Dr. Lindsay Mayberry (mixed methodologist/mHealth clinical trials). Drs. Margarita Alegria (behavioral intervention adaptation to a Latino population), Enrique Caballero (cultural tailoring of diabetes interventions to a Latino population), J. Jaime Miranda (mHealth intervention development/testing in Latino populations), and Tanayott Thaweethai (biostatistics) will provide additional focused expertise. Research: I will adapt REACH, a text message-based mHealth platform with content tailored to address self-reported barriers to diabetes medication adherence (developed by Dr. Mayberry), to a Latino population (REACH-Español) with type 2 diabetes through two specific aims. Aim 1: Adapt and develop REACH-Es content on barriers to diabetes medication adherence with engagement of a diverse group of stakeholders (n=8), qualitative input from Latino adults with type 2 diabetes (n=20-30), and beta testing for intervention refinement with stakeholder input. Aim 2: Conduct a pilot RCT (n=70) to assess feasibility, acceptability, and usability of REACH-Es, as well as intervention targets (diabetes medication adherence and barriers to adherence) comparing REACH-Es to control; secondary outcomes are HbA1c and diabetes self- efficacy. The project will generate preliminary data for an R01 hybrid-effectiveness implementation trial of REACH-Es. The completion of these training and scientific aims will facilitate my transition to becoming an independent physician-investigator focused on developing scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes.

项目摘要 背景：拉丁美洲成年人2型糖尿病和糖尿病相关疾病的负担不成比例。 并发症糖尿病药物治疗不依从性是一个重要的可改变的贡献， 拉丁美洲成年人的血糖管理，他们报告不依从糖尿病的可能性几乎是拉丁美洲成年人的两倍。 非西班牙裔白色人。除了语言障碍外， 导致该人群不依从的障碍包括对胰岛素使用的负面看法， 误解一旦HbA 1c改善，糖尿病药物的持续需求。移动的健康 技术可以减少药物依从性障碍，改善依从性行为，但移动健康工具， 解决拉丁美洲成年人中常见的糖尿病药物依从性障碍。 候选人：我是一名在拉丁美洲出生和长大的内分泌学家;我的长期职业目标是发展 可扩展的，以患者为中心的干预措施，解决糖尿病自我护理的差距，以改善 2型糖尿病的治疗方法培训：我在流行病学方面接受了出色的研究培训， 为了实现我的长期职业目标，我需要额外的培训：1）适应基于证据的 干预措施，2）混合方法，以及3）在mHealth中进行临床试验。导师：我的训练和 研究计划将由主要导师Deborah Wexler博士（2型糖尿病临床 试验/干预适应）和共同导师林赛梅伯里博士（混合方法学家/mHealth临床 审判）。Margarita阿莱格里亚博士（拉丁裔人口的行为干预适应），Enrique Caballero （针对拉丁裔人群的糖尿病干预的文化定制），J. Jaime米兰达（移动健康干预 拉丁裔人群的开发/测试）和Tanayott Thaweethai（生物统计学）将提供额外的 专注的专业知识。研究：我将适应REACH，一个基于文本消息的移动健康平台， 针对自我报告的糖尿病药物依从性障碍（由Mayberry博士开发）， 拉丁裔人群（REACH-Español）2型糖尿病通过两个特定的目标。目标1：适应和发展 关于糖尿病药物依从性障碍的REACH-E内容， 利益相关者（n=8），拉丁美洲成人2型糖尿病患者（n=20-30）的定性输入，以及 在利益攸关方投入下完善干预措施。目的2：进行一项试验性RCT（n=70）以评估可行性， REACH-E的可接受性和可用性，以及干预目标（糖尿病药物治疗依从性和 依从性障碍）比较REACH-E与对照;次要结局为HbA 1c和糖尿病自我评估。 功效该项目将为R 01混合有效性实施试验产生初步数据， REACH-ES。完成这些训练和科学目标将有助于我成为一名 独立的医生调查员专注于开发可扩展的，以患者为中心的干预措施， 解决糖尿病自我护理方面的差距，以改善拉丁美洲成年2型糖尿病患者的结局。