Web-based Training of Peers to Deliver Diabetes Self-Management Support (DSMS)

描述（由申请人提供）：本提案的具体目的是测试开发，利用和评估基于网络的糖尿病自我管理支持（DSMS）培训计划的可行性，该计划在文化上为非裔美国人社区量身定制。有效的自我管理是改善糖尿病预后、避免并发症和降低成本的关键。对许多非裔美国人来说，持续维持自我管理尤其具有挑战性。糖尿病自我管理教育（DSME）的发展是为了解决这一关键差距在自我管理支持。如果根据文化进行调整，DSME在非裔美国人社区尤其有效。然而，DSME的影响并不是持久的。持续的糖尿病自我管理支持（DSMS）在DSME后被用来维持DSME的积极作用。同伴导师（训练有素的外行成功管理自己的糖尿病）是提供DSMS的一种负担得起的有效手段。同伴导师目前都是面对面的培训，这种培训缺乏可扩展性，极大地限制了可以培训的同伴导师的数量。因此，我们建议开发和评估基于网络的DSMS同伴导师培训，以代替面对面的培训。为了实现第一阶段的具体目标，我们将进行四项任务：任务一：进行焦点小组：我们将进行两个焦点小组，每个小组有6名未控制的糖尿病患者，两个焦点小组，每个小组有6名糖尿病同伴导师。其目标是了解如何将非裔美国人量身定制的面对面培训材料转化为有效的网络项目。任务2：为同侪导师开发DSMS培训计划原型：将基于Tang等人开发并证明有效的模块创建12个基于网络的电子学习模块和评估。任务3。对24名被试同伴训练效果进行评价。招募30名糖尿病同侪导师候选人，完成网络培训和评估；流失率占20%。培训标准：80%以上的导师必须通过所有个人合格标准：1)糖尿病知识测试bbbb80分，糖尿病知识问卷bbbb80分，理解管理实践量表平均得分bbbb4分；(2)在6个灌顶短片中，3个短片+2，其余3个短片至少+1；(3)自我效能感调查；(4)目标设定模拟的及格分数；在积极倾听观察量表的改编版中，平均得分为bbbb40。任务4。评估同伴导师提供DSMS的可行性：一项两组随机临床试验将评估使用网络培训的同伴导师在非裔美国人社区进行DSME后提供DSMS的可行性。可行性测试：我们预计HbA1c降低1%的差异在6个月时持续。II期计划：为多个多样性群体开发一套类似的产品，并进行一项大型多组随机临床试验，以测试同行交付的DSMS的疗效，以支持产品的商业化。

DESCRIPTION (provided by applicant): The Specific Aim of this proposal is to test the feasibility of developing, utilizing, and evaluating a web-based diabetes self-management support (DSMS) training program that is culturally tailored for the African American community. Effective self-management is the key to improving diabetes outcomes, avoiding complications, and reducing costs. Ongoing maintenance of self-management is particularly challenging among many African- Americans. Diabetes self-management education (DSME) was developed to address this critical gap in self- management support. When culturally tailored, DSME can be particularly effective in African American communities. However, the impact of DSME is not long lasting. Ongoing diabetes self-management support (DSMS) after DSME has been used to sustain the positive effects of DSME. Peer mentors (trained lay individuals successfully managing their own diabetes) are an affordable and effective means of delivering DSMS. Peer mentors are currently trained in-person, which greatly limits the number of peer mentors that can be trained due to lack of scalability of such training. Thus we propose the development and evaluation of a web-based DSMS training of peer mentors in lieu of in-person training. To achieve our Phase I Specific Aim, we will carry out four Tasks: Task 1: Conduct focus groups: We will conduct two focus groups with 6 uncontrolled diabetes patients each and two focus groups with 6 diabetes peer mentors each. The goal is to understand how to translate the African American-tailored in-person training material into an effective web-based program. Task 2: Develop DSMS Training Program Prototype for Peer Mentors: 12 web-based, e-Learning modules and assessments will be created based on the modules developed and proven effective by Tang et al. (2011). Task 3. Evaluate Peer Training Efficacy with 24 Subjects. Recruit 30 diabetes peer mentor candidates to complete the web-based training and evaluations; accounting for 20% attrition. Training Criteria to be Met: More than 80% of mentors must pass all of the individual passing criteria: 1) >80% score on the Diabetes Knowledge Test, >80% score on the Diabetes Knowledge Questionnaire, and mean score of >4 on the Understanding Management Practice scale; (2) +2 on 3 of the 6 empowerment-based vignettes and at least +1 on the remaining 3 vignettes; (3) >4 on Self-Efficacy Survey; (4) passing score in Goal-Setting Simulation; and a (5) mean score >4 on an adapted version of the Active Listening Observation Scale. Task 4. Evaluate Feasibility of DSMS Delivered by Peer Mentors: A two-arm randomized clinical trial will assess the feasibility of using web-trained peer mentors to deliver DSMS after DSME in the African American community. Test of Feasibility: We expect a 1% difference in HbA1c reduction to be sustained at 6 months. Phase II Plans: Develop a set of similar products for multiple diversity groups and conduct a large multi-arm randomized clinical trial to test efficacy of peer-delivered DSMS to support commercialization of the product.