A Family-Dyad-focused Diabetes Self-Management Intervention for African American Adults with Type 2 Diabetes

点击翻译按钮获取中文摘要

Project Summary/Abstract African Americans (AAs) with Type 2 diabetes (T2D) have worse glycemic control and a 50% higher mortality rate of diabetes compared to non-Hispanic Whites (NHWs). AAs with T2D have 3.2 times more hospital admissions for uncontrolled diabetes compared to NHWs. Multiple, intertwined factors at the individual, interpersonal, community, societal, and healthcare system levels contribute to lower adherence to diabetes self- management, greater difficulty achieving glycemic control, and higher rates of microvascular and macrovascular complications. The NIH Science of Behavior Change identifies interpersonal and social processes as one of the three key mechanisms for behavior change, providing greater support for this strategy. Family is a critical social context in which interdependence, collectivism, and extended family network is central to their way of life among AAs. Indeed, focusing on the individual-level demonstrated only limited improvements in glycemic control for AAs with T2D. Thus, effective multi-level interventions that promote adherence to diabetes self-management in this vulnerable population are sorely needed. Our proposed phase I/II randomized controlled trial will not only improve glycemic control for participants with T2D, but also engage family members in physical activity and healthy eating strategies. The specific aims are: 1. to examine the feasibility and acceptability of a family-dyad- focused diabetes intervention in AA adults with T2D and their designated family members; 2. to examine the preliminary efficacy of the family-dyad-focused diabetes self-management intervention compared to a waitlist control arm on: (1) glycemic control (hemoglobin A1c) and health-related quality of life (HRQOL) (primary outcomes); and (2) blood pressure control (secondary outcome) in participants with T2D; and 3. to explore the dyadic relationship (quality and support) and its association with a) changes in dyadic stress, physical activity and dietary intake, and b) health outcomes (glycemic control, HRQOL and blood pressure control) over time in participants with T2D. We will conduct a two-arm RCT. We will enroll 104 AAs with T2D and one family member of each patient (104 dyads), randomized 1:1 to intervention or wait list control arm (n=52/arm). All participants will undergo the standard usual care held at the pharmacy clinic. Patient-family-member dyads in the intervention arm will receive 1) 14 session over 20 weeks of family dyad-focused, in-person group sessions on diabetes self- management and family support; 2) family dyad-focused support component in each group session; and 3) individual family feedback telephone sessions. All participants will be assessed at baseline, post-intervention and six months after intervention. Our goals of the intervention are to encourage participants to (1) daily self- manage diabetes and stress; (2) establish a healthy eating pattern reducing overall calorie and carbohydrate intake; (3) engage in brisk walking of 150 or more minutes a week; and (4) use solution-focused problem-solving strategy and supportive family communication skills. Our approach will add to the scientific knowledge and identify interpersonal and social mechanisms in adherence to diabetes self-management among AAs.