Engaging At-Risk Minority Women in Health System Diabetes Prevention Programs

描述（由申请人提供）：预防2型糖尿病是卫生保健系统的高度优先事项。需要特别关注不成比例地患有糖尿病及其并发症的种族和族裔少数群体。成功不仅取决于患者是否能参与生活方式项目以降低风险，还取决于患者是否参与这些项目。然而，缺乏以证据为基础的战略，以增加在临床环境中的参与。这个K 01职业发展奖将提供苏珊D。布朗博士拥有实现她的长期目标所需的专业知识，即通过让不同的高危患者（如有妊娠糖尿病史的超重和肥胖妇女）参与医疗保健机构的预防计划，减少糖尿病的健康差距。这项提案审查了两种理论驱动的外展策略，量身定制的糖尿病风险信息和自我肯定，是否影响了三个最初的 和持续的患者参与结果：患者对外展材料的反应，以及参与和保留生活方式计划。核心假设是，根据女性的种族/民族和来自电子病历的糖尿病风险因素单独定制的糖尿病风险信息可能会增加患者的参与度。然而，量身定制的风险信息可能具有心理威胁性;因此，当个人能够通过积极反思对他们来说重要的价值观来确认自我价值感时，其影响将会增强，威胁将会减轻。 他们在有妊娠糖尿病史的超重/肥胖女性中，具体目标如下。目标1：与患者和卫生系统利益相关者合作，开发新的、互动的外展材料，用于临床环境，其中包含量身定制的糖尿病风险信息和自我肯定。目标二：在2（定制与非定制）x 2（自我肯定与无自我肯定）设计中，对开发的外展材料对患者反应的影响进行实验性预测试。目标3：实验性试点测试的影响，互动外展材料对病人参与卫生系统的生活方式计划，相比标准的推广，我还将探讨对减肥的影响。在现实世界的临床环境中进行的这项基于理论的研究将扩大我们关于患者参与糖尿病预防的有限知识基础。布朗博士将受益于Assiamira费拉拉，医学博士，博士，高级研究科学家和妇女和儿童健康科科长在凯撒永久北方加州研究部的主要指导。补充布朗博士在临床心理学和肥胖治疗方面的优势，这个K 01奖将提供由糖尿病和糖尿病预防专家监督的系统培训（费拉拉博士），实施科学（Constance Weisner，DrPH，MSW和Julie Schmittdiel，PhD），健康差距（Alyce亚当斯，博士）和生物统计学（查尔斯Quesenberry，博士），以确保布朗博士作为一个独立的糖尿病预防研究者的成功。

DESCRIPTION (provided by applicant): Preventing type 2 diabetes is a high priority for health care systems. Particular focus is needed on racial and ethnic minority populations who suffer disproportionately from diabetes and its complications. Success depends not only on patient access to lifestyle programs to reduce risk, but on patient engagement in such programs. Yet evidence-based strategies to increase engagement in clinical settings are lacking. This K01 career development award will provide Susan D. Brown, PhD with the expertise needed to achieve her long- term goal of reducing health disparities in diabetes by engaging diverse at-risk patients, such as overweight and obese women with a history of gestational diabetes, in preventive programs in health care settings. This proposal examines whether two theory-driven outreach strategies, tailored diabetes risk information and self- affirmation, impact three initial and sustained patient engagement outcomes: patient responses to outreach materials, and participation and retention in a lifestyle program. The central hypothesis is that diabetes risk information individually tailored to women's race/ethnicity and diabetes risk factors derived from electronic medical records may increase patient engagement. Yet tailored risk information can be psychologically threatening; thus its effects will be enhanced, and the threat mitigated, when individuals can affirm a sense of self-worth by actively reflecting on values that are important to them. Among overweight/obese women with a history of gestational diabetes, the Specific Aims are as follows. Aim 1: Develop novel, interactive outreach materials to be used in the clinical setting containing tailored diabetes risk information and self-affirmation, in collaboration with patients and health system stakeholders. Aim 2: Experimentally pre-test the impact of the developed outreach materials on patient responses in a 2 (tailored vs. non-tailored) x 2 (self-affirmation vs. no self-affirmation) design. Aim 3: Experimentally pilot test the impact of interactive outreach materials on patient engagement in a health system lifestyle program, as compared to standard outreach; I will also explore effects on weight loss. This theory-based research in a real-world clinical setting will expand our limited knowledge base regarding patient engagement for diabetes prevention. Dr. Brown will benefit from the primary mentorship of Assiamira Ferrara, MD, PhD, Senior Research Scientist and Section Chief for Women's and Children's Health at the Kaiser Permanente Northern California Division of Research. Complementing Dr. Brown's strengths in clinical psychology and obesity treatment, this K01 award will provide systematic training overseen by experts in diabetes and diabetes prevention (Dr. Ferrara), implementation science (Constance Weisner, DrPH, MSW and Julie Schmittdiel, PhD), health disparities (Alyce Adams, PhD), and biostatistics (Charles Quesenberry, PhD) to ensure Dr. Brown's success as an independent diabetes prevention investigator.