Problem Solving & CVD Risk Management in Diabetic Blacks

描述（由申请人提供）： 患有2型糖尿病的非裔美国人具有心血管疾病风险和不良血管事件（如中风和外周血管疾病）的高负担。通过药物管理和生活方式行为改变，血压、血脂和血糖控制不佳等CVD风险因素是可控的。传统的初级保健医疗管理模式对这些慢性心血管疾病的风险是不够的，模式正在转向增加疾病相关的决策和自我管理的病人。然而，精确的方法：1）识别与疾病相关的问题解决技能无效的患者，以及2）为患者提供包含问题解决和决策技能的疾病相关教育，尚未确定。这项拟议的研究将通过测试一种测量工具和一种新的训练干预来解决文献中的这一局限性，这种方法适用于非裔美国人2型糖尿病高CVD风险的自我管理。具体目标是：1）评估有效与无效CVD风险相关问题解决能力的临床衍生评估工具的有效性和可靠性（健康问题解决量表，HPSS），2）开发一种新的干预措施，向无效的问题解决者教授CVD风险相关的问题解决技能，和3）对患有2型糖尿病的非洲裔美国人进行试点研究，这些人具有高CVD风险特征（次优血压、血脂和/或HbA 1c）和无效的CVD风险相关问题解决技能，通过HPSS测量。候选人的职业目标是成为高风险非洲裔美国人人群中CVD风险自我管理的独立研究人员，并成为开发和实践新型，理论驱动和基于经验的干预措施的领导者，以改善患者CVD风险的自我管理。因此，候选人提出了以下两个领域的职业发展培训，以准备她的这项任务：1）正式的课程和培训心血管流行病学，研究方法，生物统计学，行为科学和健康促进;和2）在解决问题的培训干预研究高心血管疾病风险的非洲裔美国人与2型糖尿病。 这项干预措施的结果将导致在04年制定一个试点项目，并在05年制定一项R 01提案，以调查在这一高危人群中解决问题的干预措施的效力。

DESCRIPTION (provided by applicant): African Americans with type 2 diabetes carry high burden of cardiovascular disease risk and adverse vascular events such as stroke and peripheral vascular disease. CVD risk factors of suboptimal blood pressure, lipids, and glycemic control are controllable through medical management and lifestyle behavior modification. The traditional primary care medical management model for these chronic CVD risks is inadequate, and models are shifting toward increased disease-related decision-making and self-management on the part of the patient. Yet, precise methods for: 1) identifying patients with ineffective disease-related problem-solving skills, and 2) providing patients with disease-related education that incorporates problem-solving and decision-making skills, have yet to be determined. The proposed study will address this limitation in the literature by testing a measurement tool and a novel training intervention for problem solving as applied to self-management of high CVD risk in African Americans with type 2 diabetes. The specific aims are to: 1) assess the validity and reliability of an empirically-derived assessment tool of effective vs. ineffective CVD risk-related problem solving ability (the Health Problem Solving Scale, HPSS), 2) develop a novel intervention to teach CVD risk-related problem-solving skills to ineffective problem solvers, and 3) conduct a pilot study with a sample of African Americans with type 2 diabetes who have a high CVD risk profile (suboptimal blood pressure, lipids, and/or HbA1c) AND ineffective CVD risk-related problem-solving skills, as measured by the HPSS. The candidate's career goal is to become an independent researcher in self-management of CVD risk in high-risk African American populations, and to be a leader in the development and translation into practice of novel, theory-driven and empirically based interventions to improve patient self-management of CVD risks. Therefore, the candidate proposes the following two areas of career enhancement training to prepare her for this task: 1) formal coursework and training in cardiovascular epidemiology, research methodology, biostatistics, and behavioral science and health promotion; and 2) research in problem-solving training interventions for high CVD risk African Americans with type 2 diabetes. Results of this intervention will lead to development of a pilot project in year 04 and an R01 proposal in year 05 to investigate the efficacy of a problem-solving intervention in this high-risk population.