Primary Care-Based Physical Activity for Diabetic Latinas

描述（由申请人提供）：在这个K01培训模块中，我计划获得必要的培训，通过行为干预在初级保健机构中从事II型糖尿病的一级和二级预防工作，重点关注服务不足的人群。在过去的两年中，我接受了流行病学的基础培训和研究经验，并利用现有的数据集研究健康行为与慢性疾病，包括心血管疾病和糖尿病之间的关系。我还观察了健康成人身体活动干预的设计、适应和实施。我最近指导了一项小型示范试验（N=10），针对拉丁裔男性进行体育活动干预，结果显示12周后运动量显著增加。在K01培训期间，我计划在设计和实施针对初级保健机构特定人群的体育活动干预的随机对照试验方面获得进一步的经验，并在II型糖尿病的病理生理学、相关生物标志物和治疗方面获得全面的培训。此外，我计划建立一套基本技能，评估初级保健干预措施的成本和成本效益。我将通过课程学习、培训研讨会、临床观察、会议和导师一对一的培训练习来实现这些目标。这些培训目标将由一个非常合格的指导团队进行监督和支持，该团队在体育活动干预、糖尿病流行病学和临床治疗以及成本效益方面具有丰富的经验，此外还具有指导研究员、住院医师和初级教师的丰富经验。这次培训将使我掌握必要的技能，以便在糖尿病初级保健中设计和实施具有成本效益的行为干预措施，我认为这是一个对公共卫生至关重要的领域。研究计划的目标是实施一种文化和语言适应的基于网络的身体活动干预，专门为初级保健机构中的拉丁裔2型糖尿病患者设计。预计在未来几十年，拉丁裔糖尿病患病率将出现最大的增长，预计本世纪出生的拉丁裔糖尿病患病率将超过50%，但很少有专门针对这一高风险群体的干预措施，该群体报告了许多文化，语言，

DESCRIPTION (provided by applicant): In this K01 training module, I plan to acquire necessary training to pursue a career in primary and secondary prevention of type II diabetes in primary care settings through behavioral interventions, with a focus on underserved populations. For the past two years, I have received foundational training and research experience in epidemiology, and have used existing datasets to study the associations between health behaviors and chronic diseases, including cardiovascular disease and diabetes. I have also observed the design, adaptation, and implementation of physical activity interventions in healthy adults. I recently directed a small demonstration trial (N=10) of a physical activity intervention adapted for Latino men, which showed significant increases in activity after 12 weeks. In the K01 training period, I plan to gain further experience in designing and implementing randomized controlled trials of physical activity interventions for specific populations in primary care settigs, and to gain thorough training in the pathophysiology, relevant biomarkers, and treatment of type II diabetes. Furthermore, I plan to build a basic skillset in assessments of cost and cost- effectiveness of primary care-based interventions. I will accomplish these goals through a combination of coursework, training seminars, clinic observation, and meetings and one-on-one training exercises with mentors. These training goals will be overseen and supported by an extremely qualified mentoring team with extensive experience in physical activity interventions, diabetes epidemiology and clinical treatment, and cost- effectiveness, in addition to thorough experience mentoring fellows, residents, and junior faculty. This training will give me the skills necessary to design and implement cost-effective behavioral interventions in primary care for diabetes, an area I feel is critical to public health. The goal of the research plan is to implemen a culturally and linguistically adapted web-based physical activity intervention designed specifically for Latinas with type II diabetes in a primary care setting. Latinas are projected to experience the largest increases in diabetes prevalence in the coming decades, with projected prevalence rates exceeding 50% for Latinas born in this century, yet few interventions have been designed specifically for this high-risk group which reports a number of cultural, linguistic, and socioeconomic barriers to participating in self-management interventions. The proposed intervention will be based on a web-delivered intervention developed for Latinas by the primary mentor, which is based on the Transtheoretical Model and Social Cognitive Theory. Past trials have shown efficacy of the intervention in non-diabetic populations, yet it has never been tested with clinical populations or in a primary care setting. In the current proposal, this intervention ill be modified for a diabetic population and, in collaboration with the UCSD Family Medicine Clinic, will be implemented in a primary care setting as a diabetes management program. Conducting a small randomized controlled trial (N=80), we will accomplish four specific aims: 1) to test the efficacy of the culturally adapted web-based individually tailored physical activity intervention in increasing weekly minutes of moderate-to-vigorous physical activity, 2) to test the effect of the intervention on clinical markers of diabetes, such as glucose and HbA1c, in addition to medication use, 3) to assess the cost of the intervention in increasing physical activity in order to provide preliminary cost-effectiveness analyses in using the intervention as a diabetes management program, and 4) to assess maintenance of behavior change and change in clinical markers. The proposed intervention incorporates features shown in past diabetes management trials to effectively increase physical activity behavior, including goal setting, self-monitoring, individually tailored feedback, and community support, and also addresses barriers commonly cited by Latinas, such as lack of transportation, linguistic barriers, and lack of support, thus it has great potential to increase physical activity in diabetic Latinas. Furthermore, the web-based format reduces staff and participant burden and increases participant engagement, and is appropriate given the large increases in Internet use among Latinos in recent years. Finally, the web-based format could allow for widespread dissemination in primary care, making it a potentially low cost, high reach approach for promoting an important disease management behavior in an at-risk population.