Older Adults Using Social Support to Improve Self-Care (OASIS): Adaption, Implementation, and Feasibility of Peer Support for Older Adults with T2DM in Appalachia

项目摘要 美国约有3410万（13%）成年人患有2型糖尿病（T2D）。T2D的患病率为17%。 与城市居民相比，农村居民的T2D患病率更高，T2D患病率随着年龄的增长而增加， 估计有25%的老年人（≥ 65岁）被确诊。适当的自我护理是必要的， 临床结果和自我护理的变异性占血糖控制变异的90%。总体而言，T2D 一般人口的自我照顾能力一直很差，而农村居民和老年人的自我照顾能力更差。 这在肯塔基州的农村尤其如此，那里阿巴拉契亚社区高达23%的成年人 被诊断为T2D，其中26.8%是老年人。为了获得最佳的临床结果，社会 环境因素，包括社会支持，在促进T2D自我护理时是不可或缺的。具体来说，Peer 支持已被证明在改善T2D自我护理行为方面是有效的;它提供情感支持， 工具支持和教育，同时也帮助个人发展新技能。同样，同伴支持 也被证明可以改善与T2D相关的临床和心理社会结局;然而，有文献表明， 还表明，自我选择的社会支持可能会阻碍当试图从事健康的活动。 目前可用的基于证据的干预措施（EBI）使用同行的支持还没有被专门用于 优先考虑老年人，特别是生活在农村社区的老年人。为了解决研究中的这一差距，我们 与区域从业者、阿巴拉契亚服务组织领导人进行了形成性研究， 居民，并通过这一过程，我们共同确定了一个可接受的和可行的同行支持EBI- 同伴健康指导（PHC）-改善了T2D相关的临床和心理社会结局 未居住在农村社区且年龄≥ 65岁的受试者。通过这些社区 我们还确定了对EBI进行必要的先验调整，以确保其文化和背景 与区域需求和价值观的相关性。由于初级保健是一种以社区为基础的低成本干预措施， 承诺在资源匮乏的阿巴拉契亚肯塔基州成为一个可持续和可扩展的模式， 但社区纽带是有价值的根据文献和利益攸关方的反馈， 拟议的研究是使用2x2析因设计来测试适应的PHC组件，并确定其 促进生活自理行为和改善老年人血糖控制的初步效果 在阿巴拉契亚肯塔基州。析因设计的主要组成部分将是如何选择同伴教练 参与者（自选vs配对）和与教练联系的频率（每周一次vs每2次 周）。为了实现这一目标，我们将（1）确定哪些EBI组件与改善的T2D相关- 生活在阿巴拉契亚肯塔基州的老年人的相关结果和（2）评估务实的可实施性 适应EBI。

PROJECT SUMMARY Approximately 34.1 million (13%) adults in the US have type 2 diabetes (T2D). The prevalence of T2D is 17% higher in rural dwellers compared to their urban counterparts, and the prevalence of T2D increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes, and variability in self-care accounts for 90% of the variance in glycemic control. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. This is particularly true in rural Kentucky, where up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are integral when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors; it provides emotional support, instrumental support, and education while also helping individuals develop new skills. Similarly, peer support has also been shown to improve clinical and psychosocial outcomes related to T2D; however, there is literature that also suggests self-selected social support can be obstructive when trying to engage in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used specifically to prioritize older adults, especially those living in rural communities. To address this gap in research, we have conducted formative research with regional practitioners, leaders of service organizations in Appalachia, and residents, and through that process, we collaboratively identified an acceptable and feasible peer support EBI— peer health coaching (PHC)—that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. Through these community conversations, we also determined necessary a priori adaptations to the EBI to ensure its cultural and contextual relevance to regional needs and values. Because PHC is a community-based and low-cost intervention, it holds promise to be a sustainable and scalable model across Appalachian Kentucky where resources are often scant, but community bonds are valued. Informed by literature and feedback from stakeholders, the goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. The main components of the factorial design will be how peer coaches are selected for participants (self-selected vs matched) and frequency of contact with coach (once per week vs every 2 weeks). To achieve this goal, we will (1) determine which EBI components are associated with improved T2D- related outcomes in older adults living in Appalachia Kentucky and (2) evaluate the pragmatic implementability of the adapted EBI.