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慢性病患者进行自我管理：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；超越无效、非互动的健康行为干预。通信技术的进步，如Web2.0，是满足这些需求的一种手段。虚拟环境(VE)通过应用和反馈促进社交互动和学习，带来卓越的学习和技能集转移。我们建议测试一种理论上的、基于技术的生物行为干预，使用VE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(T2D)(NIDDK，2009)。众所周知，代谢控制可以降低糖尿病的发病率和死亡率，但它仍然是美国主要的死亡原因。T2D患者提供了大部分自己的护理，使糖尿病自我管理(DSM)(如饮食、运动)成为控制不可缺少的一部分。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，异步通信仍然是“平淡的”。VES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。我们的R21(R21LM010727-01)的初步发现表明，在患有T2D的成年人之间以及与医疗保健专业人员之间实时互动的虚拟糖尿病社区是可行的，并具有影响代谢控制和心理社会中介的潜力。因此，我们提出了一项随机对照试验，以确定参与包含实时糖尿病自我管理培训和支持的VE的效果是否与健康行为的积极变化有关。现场社区将由社区中心、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。在此基础上，我们的主要目标是：(1)在VE中提供DSMT/S，与传统的DSMT/S相比，在12个月内确定DSMT/S对T2D成年人饮食和体力活动行为的影响。我们的次要目标是：(2)确定对代谢结果的影响；(3)评估生活中的参与程度和社交网络形成是否对行为结果产生不同的影响；(4)考察自我效能感、糖尿病知识、糖尿病相关痛苦和社会支持变化对行为变化和代谢结果的潜在中介效应。如果LIFE被证明在改善糖尿病的自我管理方面有效，类似的干预措施可以应用于其他流行的慢性病。LIVE等创新方案有可能以一种易于传播的替代医疗模式改善医疗服务的可及性，这种模式可能会扩大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.