Improving Patient Self-Advocacy and Communication with Providers through Diabetes Self-Management Education: A Randomized Controlled Trial

通过糖尿病自我管理教育改善患者的自我倡导以及与医疗服务提供者的沟通：随机对照试验

• 批准号: 10536514
• 负责人: Brenna Owens Kirk
• 金额: $ 4.68万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536514
• 关键词: Address; Adherence; Adult; Advocacy; Advocate; Affect; Age; Appalachian Region; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Blood specimen; Caring; Characteristics; Chronic Disease; Clinical; Clinical Management; Communication; Control Groups; Data; Diabetes Mellitus; Diet; Disadvantaged; Disease Management; Distress; Education; Ethnic Origin; Fasting; Fellowship; Focus Groups; Gender; Glycosylated hemoglobin A; Goals; Group Interviews; Health; Health Disparities Research; High Prevalence; Home; Hypertension; Intervention; Interview; Knowledge; Lead; Lipids; Medical center; Mentorship; Methodology; Methods; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient advocacy; Patients; Perception; Personal Satisfaction; Physical activity; Prevention; Provider; Publications; Questionnaires; Race; Randomized; Randomized Controlled Trials; Recording of previous events; Research Activity; Research Design; Research Methodology; Research Personnel; Research Training; Rural; Rural Appalachia; Self Care; Self Efficacy; Self Management; Self Perception; Site; Testing; Training Activity; United States; West Virginia; active control; arm; base; care preference; career; clinically relevant; comorbidity; comparison intervention; design; diabetes distress; diabetes management; diabetes self-management; effectiveness testing; empowered; empowerment; experience; group intervention; health equity; improved; innovation; lifestyle intervention; medically underserved; medication compliance; patient oriented; patient-clinician communication; patient-level barriers; post intervention; preference; programs; prospective; psychosocial; rural health disparities; rural healthcare; self-management program; skills; social determinants; trait; treatment as usual; trial design; urban residence; usual care arm

PROJECT SUMMARY West Virginia (WV) is a rural state in Appalachia, a region known for unique cultural traits, but also a history of disempowerment, disadvantage, and poor social determinants that impact effective self-management of type 2 diabetes mellitus (T2DM). WV experiences a high burden of chronic disease as the state has the highest rate of T2DM (16.2%) in the US. Communication in the patient-provider relationship is a key component of chronic disease management and supports the prevention of devastating long-term complications. However, patients living with T2DM are often reluctant to openly share their concerns regarding self-care with their provider. This study aims to test the effectiveness of the Diabetes and Hypertension Self-Management Program (DHSMP), a 12-week group lifestyle intervention implemented in two Patient Centered Medical Homes in WV on improving patients' self-advocacy and communication in the patient-provider relationship regarding their concerns and preferences in management and treatment of their T2DM. The program's impact on relevant clinical (HbA1c, fasting blood glucose, lipids), behavioral (self-care) and psychosocial (diabetes distress) variables will also be assessed and relationships between these variables and patient self-advocacy and patient-provider communication will be explored. The DHSMP utilizes health coaches to deliver group educational sessions and support participants in improving self-care behaviors, including encouraging and empowering participants to self-advocate/communicate their needs to their providers. Using a randomized controlled trial (RCT) design and an integrated and explanatory sequential mixed-method approach, the objectives of this study are: to assess the DHSMP's impact on improving patient self-advocacy and communication with providers regarding diabetes compared to an active control group (Aim 1), to understand participants' experiences and perceptions of the DHSMP and patient-provider communication regarding diabetes self-management via focus groups and interviews (Aim 2a), and to assess differences in experiences/perceptions of self-advocacy and patient- provider communication based on various participant characteristics (Aim 2b). This study is innovative in that it is the first RCT to test the impact of a lifestyle intervention on patient self-advocacy and patient-provider communication regarding diabetes care, management, and related distress. Furthermore, this study will advance understanding of patient-provider relationships and fill an important gap by informing strategies to address patient-provider communication regarding self-management of diabetes among rural Appalachian adults. This fellowship will also equip Ms. Brenna Kirk (PI) with skills and experience in managing a multi-site intervention, conducting mixed-methods research, disseminating results via publications/presentations, and will enhance her understanding of rural clinical management of chronic diseases and approaches for operationalizing health equity in practice. The research and training plan will thus prepare Ms. Kirk to become a leading behavioral investigator in health disparities research focused on diabetes among rural adults.

项目总结