Tailored Approaches to Reduce Distress and Improve Self-Management for Veterans with Diabetes (TARDIS)

背景：糖尿病自我管理对于在确诊后维持最佳健康至关重要。 糖尿病苦恼(DD)是影响退伍军人糖尿病自我投入的重要因素 管理层。DD不同于抑郁症，它包括四个领域(即养生、情绪、 人际关系、医疗保健提供者)。DD的存在对自我管理的参与度有负面影响 和HbA1c。尽管旨在减少DD的干预措施，但这些干预措施显示出最小的持久性 效果。一个原因可能是因为干预措施不会针对个人的DD量身定做信息。 意义/影响：该提案将第一次审查相关因素对DD的影响， 然后设计和测试针对退伍军人的DD类型定制的自我管理干预。这项建议 解决[VHA战略计划优先领域，更有效地利用资源和改善 服务的及时性，以及人口健康/整体健康和初级健康的高铁与研发研究重点 关爱实践。这项提案的发现可以改善退伍军人的护理提供和健康结果，因为我们 创新：该提案将开发一种针对次优T2D自我管理的干预措施，方法是 提供量身定制的自我管理信息以及与支持性服务的连接。我们会 确定DD及其因素如何以及在多大程度上影响退伍军人的自我管理行为。 具体目标：目标1将审查[心理社会因素(抑郁、创伤后应激障碍)、 环境因素(财务、支持)、自我管理行为和HbA1c伴DD。这些目标1数据 将有助于确定可修改的因素和选择人群]进行糖尿病自身 退伍军人T2D的管理干预。目标2将描述自我管理的挑战和 首选学习策略[为有以下情况的退伍军人提供干预内容和交付方法 T2D。 偏好对于定制干预组件是必不可少的]。目标3的目的是设计和试运行测试和 为退伍军人提供创新、量身定做的T2D自我管理信息和支持性服务干预 在目标3中，我们将确定可行性和 退伍军人T2D干预的可接受性研究 方法：本提案使用解释性的、顺序的混合方法设计来描述 在达勒姆接受护理的退伍军人样本。在目标1中，我们将调查退伍军人(n=200)，并平衡 参加HbA1C(&lt；9或≥9)和药物使用(胰岛素，不使用胰岛素)。在目标2中，我们将进行半 对AIM 1中接受调查的退伍军人进行了结构化访谈(n=~36)。我们将平衡入学人数 按糖化血红蛋白、用药情况和糖尿病危机量表(轻度、中度、 高)。在目标3中，我们将使用目标1和2的结果以及策略来开发和改进干预措施 成功地被合作导师使用。为了开发干预措施，我们将进行半结构化访谈 利益相关者(n=~20：医生、护士、管理人员)审查组件(例如，学习方法、 相关退伍军人事务部/社区资源)，以确保相关性。我们将修改组件和交付策略 视需要而定。然后，我们将对30名退伍军人进行干预测试，以评估[可行性和可接受性]，以及 利用推荐的支持性服务，采用定量和定性的方法。 实施/下一步：下一步包括传播关于DD的调查结果，以及其 关联，和IIR的发展。该IIR将是第三阶段疗效试验，并将充分 用于测试提供自我管理信息和与支持性服务的连接的效果 为老兵的DD量身定做，以改善HbA1c。

Background: Diabetes self-management is critical to sustaining optimal health following diagnosis. Diabetes distress (DD) is a crucial factor that influences a Veteran’s engagement in diabetes self- management. DD is distinct from depression, and includes four domains (i.e., regimen, emotional, interpersonal, healthcare provider). The presence of DD negatively impacts engagement in self-management and HbA1c. Despite interventions aimed at decreasing DD, these interventions have shown minimal lasting effects. One reason may be because interventions do not tailor information to an individual’s DD. Significance/Impact: This proposal will be the first to examine the impact of correlating factors on DD, and then design and test a self-management intervention tailored upon a Veteran’s DD type. This proposal addresses the [VHA Strategic Plan Priority areas of utilizing resources more efficiently and improving the timeliness of services, and the HSR&D Research Priorities of Population Health/Whole Health and Primary Care Practice. This proposal’s findings can improve both care delivery and health outcomes of Veterans, as we will help facilitate the Veteran’s linkage to ubiquitous, existing VHA and community services]. Innovation: This proposal will develop an intervention that targets sub-optimal T2D self-management by providing tailored self-management information in conjunction with connections to supportive services. We will identify how, and to what extent, DD and its factors, influence a Veteran’s self-management behaviors. Specific Aims: Aim 1 will examine the association of [psychosocial factors (depression, PTSD), environmental factors (finances, support), self-management behaviors, and HbA1c with DD. These Aim 1 data will inform the identification of modifiable factors and selection of the population] for a diabetes self- management intervention for Veterans with T2D. Aim 2 will describe self-management challenges and preferred learning strategies [to inform the intervention components and delivery approach for Veterans with T2D. Obtaining in-depth perceptions of DD type, self-management strategies and challenges, and learning preferences is essential to tailoring intervention components]. The purpose of Aim 3 is to design & pilot test an innovative, tailored T2D self-management information and supportive services intervention for Veterans with T2D, to promote engagement in self-management behaviors. In Aim 3 we will determine the feasibility and acceptability of the intervention for Veterans with T2D. Methodology: This proposal uses an explanatory, sequential mixed-methods design to describe DD in a sample of Veterans who receive care at Durham. In Aim 1 we will survey Veterans (n = 200), and balance enrollment by HbA1C (< 9 or ≥ 9) and medication use (insulin, no insulin). In Aim 2 we will conduct semi- structured interviews with a sub-sample (n = ~36) of Veterans surveyed in Aim 1. We will balance enrollment by HbA1C, medication use, and DD level as operationalized by the Diabetes Distress Scale (low, moderate, high). In Aim 3 we will develop and refine the intervention using findings from Aims 1 & 2 and strategies successfully used by co-mentors. To develop the intervention we will conduct semi-structured interviews with stakeholders (n = ~20: physicians, nurses, administrators) to review components (e.g., learning approaches, relevant VA/community resources) to ensure relevancy. We will modify components and the delivery strategy as needed. Then, we will test the intervention with 30 Veterans to evaluate [feasibility and acceptability], and utilization of recommended supportive services, using quantitative and qualitative approaches. Implementation/Next Steps: The next steps include dissemination of findings about DD, and its correlates, and the development of an IIR. This IIR will be a Phase III efficacy trial and will be sufficiently powered to test the effects of providing self-management information and connections to supportive services tailored to a Veteran’s DD to improve HbA1c.