Diabetes Self-Management & Support LIVE (Learning in Virtual Environments)

描述（由申请人提供）：需要采取干预措施帮助患者进行慢性病自我管理，以：消除医疗保健障碍;适应有限的健康素养;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、非互动的健康行为干预。Web 2.0等通信技术的进步是满足这些需求的一种手段。虚拟环境（VE）通过应用和反馈促进社会互动和学习，导致上级学习和技能转移。我们建议测试一个理论上接地，技术为基础的，生物行为干预使用VE，以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（T2 D）（NIDDK，2009）。已知代谢控制可降低糖尿病发病率和死亡率，但它仍然是美国的主要死亡原因。患有T2 D的个体提供大部分自己的护理，使糖尿病自我管理（DSM）（例如饮食，运动）成为控制的组成部分。利用患者-提供者互动的定制DSM干预措施具有令人鼓舞的短期效果。然而，这种频繁的互动是无法实现的，而且成本高昂。互联网干预有可能捕捉患者-提供者互动的动态，但迄今为止仍然是“平面”的异步通信。虚拟环境是一种潜在的解决方案，通过互动，同步通信，知识应用和社交网络在一个身临其境的环境中捕捉病人提供者的动态。我们的R21（R21 LM 010727 -01）的初步研究结果表明，在T2 D成人患者中与医疗保健专业人员进行实时互动的虚拟糖尿病社区是可行的，并且有可能影响代谢控制和心理社会介质。因此，我们建议进行一项随机对照试验，以确定参与包含实时糖尿病自我管理培训和支持的VE的影响是否与健康行为的积极变化相关。LIVE社区将由社区中心、健身房、杂货店和其他地点组成，每个地点都允许交互式知识应用。基于该设计，我们的主要目的是（1）确定在VE中提供DSMT/S与传统DSMT/S相比，在12个月内对T2 D成人饮食和体力活动行为变化的影响。我们的次要目标是：（2）确定对代谢结果的影响;（3）评估LIVE中的参与水平和社会网络形成是否对行为结果产生差异性影响;（4）检查自我效能、糖尿病知识、糖尿病相关痛苦和社会支持对行为变化和代谢结果的潜在中介作用。如果LIVE被证明在改善糖尿病自我管理方面有效，类似的干预措施可以应用于其他流行的慢性病。LIVE等创新项目有可能通过一种易于传播的替代护理模式改善医疗保健的可及性，从而有可能提高DSMT/S的覆盖范围。

DESCRIPTION (provided by applicant): Interventions to assist 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. Virtual environments (VE) promote social interaction and learning via application and feedback, leading to superior learning and skill set transfer. We propose to test a theoretically grounded, technologically-based, bio-behavioral intervention using a VE to facilitate self-management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2D) (NIDDK, 2009). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains a leading cause of death in the U.S. Individuals with T2D provide a majority 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" with asynchronous communication. VEs are a potential solution to capture patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. Preliminary findings from our R21 (R21LM010727-01) showed that a virtual diabetes community with real-time interaction among adults with T2D, and with healthcare professionals is feasible and has the potential to influence metabolic control and psychosocial mediators. Thus we are proposing a randomized controlled trial to determine whether the effects of participation in a VE that incorporates real-time diabetes self-management training and support will be associated with positive changes in health behaviors. The LIVE community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our primary aim is to (1) determine the effects of providing DSMT/S in a VE on diet and physical activity behavior change in adults with T2D compared to traditional DSMT/S over 12 months. Our secondary aims are: (2) to determine the effects on metabolic outcomes; (3) to assess whether level of engagement and social network formation in LIVE differentially impacts behavioral outcomes; and (4) to examine the potential mediating effects of changes in self-efficacy; diabetes knowledge, diabetes-related distress and social support on behavior change and metabolic outcomes. Should LIVE prove effective in improved self-management of diabetes, similar interventions could be applied to other prevalent chronic diseases. Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of DSMT/S.