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授权慢性疾病患者自我管理：消除医疗保健障碍；提供有限的卫生知识；提供可持续的、具有成本效益的患者教育和支持；并超越无效的、非互动性的健康行为干预。诸如Web 2.0之类的通信技术的进步是满足这些需求的一种手段。最初的研究表明，虚拟环境通过重复、练习、反馈和应用来促进社会互动，从而导致卓越的学习和技能转移。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，利用虚拟环境，第二人生来促进糖尿病的自我管理。糖尿病影响2360万美国成年人，其中大多数患有2型糖尿病（T2DM）。众所周知，代谢控制可以降低糖尿病的发病率和死亡率，但它仍然是美国第六大死亡原因。2型糖尿病患者提供99%的自我护理，使糖尿病自我管理（如饮食、运动）成为控制的组成部分。量身定制的DSM干预利用患者与提供者的互动已经有了令人鼓舞的短期效果。然而，这种频繁的交互是不可能实现的，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“扁平的”和单向的异步通信。虚拟环境（如Second Life）是一种潜在的解决方案，可以通过沉浸式环境中的交互性、同步通信、知识应用和社交网络来捕获患者-提供者动态。我们建议建立一个虚拟糖尿病社区（SLIDES），在2型糖尿病成人、医疗保健专业人员和同龄人之间进行实时互动，这是可行的，并且有可能影响代谢控制和社会心理介质。本试点研究采用单组、前后测量研究设计来评估参与幻灯片的可行性、可用性和效果，其中包括交互式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，每个地方都允许交互式知识应用。基于本次设计，我们的具体目标是：(1)利用Second Life开发一个沉浸式糖尿病社区（SLIDES），并通过分析过程数据来评估可行性；(2)确定参与slide干预对代谢控制和潜在的社会心理中介变量的初步影响，作为未来干预研究的效应大小和方差的基础。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效果测试。由于对虚拟环境中健康干预的可接受性和有效性知之甚少，本研究构成了理解它们如何促进自我管理的重要步骤。像SLIDES这样的创新项目有可能通过一种易于传播的替代医疗模式来改善医疗服务的可及性，从而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.