Self-Management in African Americans with Diabetes and Hypertension

描述(由申请人提供)：几乎没有数据表明患有糖尿病和高血压的非裔美国人在改变生活方式方面取得了成功，他们代表着一个高风险群体，在生活方式和医疗管理方面面临着多重坚持挑战。非裔美国人更有可能出现与这些并存疾病相关的并发症，如视网膜病变、肾病和下肢截肢。疾病负担增加的部分原因是对患者引发的风险因素管理不善，这些因素包括缺乏锻炼、超重或肥胖以及不良的饮食习惯。糖尿病和高血压共病的有效管理包括启动和维持复杂的行为改变，以适应这两种情况所需的大量生活方式调整建议。非洲裔美国人不太可能从事自我管理行为，这种行为已知会改善与高血压和糖尿病相关的结果，他们需要改善自我管理的干预措施。同伴主导的干预措施在影响自我效能、卡路里摄入量和体力活动方面取得了一定的成功，并为未来的发展带来了希望。该提案的主要目的是1)为患有糖尿病和高血压的弱势非裔美国人设计基于群体的、文化上合适的自我管理技能培训干预措施，并编写一份干预操作手册(MOO)；2)招募和培训同行领导，以提供自我管理技能培训干预；3)在这一人群中，确定在标准糖尿病教育的基础上，增加具有文化敏感性的、由同行领导的自我管理技能培训干预措施，是否可以在坚持的情况下实现自我效能的提高，即比仅通过标准糖尿病教育一年所实现的自我效能提高1个标准差；为了确定在这一弱势群体中，在标准糖尿病教育的基础上增加具有文化敏感性的、同行主导的自我管理技能培训干预措施，是否可以比仅通过一年的标准糖尿病教育在遵守相关危险因素建议方面取得35%的改善。相关的危险因素目标是体力活动，饮食目标为2400毫克。每天盐的摄入量和碳水化合物摄入量的45%-65%；减肥目标是基线体重的5%。试点研究还将有助于确定计算较大试验样本量所需的关键要素。这项试点工作的结果将被用来计划一项大规模的行为临床试验，以在这一重要的、服务不足的人群中启动、维持和维持必要的自我管理行为。公共健康影响：这项研究和未来的研究结果可以帮助确定具有成本效益和文化效率的方法，帮助患有糖尿病和高血压的非裔美国人接近并改变生活方式，使他们变得更健康。几乎没有数据表明，患有糖尿病和高血压的非裔美国人在改变生活方式方面取得了成功，他们代表着一个高危群体，在生活方式和医疗管理方面面临着多重坚持挑战。疾病负担增加的部分原因是对患者引发的风险因素管理不善，这些因素包括缺乏锻炼、超重或肥胖以及不良的饮食习惯。糖尿病和高血压共病的有效管理包括启动和维持复杂的行为改变，以适应这两种情况所需的大量生活方式调整建议。非洲裔美国人不太可能从事自我管理行为，这种行为已知会改善与高血压和糖尿病相关的结果，他们需要改善自我管理的干预措施。同伴主导的干预措施在影响自我效能、卡路里摄入量和体力活动方面取得了一定的成功，并为未来的发展带来了希望。这一赠款申请中建议采取的步骤将利用现有的对同伴教育工作者的支持，并希望加强治疗效果，将利用已证实的频繁、密集接触和高度组织的培训战略，以促进这一难以接触到的患有糖尿病和高血压的少数族裔患者样本的有益治疗结果。

DESCRIPTION (provided by applicant): Little data exists that addresses success in lifestyle change for African-Americans living with diabetes and co- morbid hypertension, who represent a high risk group with multiple adherence challenges related to lifestyle and medical management. African-Americans are more likely to develop complications related these co-morbid conditions, such as retinopathy, nephropathy, and lower-extremity amputations. This increased burden of disease is partly due to poor management of patient initiated risk factors which include lack of exercise, being overweight or obese, and poor dietary practices. Effective management of comorbid Diabetes and Hyper- tension involves initiating and sustaining complex behavioral changes to accommodate the large number of lifestyle modification recommendations that both conditions require. African-Americans are less likely to engage in self-management behaviors known to improve outcomes related to hypertension and diabetes and are in need of interventions that improve self-management. Peer-led interventions have shown moderate success at influencing self-efficacy, caloric intake, and physical activity and hold promise for future development. The primary aims of the proposal are 1) to design a group-based, culturally appropriate self- management skills training intervention for disadvantaged African-Americans with both diabetes and hypertension and to compile an intervention Manual of Operations (MOO);2) to recruit and train peer leaders to deliver the self-management skills training intervention; 3) to determine, in this population, whether the addition of a culturally sensitive, peer-led self-management skills training intervention, added to standard diabetes education, can achieve an improvement in self-efficacy at adherence that is 1 standard deviation greater than that achieved by standard diabetes education alone at one year; to determine, in this disadvantaged population, whether the addition of a culturally sensitive, peer-led self-management skills training intervention, added to standard diabetes education, can achieve a 35% greater improvement in adherence to relevant risk factor recommendations than that achieved by standard diabetes education alone at one year. The relevant risk factor goals are physical activity, dietary goals of <2400 mg. of salt/day and 45-65% intake of carbohydrates/ day; weight reduction goal of >5% of baseline weight. The pilot study will also help to determine the key elements needed to calculate sample size for a larger trial. The results of this pilot work will be used to plan a large-scale behavioral clinical trial to initiate, maintain, and sustain necessary self-management behaviors in this important, underserved population. Public health impact: Findings from this study and future studies of the same can help identify cost-effective, culturally effective ways to help African-Americans who have both diabetes and hypertension to approach and make lifestyle changes that will make them healthier. Little data exists that addresses success in lifestyle change for African-Americans living with diabetes and co-morbid hypertension, who represent a high risk group with multiple adherence challenges related to lifestyle and medical management. This increased burden of disease is partly due to poor management of patient initiated risk factors which include lack of exercise, being overweight or obese, and poor dietary practices. Effective management of co-morbid Diabetes and Hypertension involves initiating and sustaining complex behavioral changes to accommodate the large number of lifestyle modification recommendations that both conditions require. African-Americans are less likely to engage in self-management behaviors known to improve outcomes related to hypertension and diabetes and are in need of interventions that improve self- management. Peer-led interventions have shown moderate success at influencing self-efficacy, caloric intake, and physical activity and hold promise for future development. The step proposed to be taken in this grant application will draw on the support that does exist for the use of peer educators and, in hopes of strengthening treatment effects, will draw on the proven strategy of frequent, intensive contacts and highly organized training to promote a beneficial treatment outcome in this difficult to reach sample of underserved minority patients living with co-morbid diabetes and hypertension.