Improving Veteran Engagement in Diabetes Prevention

 描述（由申请人提供）： 预防2型糖尿病（T2 DM）是VHA的高度优先事项。尽管有循证策略来预防T2 DM，但高危退伍军人对这些策略的参与度很低。让高危退伍军人参与预防T2 DM的干预措施的一个关键机会是，当他们通过筛查测试被告知患有前驱糖尿病，并通过他们的患者对齐护理团队（PACT）传达这些测试结果时。这种沟通的设计可以通过结合行为经济学和健康心理学的最新见解来改进。然而，目前尚不清楚如何修改VHA与诊断为前驱糖尿病的患者的沟通，以改善他们对循证预防策略的参与。 通过这个CDA，我将建立在我以前的培训行为经济学获得内容专业知识在健康心理学和相关学科，以及获得先进的技能，在实验设计和混合方法评估。通过这次培训和CDA导师的支持，我将实现3个目标。目的1：描述高危退伍军人目前参与预防T2 DM的行为以及这种参与的中介。我们将调查VA安阿伯医疗保健系统（VAAAHS）的189名非糖尿病退伍军人，这些退伍军人的体重指数（BMI）≥ 30 kg/m2或BMI ≥ 25 kg/m2且伴有肥胖相关合并症。这些退伍军人将被问及他们参与预防T2 DM的行为以及这种参与的介导因素，例如风险感知，动机以及对预防策略的认识和偏好。目的2：研究接受糖尿病前期诊断对高危退伍军人体重和参与预防T2 DM行为的影响。我们将在项目1的189名非糖尿病退伍军人中进行一项试点随机试验，其中我们将随机分配126名退伍军人，使用血红蛋白A1 c（HbA 1c）检测进行T2 DM筛查。我们计划的63名退伍军人的HbA 1c值将在糖尿病前期范围内，他们将通过简短的标准化咨询获得PACT提供者的诊断和预防建议。所有189名退伍军人将在明年跟踪他们的体重，并将在筛查和简短的咨询过程后立即进行调查，在3个月和1年。 然后，我们将比较体重的变化，参与预防T2 DM的行为，以及我们计划的63名退伍军人将患有前驱糖尿病和63名未接受筛查的退伍军人之间的这种参与的中介。在63名患有糖尿病前期的退伍军人中，我们将进行20次半结构化访谈，以深入了解这种诊断的影响，并简要介绍 辅导目标3：确定行为经济学和健康心理学的4种策略对糖尿病前期退伍军人体重、HbA 1c和参与行为预防T2 DM的影响。我们将进行部分析因设计实验，以评估行为经济学和健康心理学的4种创新策略在促进减肥，降低HbA 1c和增加参与行为以预防VAAAHS中144名退伍军人中的T2 DM的有效性，这些退伍军人通过HbA 1c测试被确定为患有糖尿病前期。我们将对这些策略对患者的可接受性进行定性评估。 在这篇CDA中，我将使用创新的实验方法，并应用尖端的行为技术，更有效地让高危退伍军人参与以证据为基础的预防T2 DM的策略。从这项研究中产生的见解将很容易导出到其他高优先级的条件下，退伍军人参与预防行为是必不可少的，可以得到改善。通过这些项目和有针对性的额外培训，我将获得实现我的长期职业目标所需的内容专业知识和方法技能，即成为开发，评估和传播基于行为经济学和健康心理学的关键见解的可扩展VHA预防策略的国家领导者。

 DESCRIPTION (provided by applicant): Prevention of type 2 diabetes mellitus (T2DM) is a high priority within the VHA. Despite the availability of evidence-based strategies to prevent T2DM, engagement in these strategies is low among at-risk Veterans. A key opportunity to engage at-risk Veterans in interventions to prevent T2DM is when they are informed they have prediabetes through a screening test and communication of these test results through their Patient Aligned Care Team (PACT). The design of such communications could potentially be improved by incorporating state-of-the-art insights from behavioral economics and health psychology. Yet, it remains unclear just how VHA communications to patients diagnosed with prediabetes could be modified to improve their engagement in evidence-based preventive strategies. Through this CDA, I will build on my prior training in behavioral economics to gain content expertise in health psychology and related disciplines as well as acquire advanced skills in experimental design and mixed methods evaluation. With this training and support from my CDA mentors, I will achieve 3 aims. Aim 1: To describe at-risk Veterans' current engagement in behaviors to prevent T2DM and the mediators of this engagement. We will survey 189 non-diabetic Veterans in the VA Ann Arbor Healthcare System (VAAAHS) who have a body-mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 25 kg/m2 and an obesity-related comorbidity. These Veterans will be asked about their engagement in behaviors to prevent T2DM and mediators of this engagement such as risk perception, motivation, and awareness of and preferences for preventive strategies. Aim 2: To examine the effects of receipt of a prediabetes diagnosis on at-risk Veterans' weight and engagement in behaviors to prevent T2DM. We will conduct a pilot randomized trial among the same 189 non-diabetic Veterans from Project 1 in which we will randomly assign 126 of these Veterans to undergo screening for T2DM using a hemoglobin A1c (HbA1c) test. The 63 Veterans who we project will have HbA1c values in the prediabetes range will receive that diagnosis and preventive recommendations from their PACT provider via brief standardized counseling. All 189 Veterans will have their weight tracked over the next year and will be surveyed immediately after the screening and brief counseling process, at 3 months, and at 1 year. Then we will compare changes in weight, engagement in behaviors to prevent T2DM, and mediators of this engagement between the 63 Veterans who we project will have prediabetes and the 63 Veterans who were not screened. Among the 63 Veterans with prediabetes, we will conduct 20 semi-structured interviews to gain insights into the effects of this diagnosis and brief counseling. Aim 3: To identify the effects of 4 strategies from behavioral economics and health psychology on weight, HbA1c, and engagement in behaviors to prevent T2DM among Veterans with prediabetes. We will conduct a fractional factorial design experiment to evaluate the effectiveness of 4 innovative strategies from behavioral economics and health psychology in promoting weight loss, decreasing HbA1c, and increasing engagement in behaviors to prevent T2DM among 144 Veterans in the VAAAHS who are identified as having prediabetes through an HbA1c test. We will conduct qualitative evaluations of the acceptability of these strategies to patients. In this CDA, I will use innovative experimental methods and apply cutting-edge behavioral techniques to more effectively engage at-risk Veterans in evidence-based strategies to prevent T2DM. Insights generated from this research will be readily exportable to other high-priority conditions in which Veteran engagement in preventive behaviors is essential and could be improved. Through these projects and targeted additional training, I will acquire the content expertise and methodological skills I need to achieve my long-term career goal of becoming a national leader in developing, evaluating, and disseminating scalable VHA prevention strategies that are based on key insights from behavioral economics and health psychology.