Targeting Family Behaviors to Improve Diabetes Management among Adults with Type 2 Diabetes

 描述（由申请人提供）：对于2型糖尿病（T2 DM）成人患者，成功的自我管理需要日常自我护理行为，家庭成员的行为可能使其更容易或更困难。执行糖尿病特定支持行为的家庭成员（例如，提醒患者服药，与患者一起锻炼）通常还执行使成年人的自我护理更加困难的行为（例如，破坏患者的自我护理尝试或唠叨/争论自我护理）。针对家庭成员的疾病特异性行为可能对提高患者的依从性有效。然而，很少有T2 DM成人患者的家庭干预成功改善了患者的结局，并且家庭干预通常是时间密集型的，并且不依从风险最高的患者（社会经济地位低的少数群体; SES）的参与率很低。目前尚不清楚干预内容是否可以使成年患者具备识别和管理支持性和阻塞性糖尿病特异性家庭行为的必要技能。此外，纵向证据明显缺乏;我们还不知道家庭成员的糖尿病特异性行为和患者的糖尿病管理之间的关系（即，坚持自我护理行为和血糖控制）是单向的或随着时间的推移是相互的。在K 01奖项期间，主要研究者（候选人）将解决现存文献中的这些差距，同时参加指导培训经验，这将使她成为一名独立研究者，为成功做好准备，确定可持续的家庭干预方法，改善高危人群中T2 DM成人及其家庭成员的健康和福祉。具体的培训目标包括发展以下方面的专业知识：针对成人糖尿病管理的以家庭为中心的干预内容、行为随机对照试验（RCT）、通过移动的电话技术提供干预内容以及纵向分析。拟议的计划整合了教学课程和培训，指导研究经验（包括与NIDDK R 01资助的行为RCT的实践经验），参与当地和国家会议/研讨会/研讨会/会议，并积极参与一个强大的和非常支持的研究环境。该环境包括NIDDK资助的糖尿病转化研究中心和糖尿病研究与培训中心，NIH临床与转化科学奖，健康服务研究中心，健康行为和健康教育中心，AHRQ资助的以患者为中心的成果研究计划，以及促进患者和社区诊所积极参与研究的Meharry-Vanderbilt社区健康研究核心。此外，候选人的共同导师之一是犹他州大学生命周期生物行为家庭健康研究多学科联盟的主任，并将为候选人提供相关资源和相关合作。这项研究包括三个具体目标。目标1：候选人将以她对目标人群的研究结果为基础（即，一个种族/民族多样化，低SES患者人群），以开发家庭为中心的干预内容，使患者具备技能，要求家庭成员提供所需的支持性行为，并重新定向和/或脱离阻碍性家庭行为。干预内容将仅通过基本的移动的电话技术（即，文本消息和语音通信），以提高覆盖率、参与度和留存率。将招募成年T2 DM患者和一名成年家庭成员进行三轮迭代可用性测试，以在评价前完善干预措施。干预措施将在她导师的大型随机对照试验中进行为期3个月的试验评估。目标二：候选人将分析患者糖尿病自我效能、自我护理行为和血糖控制的变化在多大程度上受到家庭成员糖尿病特异性行为变化的影响（即，的目标机制），并会评估透过短讯向家庭成员传递干预内容的可接受性。目标3：最后，候选人将分析患者报告的糖尿病特异性家庭行为与患者的自我护理和结果之间的纵向关系，在12个月的时间内定期评估。该职业发展计划是候选人迄今为止研究和培训的自然延伸，并利用她的NIDDK资助的F32研究结果，为T2 DM成年人的家庭干预措施的发展提供信息。完成该计划后，候选人将拥有通过技术在低SES患者人群中开发和提供以家庭为中心的行为干预的专业知识，并使用纵向数据分析来评估干预内容对健康行为和结果的影响。结合具体目标的发现，这种独特的专业知识将加速候选人作为T2 DM成人家庭干预专家的独立研究生涯，并将帮助她实现开发和评估可扩展的家庭干预措施的最终目标，以改善T2 DM成人及其家庭成员的健康和生活质量。

 DESCRIPTION (provided by applicant): For adults with type 2 diabetes mellitus (T2DM), successful self-management requires daily self-care behaviors, which can be made easier or more difficult by family members' behaviors. Family members who perform diabetes-specific supportive behaviors (e.g., reminding patients to take medications, exercising with the patient) often also perform behaviors that make adults' self-care more difficult (e.g., sabotaging the patients' self-care attempts or nagging/arguing about self-care). Targeting family members' disease-specific behaviors may be effective for improving patients' adherence. However, few family interventions for adults with T2DM have been successful in improving patients' outcomes, and family interventions are often time-intensive and poorly attended by patients at highest risk of non-adherence (minority groups with low socioeconomic status; SES). It remains unclear whether intervention content can equip adult patients with the necessary skills to identify and manage supportive and obstructive diabetes-specific family behaviors. Furthermore, longitudinal evidence is conspicuously absent; we do not yet know if the relationships between family members' diabetes- specific behaviors and patients' diabetes management (i.e., adherence to self-care behaviors and glycemic control) are unidirectional or reciprocal over time. During this K01 award, the principal investigator (The candidate) will address these gaps in the extant literature while participating in a mentored training experience that will prepare her for success as an independent investigator who identifies sustainable approaches to family interventions that improve the health and well-being of adults with T2DM and their family members in at-risk populations. Specific training goals include developing expertise in: family-focused intervention content for adults' diabetes management, behavioral