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维持诊断后的最佳健康至关重要。 糖尿病困扰（DD）是影响退伍军人参与糖尿病自我治疗的关键因素， 管理DD与抑郁症不同，包括四个领域（即，养生，情感， 人际关系，医疗保健提供者）。DD的存在对参与自我管理产生负面影响 HbA1c。尽管采取了旨在减少DD的干预措施，但这些干预措施的持久性很低， 方面的影响.一个原因可能是因为干预措施没有针对个人的DD提供信息。 重要性/影响：本提案将首次审查相关因素对DD的影响， 然后根据退伍军人的DD类型设计和测试自我管理干预。这项建议 解决了[VHA战略计划优先领域的更有效地利用资源和改善 服务的及时性，以及人口健康/整体健康和初级保健的HSR&D研究重点 护理实践。这项提案的研究结果可以改善退伍军人的医疗服务和健康结果，因为我们 将有助于促进退伍军人与无处不在的现有VHA和社区服务的联系]。 创新：该提案将开发一种针对次优T2 D自我管理的干预措施， 提供量身定制的自我管理信息以及与支持服务的联系。我们将 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将检查[心理社会因素（抑郁症，创伤后应激障碍）， 环境因素（财务、支持）、自我管理行为和DD的HbA 1c。Aim 1数据 将告知可修改因素的识别和人群的选择]对于糖尿病自我- 对T2 D退伍军人的管理干预。目标2将描述自我管理的挑战， 首选的学习策略[告知干预组件和退伍军人的交付方法， 2型糖尿病深入了解DD类型、自我管理策略和挑战， 偏好对于调整干预内容至关重要]。目标3的目的是设计和试点测试， 为退伍军人提供创新的、量身定制的T2 D自我管理信息和支持性服务干预， T2 D，促进参与自我管理行为。在目标3中，我们将确定可行性， T2 D退伍军人干预的可接受性。 方法：本提案使用解释性的顺序混合方法设计来描述DD， 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）， 根据HbA 1C（< 9或≥ 9）和药物使用（胰岛素，无胰岛素）进行入组。在目标2中，我们将进行半- 结构化访谈的子样本（n = ~36）的退伍军人调查目标1。我们将平衡招生 通过HbA 1C、药物使用和DD水平，如糖尿病苦恼量表（低，中， 高）。在目标3中，我们将利用目标1和目标2的结果以及战略， 成功地被合作伙伴使用。为了制定干预措施，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VA/社区资源），以确保相关性。我们将修改组件和交付策略 根据需要然后，我们将用30名退伍军人测试干预措施，以评估[可行性和可接受性]， 使用定量和定性方法，利用建议的支助服务。 执行/下一步：下一步包括传播关于荒漠化和退化的调查结果， 相关，以及IIR的发展。该IIR将是一项III期疗效试验， 有能力测试提供自我管理信息和与支持服务的联系的效果 为退伍军人的DD量身定制，以改善HbA 1c。

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.