Identifying Areas for Family Intervention to Improve Adult Diabetes Self-Care

描述（由申请人提供）：对于糖尿病成人，定期自我护理行为（即，饮食、锻炼和药物依从性）预防疾病相关并发症和过早死亡。然而，社会经济地位低、健康素养低和家庭压力高的患者不太可能保持自我护理行为，更可能出现不受控制的抑郁症。即使是在同等条件和护理的环境中（例如，联邦合格的健康中心-家庭支持可能是一种未开发的资源，有可能减少糖尿病成年人之间的种族和社会经济差异。糖尿病自我护理的家庭支持（例如，提醒患者服用或补充药物，计划健康膳食，与患者一起参与锻炼，当出现自我护理障碍时与患者一起解决问题）增加了患者进行定期自我护理的可能性，并且可以改善低收入、低健康素养和高压力患者的临床结果。然而，目前尚不清楚家庭成员行为如何影响患者的自我护理和临床结果，以及种族或共病抑郁症如何调节家庭成员行为对患者自我护理行为的影响。为了探讨这些问题，主要研究者（PI）将与一项正在进行的糖尿病药物依从性研究合作，并在低收入、种族多样的2型糖尿病（T2 DM）患者样本中进行扩展。拟议的计划将使PI成为成功的独立研究者，可以在社区卫生组织中为糖尿病成人制定和实施有效的家庭干预措施。PI的近期目标是（1）熟练掌握先进的定量方法，以跨部门探索复杂的关系，并为糖尿病成人家庭支持的知识基础做出贡献，（2）结合联合收割机定量和定性方法，以了解基于种族的家庭支持作用的差异，和（3）获得与临床研究中心合作的经验，并与提供者合作进行临床相关研究。通过拟议的培训计划，PI将成为糖尿病自我护理家庭支持领域的知名研究人员，并将获得将研究成果转化为可在社区卫生保健环境中实施的培训。她将提交一份K 01提案，根据拟议研究策略的发现，在FQHC中开发和试点家庭干预措施。为了实现这些目标，PI制定了一项培训计划，该计划将高级教学课程工作、参加地方和国家研究会议/大会、指导研究经验（包括在一个国家卫生研究中心收集数据），并积极参与一个非常支持和创新的研究环境（其中包括NIDDK资助的糖尿病转化研究中心，临床和转化科学奖，以及社区可持续研究核心）。 公共卫生相关性：让家庭成员参与成年糖尿病患者的自我护理行为可以减少健康差异，并降低肥胖和糖尿病相关行为代际模式的可能性。该F32奖项将使PI获得糖尿病自我护理家庭支持方面的专业知识，以推进知识基础，并为患有糖尿病和社会经济地位低的成年人开发和试点家庭干预。

DESCRIPTION (provided by applicant): For adults with diabetes, regular self-care behaviors (i.e., diet, exercise, and medication adherence) prevent disease-related complications and premature death. However, patients with low socioeconomic status, low health literacy, and high levels of family stress are less likely to maintain self-care behaviors and more likely to have uncontrolled glycemia. Even in settings with equivalent access and care (e.g., federally qualified health centers-FQHCs), African American and Hispanic patients are less adherent to self-care behaviors and have worse glycemic control than Whites, suggesting behavioral barriers to self-care play a critical role. Family support may be an untapped resource with potential to reduce racial and socioeconomic disparities among adults with diabetes. Family support for diabetes self-care (e.g., reminding patients to take or refill medication, planning healthy meals, participating in exercise with the patient, problem-solving with the patient when barriers to self-care arise) increases the likelihood that patients perform regular self-care, and can improve clinical outcomes for patients with low income, low health literacy, and high stress. However, it remains unclear how family member behaviors influence patient self-care and clinical outcomes, and how race or comorbid depression might moderate the effects of family member behaviors on patients' self-care behaviors. To explore these issues, the principal investigator (PI) will partner with and extend an ongoing study of diabetes medication adherence in a low-income, racially diverse sample of patients with type 2 diabetes (T2DM). The proposed plan will prepare the PI for success as an independent investigator who can develop and implement effective family interventions for adults with diabetes in community health organizations. The PI's immediate goals are to (1) develop proficiency with advanced quantitative methods to explore complex relationships cross-sectionally and contribute to the knowledge base on family support for adults with diabetes, (2) combine quantitative and qualitative methods to understand differences in the role of family support based on race, and (3) gain experience partnering with a FQHC and working with providers to conduct clinically relevant research. Through the proposed training plan, the PI will become an established researcher in the area of family support for diabetes self-care, and will gain training in translating research findings to be implementable in community health care contexts. She will submit a K01 proposal to develop and pilot a family intervention in a FQHC based on findings from the proposed research strategy. To meet these goals, the PI has developed a training plan that integrates advanced didactic course work, participation in local and national research meetings/conferences, a mentored research experience (including data collection at a FQHC), and active involvement in an extremely supportive and innovative research environment (which includes an NIDDK- funded Diabetes Center for Translational Research, a Clinical and Translational Science Award, and a Community-Engaged Research Core). PUBLIC HEALTH RELEVANCE: Engaging family members in self-care behaviors of adults with diabetes may reduce health disparities and decrease the likelihood of intergenerational patterns of obesity and diabetes-related behaviors. This F32 award will allow the PI to gain expertise in family support for diabetes self-care to advance the knowledge base, and develop and pilot a family intervention for adults with diabetes and low socioeconomic status.