randomized controlled trials (RCTs), delivering intervention content via mobile phone technology, and longitudinal analysis. The proposed plan integrates didactic coursework and training, a mentored research experience (including hands- on experience with an NIDDK R01-funded behavioral RCT), participation in local and national meetings/seminars/workshops/conferences, and active involvement in a robust and extremely supportive research environment. This environment includes NIDDK-funded Center for Diabetes Translational Research and Diabetes Research & Training Center, a NIH Clinical & Translational Science Award, a Center for Health Services Research, a Center for Health Behavior and Health Education, AHRQ-funded programming in patient-centered outcomes research, and the Meharry-Vanderbilt Community Engaged Research Core which facilitates the active engagement of patients and community clinics in research. In addition, one of the candidate's co- mentors is the director of the multi-disciplinary Consortium for Life-span BioBehavioral Family Health Research at the University of Utah, and will provide the candidate will access to associated resources and relevant collaborations. The proposed research includes three specific aims. Aim 1: The candidate will build on findings from her research with the target population (i.e., a racially/ethnically diverse, low SES patient population) to develop family- focused intervention content to equip patients with skills to ask for needed supportive behaviors from family members and to redirect and/or disengage from obstructive family behaviors. Intervention content will be delivered exclusively via basic mobile phone technology (i.e., text messages and voice communications) to enhance reach, participation, and retention. Adult T2DM patients and an adult family member will be recruited for three iterative rounds of usability testing to refine the intervention prior to evaluation. The intervention will be evaluate in a 3-month trial nested within her mentor's larger RCT. Aim 2: The candidate will analyze the extent to which changes in patients' diabetes self-efficacy, self-care behaviors, and glycemic control were occasioned by changes in family members' diabetes-specific behaviors (i.e., the targeted mechanism), and will evaluate the acceptability of delivering intervention content to family members via text messages. Aim 3: Finally, the candidate will analyze the longitudinal relationships between patient-reported diabetes-specific family behaviors and patients' self-care and outcomes, assessed at regular intervals over a 12-month period. This career development plan presents a natural extension of the candidate's research and training to date, and leverages findings from her NIDDK-funded F32 to inform the development of family interventions for adults with T2DM. Upon completion of this plan, the candidate will have expertise in developing and delivering family-focused behavioral intervention in a low SES patient population via technology and in using longitudinal data analysis to evaluate effects of intervention content on health behaviors and outcomes. In combination with findings from the specific aims, this unique expertise will accelerate the candidate's independent research career as an expert in family interventions for adults with T2DM, and will help her reach her ultimate goals of developing and evaluating scalable family interventions to improve health and quality of life for adults with T2DM and their family members.