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（West Virginia，WV）是位于阿巴拉契亚的一个乡村州，该地区以独特的文化特征而闻名，但也有着悠久的历史。 影响2型自我管理的失权、劣势和不良社会决定因素 糖尿病（T2 DM）。西弗吉尼亚州的慢性病负担很高，因为该州的发病率最高 T2DM（16.2%）。医患关系中的沟通是慢性病的关键组成部分， 疾病管理和支持预防毁灭性的长期并发症。但是患者 患有T2 DM的患者通常不愿意与他们的提供者公开分享他们对自我护理的担忧。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， 12-在西弗吉尼亚州的两个以病人为中心的医疗之家实施了一周的小组生活方式干预， 病人的自我宣传和沟通的病人-提供者关系，对他们的关注， 管理和治疗T2 DM的偏好。该计划对相关临床（HbA 1c， 空腹血糖，血脂），行为（自我护理）和心理社会（糖尿病困扰）变量也将被 评估这些变量与患者自我辩护和患者提供者之间的关系 沟通将被探索。DHSMP利用健康教练提供小组教育课程， 支持参与者改善自我护理行为，包括鼓励和授权参与者 自我倡导/沟通他们的需求，他们的供应商。采用随机对照试验（RCT）设计 和一个综合的和解释性的顺序混合方法的方法，本研究的目标是： 评估DHSMP对改善患者自我宣传和与提供者沟通的影响， 糖尿病与积极控制组（目标1）相比，以了解参与者的经验和看法 DHSMP和患者-提供者通过焦点小组就糖尿病自我管理进行沟通， 访谈（目标2a），并评估自我辩护和病人- 基于不同参与者特征的供应商通信（目标2b）。本研究的创新之处在于， 是第一个测试生活方式干预对患者自我保护和患者提供者的影响的RCT 关于糖尿病护理、管理和相关困扰的沟通。此外，本研究将 促进对患者-提供者关系的理解，并通过告知战略来填补重要空白， 解决阿巴拉契亚农村地区糖尿病自我管理的患者-提供者沟通问题 成年人了该研究金还将使Brenna Kirk女士（PI）具备管理多个地点的技能和经验。 干预，进行混合方法研究，通过出版物/演示文稿传播结果，并将 提高对农村慢性病临床管理的认识， 在实践中实现卫生公平。因此，研究和培训计划将使柯克女士成为 他是健康差异研究领域的主要行为调查员，主要研究农村成年人的糖尿病。