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。需要特别关注患有糖尿病及其并发症的种族和少数民族人口。成功不仅取决于患者获得降低风险的生活方式计划，还取决于患者对此类计划的参与度。然而，缺乏以证据为基础的战略来增加临床环境的参与度。这一K01职业发展奖将为苏珊·D·布朗博士提供所需的专业知识，以实现她的长期目标，即通过吸引各种高危患者，如有妊娠期糖尿病病史的超重和肥胖女性，参与医疗保健环境中的预防计划，来减少糖尿病患者的健康差距。这项建议考察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--是否影响了三个初始阶段 持续的患者参与结果：患者对外展材料的反应，以及对生活方式计划的参与和保留。中心假设是，针对女性种族/民族的糖尿病风险信息和来自电子医疗记录的糖尿病风险因素可能会增加患者的参与度。然而，量身定做的风险信息可能在心理上具有威胁性；因此，当个人能够通过积极反思对以下方面重要的价值观来确认自我价值感时，其影响将得到增强，威胁将得到缓解。 他们。对于有妊娠期糖尿病病史的超重/肥胖妇女，具体目标如下。目标1：与患者和卫生系统利益攸关方合作，开发用于临床环境的新颖、互动的宣传材料，其中包含定制的糖尿病风险信息和自我肯定。目的2：在2(定制与非定制)x 2(自我肯定与非自我肯定)设计中，通过实验预先测试所开发的外展材料对患者反应的影响。目的3：与标准外展相比，试验性地测试互动外展材料对患者参与健康系统生活方式计划的影响；我还将探索对减肥的影响。这项在真实世界临床环境中进行的基于理论的研究将扩展我们关于患者参与糖尿病预防的有限知识基础。布朗博士将受益于阿西亚米拉·费拉拉(Assiamira Ferrara)的主要指导，他是医学博士、高级研究科学家和凯撒永久北加州研究部妇女和儿童健康科科长。除了布朗博士在临床心理学和肥胖治疗方面的优势，K01奖项还将提供系统的培训，由糖尿病和糖尿病预防专家(费拉拉博士)、实施科学专家(康斯坦斯·韦斯纳博士，DrPH、MSW和Julie Schmittdiel博士)、健康差距专家(Alyce Adams博士)和生物统计学专家(Charles Quesenberry博士)监督，以确保布朗博士作为一名独立的糖尿病预防研究者取得成功。

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.