Strengths-Based Multi-Level Behavioral Intervention to Promote Resilience and Self-Management in Youth with Type 1 Diabetes

基于优势的多层次行为干预可促进 1 型糖尿病青少年的复原力和自我管理

• 批准号: 10667615
• 负责人: Marisa Ellen Hilliard
• 金额: $ 73.94万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-20 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667615
• 关键词: Adherence; Adolescence; Adolescent; Age; Appointment; Behavior; Behavior Therapy; Behavioral; Caring; Child; Childhood; Childhood diabetes; Chronic; Clinic; Clinical; Clinical Data; Communication; Conflict (Psychology); Data; Deterioration; Development; Diabetes Mellitus; Dose; Early Intervention; Educational process of instructing; Electronic Health Record; Ethnic Origin; Family; Future; Glucose; Glycosylated hemoglobin A; Goals; Health; Health Technology; Health behavior; Health behavior change; Healthcare; Healthcare Systems; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Linguistics; Mediating; Mediator; Medical; Methods; Modeling; Outcome; Parents; Participant; Patient Outcomes Assessments; Pattern; Persons; Physiological; Pilot Projects; Prevention; Preventive; Provider; Quality of life; Race; Randomized; Reporting; Research; Risk; Science; Self Management; Social support; Structure; System; Targeted Research; Testing; Theory of Change; Time; Training; Visit; Washington; Youth; arm; behavioral adherence; brief intervention; care providers; diabetes distress; diabetes management; diabetes self-management; digital health; education resources; expectation; experience; follow-up; glycemic control; health related quality of life; high risk; improved; innovation; intervention effect; medical appointment; meetings; mobile application; multi-component intervention; novel; peer; post intervention; prevent; preventive intervention; primary outcome; promote resilience; provider intervention; psychosocial; psychosocial wellbeing; recruit; resilience; satisfaction; secondary outcome; social; social cognitive theory; socioeconomics; theories; tool; treatment arm; treatment as usual

PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) management is particularly challenging during the transition to adolescence, as this developmental period is often marked by increasing expectations for independence in self-management and poorer glycemic and quality of life outcomes. In behavioral T1D research (largely conducted with adolescents), there has been limited evidence of meaningful, lasting impact on adherence behaviors or glycemic outcomes. Novel, developmentally appropriate approaches are needed to help youth achieve “diabetes resilience” – i.e., engage in high levels of self-management behaviors, achieve HbA1c levels within the target range, and experience good quality of life – during the important late childhood and early adolescent years. Prevention science and social-ecological theories of health behavior change for pediatric health conditions recognize the importance of early interventions that target multiple systems surrounding a child with a chronic condition like T1D to promote trajectories of positive behavioral, psychosocial, and medical outcomes. The goal of this study is to evaluate a new intervention for youth age 8-12 with T1D and elevated HbA1c that uses strengths-based methods to prevent the deterioration in outcomes often observed in adolescence. In this 6-month, multi-modal intervention: (1) diabetes care providers will use youth- and parent-reports of youth’s diabetes strengths and self-management behaviors to lead a discussion of what youth are doing well for T1D during a routine diabetes care appointment, (2) parents will use an app to recognize, track, and reinforce their children’s positive T1D- related behaviors and will have “3 minute meetings” with their child about a T1D self-management goal, and (3) youth will use an app to have positive interactions with parents about their diabetes strengths and build supportive social connections with peers through videos about living well with T1D. The intervention strategies are brief, low-burden, and use digital health technologies to deliver the intervention in the context of real-world diabetes activities (i.e., routine medical appointments and everyday T1D management). We will test this intervention with 250 racially/ethnically, socioeconomically, and linguistically diverse youth in Houston, TX and Washington, DC, who are randomly assigned to the intervention or enhanced usual care. Our goal is to evaluate the intervention’s impact on key T1D outcomes: HbA1c, % glucose time in range, engagement in T1D self- management behaviors, and health-related quality of life. We will also examine psychosocial and intervention- specific factors that may be mechanisms of the intervention’s effect. Data will be collected for 15 months. The ultimate goal of this research is to test the effects of a multi-level, strengths-based preventive intervention on health behaviors, psychosocial well-being, and T1D health outcomes during the critically important and understudied developmental stage of the transition to adolescence. Results will inform future intervention strategies to maximize resilient outcomes for youth with T1D who are at elevated risk for poor outcomes.

项目摘要/摘要 在过渡到青春期期间，1型糖尿病(T1D)的管理尤其具有挑战性，因为 发展阶段的特点通常是对自我管理和自我管理的独立性的期望越来越高 血糖和生活质量结果较差。在行为T1D研究中(主要在青少年中进行)， 有有限的证据表明对依从性行为或血糖结果有有意义的持久影响。 需要新的、适合发展的方法来帮助青年实现“糖尿病复原力”，即， 从事高水平的自我管理行为，在目标范围内达到HbA1c水平，以及 体验良好的生活质量--在重要的童年后期和青春期早期。预防 儿童健康状况的健康行为改变的科学和社会生态理论认识到 针对患有慢性病的儿童周围的多个系统进行早期干预的重要性 T1D以促进积极的行为、心理社会和医学结果的轨迹。这项研究的目的是 是评估一项针对8-12岁患有T1D和HbA1c升高的年轻人的新干预措施，该干预措施使用基于强度的 预防青春期常见预后恶化的方法。在这个为期6个月的多式联运 干预：(1)糖尿病护理提供者将使用青少年和父母报告青少年的糖尿病强度和 自我管理行为，引导讨论年轻人在常规糖尿病期间哪些方面对T1D有利 护理预约，(2)父母将使用一款应用程序来识别、跟踪和加强他们孩子积极的T1D- 相关行为，并将与孩子就T1D自我管理目标进行“3分钟会议”，以及(3) 年轻人将使用一款应用程序与父母就他们的糖尿病强度进行积极互动，并建立 通过与T1D相处良好的视频，与同龄人建立支持性的社交关系。干预策略 是简短、低负担的，并使用数字健康技术在现实世界的背景下提供干预 糖尿病活动(即常规医疗预约和日常T1D管理)。我们将对此进行测试 对德克萨斯州休斯敦的250名种族/民族、社会经济和语言多样化的年轻人进行干预 华盛顿特区，他们被随机分配到干预或加强日常护理。我们的目标是评估 干预对关键的T1D结局的影响：HbA1c、血糖在范围内的时间百分比、T1D自我参与 管理行为和与健康相关的生活质量。我们还将研究心理社会和干预- 可能是干预效果的机制的特定因素。数据收集时间为15个月。这个 这项研究的最终目标是测试多层次、基于强度的预防性干预对 关键时期的健康行为、心理社会幸福感和T1D健康结局 对过渡到青春期的发展阶段研究不足。结果将为未来的干预提供信息 最大限度地提高患有T1D的青少年预后不良风险的策略。