Effects of a Mindfulness Intervention Delivered within Diabetes Education on Diabetes-related Outcomes in Military Veterans

 描述（由申请人提供）： 通过退伍军人健康管理局（VHA）接受护理的退伍军人中有25%患有糖尿病，这使得支持糖尿病自我管理成为优先事项。然而，日常自我护理任务导致的糖尿病相关痛苦影响了高达40%的糖尿病患者，使他们面临糖尿病自我管理受损、代谢控制下降以及发病率和死亡率升高的风险。新兴的研究表明，正念是过去30年来在各种慢性健康状况中研究的身心疗法，有助于减少情绪困扰，并可能改善糖尿病的结果。本研究的目的是检查正念训练和实践计划的影响，作为糖尿病教育的一部分，我们称之为Mind-STRIDE（糖尿病教育中的正念减压），对心理行为和血糖结果的影响，包括：1）正念，2）糖尿病相关的痛苦，3）糖尿病自我效能，4）糖尿病自我管理，5）血糖控制。我们还将探索退伍军人的满意度和正念训练和实践的经验。为了实现这些目标，我们将对126名退伍军人进行混合方法随机对照试验，随机分配到接受常规糖尿病教育加Mind-STRIDE的实验条件或仅接受糖尿病教育的常规护理。定量结局将通过主观问卷进行测量，但血红蛋白A1 c除外，其将通过标准实验室方法进行评估。将在基线、12周和24周时收集数据，并通过混合效应模型进行分析。定性电话访谈将在15周时在实验组的一部分参与者中进行，并将使用修改后的扎根理论方法进行分析。定量和定性结果将使用收敛平行设计进行比较和解释。通过检查患有糖尿病等慢性健康状况的退伍军人对身心干预措施的接受程度和影响，VA将受益于支持自我护理的新的以证据为基础，以患者为中心的方法。

 DESCRIPTION (provided by applicant): Twenty-five percent of military Veterans who receive care through the Veterans Health Administration (VHA) have diabetes, making support for diabetes self-management a priority. However, diabetes-related distress resulting from daily self-care tasks affects up to 40% of people with diabetes, placing them at risk for impaired diabetes self-management, decreased metabolic control, and higher morbidity and mortality. Emerging research suggests that mindfulness, a mind-body therapy studied in a variety of chronic health conditions over the past 30-years, helps to reduce emotional distress and may improve diabetes outcomes. The objectives of this study are to examine the effects of a program of mindfulness training and practice, provided as part of diabetes education, which we call Mind-STRIDE (Mindful Stress Reduction in Diabetes Education), on psycho- behavioral and glycemic outcomes including: 1) mindfulness, 2) diabetes-related distress, 3) diabetes self- efficacy, 4) diabetes self-management, and 5) glycemic control. We will also explore Veterans' satisfaction and experiences with mindfulness training and practice. To achieve these objectives, we will conduct a mixed- methods randomized controlled trial of 126 Veterans randomly assigned to either the experimental condition that receives routine diabetes education plus Mind-STRIDE, or to usual care that receives diabetes education alone. Quantitative outcomes will be measured by subjective questionnaires except for hemoglobin A1c, which will be assessed through standard laboratory methods. Data will be collected at baseline, 12-weeks, and 24- weeks, and will be analyzed by mixed-effects modeling. Qualitative telephone interviews will be conducted at 15-weeks in a subset of participants from the experimental group, and will be analyzed using modified Grounded Theory methods. Quantitative and qualitative findings will be compared and interpreted using Convergent Parallel Design. By examining the acceptance and effects of mind-body interventions like Mind- STRIDE among Veterans who have chronic health conditions such as diabetes, the VA will benefit from new evidence-based, patient-centered approaches that support self-care.