CVD RISK MANAGEMENT IN DIABETIC BLACKS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。患有2型糖尿病的非裔美国人患心脏病的几率很高。心脏病的危险因素，如高血糖、高血压和胆固醇，可以通过医疗管理和改变生活方式行为来控制。照顾糖尿病和改变生活方式可能很困难。问题解决是一种自我管理工具，被认为对于有效的糖尿病自我护理和克服障碍，使生活方式的改变对于预防或管理心脏病至关重要。但是，管理健康的培训、问题解决和决策的方法还没有很好地建立起来。这项研究将测试一种衡量健康相关问题解决能力的新问卷，以及一种适用于2型糖尿病非裔美国人糖尿病和心脏病风险因素自我管理的新问题解决培训。具体目的是：1)评估有效和无效健康相关问题解决能力问卷(健康问题解决量表)的有效性和可靠性；2)开发一种新的干预措施，向无效的问题解决者传授健康相关问题解决技能；3)对心脏病高危人群和无效的健康相关问题解决技能无效的参与者进行一项初步研究，以测试短暂的健康问题解决培训与强化的健康问题解决培训是否可以改善问题解决能力、健康行为和心脏病风险因素。参与者是患有2型糖尿病的城市非裔美国人。本研究分两部分进行，即健康问题解决量表的编制(研究1)和健康问题解决干预(研究2)。研究1的资格标准包括低心血管风险概况(在本研究提案中定义为对血压、胆固醇和血糖的最佳控制)或高心血管风险概况(定义为高血压、和/或高胆固醇和/或高血糖)。参与者将完成健康问题解决量表以及解决问题和行为的额外测试。在健康问题解决量表问卷验证研究完成后，符合心血管疾病高风险标准的60名参与者将参加研究2，即问题解决培训研究，这些参与者在健康问题解决量表上的一系列无效问题解决得分。参与者将被随机分配到最低干预组或强化干预组，就像掷硬币一样。最小干预组将接受心脏病风险教育课程+简短的健康问题解决培训(每周2次小组会议和1次电话随访)。强化干预组将接受心脏病风险教育课程+强化健康问题解决培训(每周9次小组会议和1次电话随访)。在基线和干预组结束后6个月，参与者将接受血糖(HbA1c)、胆固醇和血压的评估。此外，他们将完成关于问题解决、自我管理坚持、知识、健康行为、朝着心血管疾病风险管理目标的进展以及生活质量的问卷调查。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. African Americans with type 2 diabetes suffer high rates of heart disease. Risk factors for heart disease, such as high blood sugar, blood pressure, and cholesterol, can be controlled through medical management and changes in lifestyle behaviors. Taking care of diabetes and changing lifestyle behaviors can be difficult. Problem solving is one self-management tool deemed important for effective self-care of diabetes and for overcoming barriers to making the lifestyle changes essential for preventing or managing heart disease. But, methods for training problem solving and decision making for managing health have not been well established. This study will test a new questionnaire for measuring health-related problem-solving abilities and a new problem-solving training applied to self-management of diabetes and heart disease risk factors in African Americans with type 2 diabetes. The specific aims are: 1) to assess the validity and reliability of a questionnaire of effective vs. ineffective health-related problem-solving ability (Health Problem-Solving Scale), 2) to develop a new intervention to teach health-related problem-solving skills to ineffective problem solvers, and 3) to conduct a pilot study with a sample of participants who have a high risk for heart disease AND ineffective health-related problem-solving skills, to test whether a brief vs. an intensive health problem-solving training improves problem solving ability, health behaviors, and heart disease risk factors. Participants are urban African Americans with type 2 diabetes. The research will be conducted in two parts, Health Problem-Solving Scale development (Study 1) and Health Problem-Solving Intervention (Study 2). Eligibility criteria for Study 1 include Low CVD Risk Profile (defined in this research proposal as optimal control of blood pressure, cholesterol, and blood sugar), or a High CVD Risk Profile (defined as high blood pressure, and/or high cholesterol, and/or high blood sugar). Participants will complete the Health Problem-Solving Scale and additional tests of problem solving and behavior. Upon completion of the Health Problem-Solving Scale questionnaire validation study, 60 participants who meet criteria for high CVD risk, and who score with a range of ineffective problem solving on the Health Problem-Solving Scale, will be participants in Study 2, the problem-solving training study. Participants will be randomly assigned, like flipping a coin, into either a Minimal Intervention group or an Intensive Intervention group. The Minimal Intervention group will receive Heart Disease Risk Education class + Brief Health Problem-Solving Training (2 weekly group sessions and 1 telephone follow-up). The Intensive Intervention Group will receive the Heart Disease Risk Education class + Intensive Health Problem-Solving Training (9 weekly group sessions and 1 telephone follow-up). At baseline and at 6 months after the intervention groups have ended, participants will have their blood sugar (HbA1c), cholesterol, and blood pressure assessed. In addition, they will complete questionnaires about problem solving, self-management adherence, knowledge, health behaviors, progress toward CVD risk management goals, and quality of life.