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，该计划在文化上适合非裔美国人社区。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，持续保持自我管理尤其具有挑战性。糖尿病自我管理教育（DSME）的开发是为了解决自我管理支持的这一关键差距。当文化上适合，DSME可以在非洲裔美国人社区特别有效。然而，DSME的影响并不持久。DSME后持续的糖尿病自我管理支持（DSMS）已被用于维持DSME的积极作用。同伴导师（受过训练的非专业人士成功地管理自己的糖尿病）是提供DSMS的一种负担得起的有效手段。同侪导师目前是亲自培训的，由于这种培训缺乏可扩展性，这大大限制了可以培训的同侪导师的数量。因此，我们建议开发和评估一个基于网络的DSMS培训的同行导师，而不是在人的培训。为了实现我们的第一阶段具体目标，我们将开展四项任务：任务1：开展焦点小组：我们将开展两个焦点小组，每个小组有6名未受控制的糖尿病患者，两个焦点小组，每个小组有6名糖尿病同伴导师。我们的目标是了解如何将非洲裔美国人量身定制的培训材料转化为有效的基于网络的计划。任务二：为同行导师开发DSMS培训计划原型：将根据Tang等人（2011）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名受试者进行同伴训练效果评价。招募30名糖尿病同伴导师候选人完成基于网络的培训和评估;占20%的流失率。应满足的培训标准：超过80%的导师必须通过所有个人合格标准：1）糖尿病知识测试得分>80%，糖尿病知识问卷得分>80%，理解管理实践量表平均得分>4;（2）6个赋权型小插曲中的3个+2，其余3个小插曲至少+1;（3）自我效能调查>4分;（4）目标设定模拟及格;（5）主动倾听观察量表改编版平均分>4分。任务4.评估由同伴导师提供的DSMS的可行性：一项双臂随机临床试验将评估在非裔美国人社区中使用网络培训的同伴导师在DSME后提供DSMS的可行性。可行性测试：我们预计HbA 1c降低1%的差异将在6个月时持续。第二阶段计划：为多个多样性群体开发一套类似产品，并进行大型多组随机临床试验，以测试同行交付的DSMS的有效性，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.