Social Network Analysis and Social Support Intervention for Rural Dwelling Older Adults with T2DM

7.项目摘要/摘要 在美国，大约有2910万(9.3%)成年人患有2型糖尿病(T2 DM)。 严重的并发症包括过早的冠状动脉疾病、肾脏疾病、中风和 估计显示，与城市居民相比，农村居民的2型糖尿病患病率高出17% 例如，在肯塔基州阿巴拉契亚州的农村地区，成年人中T2 DM的患病率是 13.6%，3与全州10.6%的患病率相比3。适当的自我照顾行为对于 T2 DM 4-6的最佳临床结果，可解释血糖控制变异的90%。 众所周知，在T2 DM人群中，总体上是贫穷的，农村居民的情况更糟。不注重改进 在这群人中，我们正面临着美国农村地区T2 DM并发症的流行。 农村社区患有2型糖尿病的影响在人口老龄化中更加严重。这个 T2 DM的患病率随着年龄的增长而增加，估计有25%的老年人(≥65岁)患有T2 DM 8。 患有T2 DM的成年人比年轻人更难坚持自我护理方案和 社会/环境因素占他们自我保健不依从性的85%。 社会/环境因素包括相互竞争的社会需求、缺乏社会支持(SS)和压力。 支持在患有T2 DM的老年人中扮演着特别重要的角色。中提供的SS的范围和类型 农村社区可以对被诊断为T2 DM的人的自我护理产生积极或消极的影响。18-25岁 为了更好地了解农村老年住宅所在社区的社会环境的影响 成人居住并为干预奠定基础，将使用社会网络分析(SNA)来确定 社会支持网络结构。通过使用SNA，可以发展社会支持结构并建立关系 可以对社交网络内的个人之间的关系进行评估。26这项研究的总体目标是改进 通过将有影响力的社区成员培训为 社区卫生工作者，并在老年人现有的社交网络中提供社会支持策略 这促进了T2 DM的自我护理。 拟议的研究旨在： 目标1-使用社会网络分析确定农村社区中的关键角色作为社区 为2型糖尿病患者提供的卫生工作者。 目的2-使用混合方法评估社会支持对2型糖尿病自我护理和临床的影响 农村老年2型糖尿病患者的结果和社会网络评估。 目标3-测试为期6周的干预措施的可行性和初步效果 在老年人个人社交网络成员的支持下，社区卫生工作者。

7. PROJECT SUMMARY/ABSTRACT Approximately 29.1 million (9.3%) adults in the US have type 2 diabetes (T2DM).1 T2DM is associated with significant complications including premature coronary artery disease, kidney disease, stroke, and blindness.1 Estimates show that prevalence of T2DM is 17% higher in rural dwellers compared to their urban counterparts.2 For example, the prevalence of T2DM for adults in Kentucky's rural Appalachian counties is 13.6%,3 compared to the overall state prevalence of 10.6% 3. Appropriate self-care behaviors are necessary for optimal clinical outcomes in T2DM 4-6 and account for 90% of the variance in glycemic control 7. Yet, self-care among T2DM is notoriously poor in general and even worse in rural-dwellers. Without attention to improving self-care in this population, we are facing an epidemic of T2DM complications in rural areas of the US. The impact of living with T2DM in rural communities is compounded in the aging population. The prevalence of T2DM increases with age and an estimated 25% of older adults (≥65 years) have T2DM 8. Older adults living with T2DM have more difficulty than younger people adhering to self-care regimens and social/environment factors account for up to 85% of their self-care nonadherence.6,9-13 Notable social/environment factors include competing social demands, lack of social support (SS), and stress.14-17 Social support plays a particularly significant role in older adults with T2DM. The extent and type of SS available in rural communities can positively or negatively impact self-care in those diagnosed with T2DM. 18-25 To better understand the effects of the social environment in communities where older rural dwelling adults reside and to lay the foundation for interventions, social network analysis (SNA) will be used to determine social support network structures. By using SNA, social support structures can be developed and relationships between individuals within a social network can be evaluated. 26 The overall objective of this study is to improve T2DM self-care regimens in older rural dwelling adults by training influential community members to be community health workers and provide social support strategies within an older adults' existing social network that promotes T2DM self-care. The proposed study seeks to: Aim 1—Use social network analysis to identify key players in a rural community to serve as community health workers for those living with T2DM. Aim 2—Use mixed methods to evaluate the impact of social support on T2DM self-care and clinical outcomes and evaluate social networks in rural dwelling older adults with T2DM. Aim 3—Test the feasibility and preliminary effectiveness of a 6-week intervention administered by community health workers with the support of members of older adults' individual social network.