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: 10732222
• 负责人: Brenna Owens Kirk
• 金额: $ 4.77万
• 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/10732222
• 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; Data; Diabetes Mellitus; Diet; Disadvantaged; Disease Management; Distress; Education; Ethnic Origin; Fasting; Fellowship; Focus Groups; Gender; Glycosylated hemoglobin A; Goals; Health; Health Disparities Research; High Prevalence; Hypertension; Intervention; Interview; Knowledge; Lead; Lipids; 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; Research Activity; Research Design; Research Methodology; Research Personnel; Rural; Rural Appalachia; Self Care; Self Efficacy; Self Management; Self Perception; Site; Testing; Training; Training Activity; United States; West Virginia; active control group; arm; care preference; career; clinically relevant; comorbidity; comparison intervention; design; diabetes distress; diabetes management; diabetes self-management; effectiveness testing; empowerment; experience; group intervention; health equity; improved; innovation; lifestyle intervention; medically underserved; medication compliance; patient centered medical home; patient-clinician communication; patient-level barriers; post intervention; preference; programs; prospective; provider communication; 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.

项目摘要 西弗吉尼亚州（WV）是阿巴拉契亚州的农村国家，一个以独特的文化特征而闻名的地区，也是一个历史 影响2型有效自我管理的剥夺权力，劣势和贫穷的社会决定因素 糖尿病（T2DM）。 WV承担着慢性病的高负担，因为该州的速度最高 美国的T2DM（16.2％）。患者提供者关系中的交流是慢性的关键组成部分 疾病管理并支持预防毁灭性的长期并发症。但是，患者 与T2DM一起生活通常不愿意与提供者公开分享他们对自我保健的担忧。这 研究旨在测试糖尿病和高血压自我管理计划（DHSMP）的有效性， 在WV的两个以患者为中心的医疗住宅中实施的为期12周的小组生活方式干预有关改善 患者在患者培训者关系中的自我顾问和沟通方面就其关注和 其T2DM的管理和治疗偏好。该计划对相关临床的影响（HBA1C， 禁食的血糖，脂质），行为（自我护理）和社会心理（糖尿病困扰）变量也将是 这些变量与患者自我顾问与患者提供者之间的评估和关系 将探索沟通。 DHSMP利用健康教练来提供小组教育会议和 支持参与者改善自我保健行为，包括鼓励和授权参与者 自我辅助/传达他们的需求与提供者。使用随机对照试验（RCT）设计 以及一种综合和解释的顺序混合方法方法，本研究的目标是： 评估DHSMP对改善患者自我顾问和与提供者的沟通的影响 与主动对照组相比糖尿病（AIM 1），以了解参与者的经验和看法 DHSMP和有关糖尿病自我管理的患者沟通以及通过焦点小组的自我管理的交流 访谈（AIM 2A），并评估自我顾问和患者的经验/看法的差异 - 提供者的沟通基于各种参与者特征（AIM 2B）。这项研究具有创新性 是第一个测试生活方式干预对患者自我顾问和患者提供者的影响的RCT 有关糖尿病护理，管理和相关困扰的沟通。此外，这项研究将 通过告知策略来提高对患者支持者关系的理解，并填补重要的空白 解决有关糖尿病在阿巴拉契亚语中糖尿病的自我管理的沟通 成年人。该奖学金还将为Brenna Kirk女士（PI）提供管理多站点的技能和经验 干预，进行混合方法研究，通过出版物/演示进行传播结果，并将 增强她对慢性疾病和方法的农村临床管理的理解 实践中的健康公平。因此，研究和培训计划将使柯克女士做好准备 健康差异研究领域的主要行为研究者集中在农村成年人中。