eHealth: Second Life Impacts Diabetes Education & Self-Management (SLIDES)

描述(由申请人提供)：需要创新和媒介来帮助和增强慢性病患者的自我管理能力：消除医疗保健障碍；适应有限的健康素养；提供可持续的、成本效益高的患者教育和支持；以及超越无效的、非交互式的健康行为干预。通信技术的进步，如Web2.0，是满足这些需求的一种手段。初步研究表明，虚拟环境通过重复、练习、反馈和应用来促进社交互动，从而带来更好的学习和技能集转移。因此，我们建议开发和测试一种基于理论、基于技术的生物行为干预，使用虚拟环境Second Life来促进糖尿病的自我管理。糖尿病影响着2360万美国成年人，其中大多数人患有2型糖尿病(T2 DM)。众所周知，代谢控制可以降低糖尿病的发病率和死亡率，但在美国，它仍然是第六大死亡原因。2型糖尿病患者提供99%的自我护理，使糖尿病自我管理(DSM)(如饮食、运动)成为控制不可或缺的一部分。利用患者-提供者互动的量身定制的DSM干预措施已经产生了令人鼓舞的短期效果。然而，这种频繁的互动是遥不可及的，而且代价高昂。互联网干预有可能捕捉到患者-提供者互动的动态，但到目前为止，仍然是“平坦的”和单向的异步通信。像Second Life这样的虚拟环境是一种潜在的解决方案，可以在身临其境的环境中通过互动、同步通信、知识应用和社交网络来捕获患者和提供者之间的动态。我们认为，在患有T2 DM的成年人、医疗保健专业人员和同龄人之间进行实时互动的虚拟糖尿病社区(幻灯片)是可行的，并有可能影响代谢控制和心理社会调节因素。这项先导性研究利用一组前后测量后的研究设计来评估参与幻灯片的可行性、可用性和效果，其中包括互动的DSM教育、支持和资源。幻灯片社区将由社区中心、健身房、杂货店和其他地点组成，每个地点都允许互动知识应用。基于此设计，我们的具体目标是：(1)使用Second Life开发沉浸式糖尿病社区(SLODS)，并通过分析过程数据评估其可行性；以及(2)确定参与SLICS干预对代谢控制的初步影响以及潜在的心理社会中介变量，作为未来干预研究的效果大小和方差的基础。如果我们的方法是有希望的，我们将在未来的研究中进行实验疗效测试。由于人们对虚拟环境中健康干预的可接受性和有效性知之甚少，这项研究是理解它们如何促进自我管理的重要步骤。幻灯片等创新方案有可能以一种易于传播的替代医疗模式改善医疗保健机会，促进具有成本效益的资源利用。

DESCRIPTION (provided by applicant): Innovations and mediums to assist and empower patients in chronic illness self-management are needed to: eliminate barriers to healthcare; accommodate limited health literacy; provide sustainable, cost-effective patient education and support; and move beyond ineffective, non-interactive health behavior interventions. Advances in communication technology such as the Web 2.0 are a means to fill these needs. Initial studies suggest that virtual environments, which promote social interaction via repetition, practice, feedback, and application, lead to superior learning and skill set transfer. Therefore, we propose to develop and test a theoretically grounded, technologically-based, bio-behavioral intervention using the virtual environment, Second Life to facilitate self- management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2DM). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains the 6th leading cause of death in the U.S... Individuals with T2DM provide 99% of their own care, making diabetes self- management (DSM) (e.g. diet, exercise) integral to control. Tailored DSM interventions utilizing patient- provider interaction have had encouraging short-term effects. However, this frequent interaction is unattainable and costly. Internet interventions have the potential to capture the dynamics of patient-provider interaction, but to date remain "flat" and unidirectional with asynchronous communication. Virtual environments such as Second Life are a potential solution to capturing patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. We propose that a virtual diabetes community (SLIDES) with real-time interaction among adults with T2DM, healthcare professionals, and peers is feasible and has the potential to influence metabolic control and psychosocial mediators. This pilot study utilizes a one group, pre-mid-post measure study design to evaluate the feasibility, usability, and effect of participation in SLIDES, which includes interactive DSM education, support, and resources. The SLIDES community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our specific aims are: (1) Develop an immersive diabetes community (SLIDES) using Second Life and assess the feasibility by analyzing process data; and (2) Determine the preliminary effects of participation in the SLIDES intervention on metabolic control and potential psychosocial mediating variables as a basis for effect sizes and variance in future intervention studies. If our approach is promising, we will pursue experimental efficacy testing in future studies. As little is known about the acceptability and efficacy of health interventions in a virtual environment, this study constitutes important steps to understand how they promote self-management. Innovative programs such as SLIDES have potential for improving healthcare access in an easily disseminated alternative model of care that promotes cost-effective resource utilization.