Improving Patient Self-Advocacy and Communication with Providers through Diabetes Self-Management Education: A Randomized Controlled Trial

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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.