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，在初级保健环境中从事II型糖尿病的初级和二级预防工作，重点是服务不足的人群。在过去的两年里，我接受了流行病学的基础培训和研究经验，并使用现有的数据集来研究健康行为与慢性疾病之间的关联，包括心血管疾病和糖尿病。我还观察了健康成年人身体活动干预措施的设计，适应和实施。我最近指导了一项针对拉丁裔男性的体力活动干预的小型示范试验（N=10），该试验显示12周后活动量显著增加。在K01培训期间，我计划在初级保健环境中为特定人群设计和实施体力活动干预的随机对照试验方面获得更多经验，并在病理生理学，相关生物标志物和II型糖尿病治疗方面获得全面培训。此外，我计划建立一个基本的技能，在评估成本和成本效益的初级保健为基础的干预措施。我将通过课程作业、培训研讨会、临床观察、会议和与导师的一对一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监督和支持，该团队在身体活动干预，糖尿病流行病学和临床治疗以及成本效益方面拥有丰富的经验，此外还具有全面的指导研究员，居民和初级教师的经验。这项培训将使我掌握必要的技能，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。该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，专门为拉丁美洲的II型糖尿病患者设计。预计拉丁美洲人在未来几十年内将经历糖尿病患病率的最大增长，预计本世纪出生的拉丁美洲人的患病率将超过50%，但很少有专门针对这一高危人群设计的干预措施，该人群报告了许多文化，语言， 以及参与自我管理干预的社会经济障碍。拟议的干预措施将基于网络交付的主要导师，这是基于跨理论模型和社会认知理论为拉丁美洲开发的干预措施。过去的试验已经显示了干预在非糖尿病人群中的疗效，但从未在临床人群或初级保健环境中进行过测试。在目前的提案中，这种干预措施将被修改为糖尿病人群，并与UCSD家庭医学诊所合作，将在初级保健环境中实施糖尿病管理计划。进行一项小型随机对照试验（N=80），我们将实现四个具体目标：1）测试文化适应的基于网络的个体定制的身体活动干预在增加每周中等到剧烈身体活动分钟数方面的功效，2）测试 除了药物使用之外，干预措施对糖尿病临床标志物（例如血糖和HbA 1c）的影响，3）评估增加体力活动的干预成本，以便提供使用干预措施的初步成本效益分析作为糖尿病管理计划，以及4）评估行为变化和临床标志物变化的维持情况。拟议的干预措施结合了过去糖尿病管理试验中显示的特征，以有效地增加体力活动行为，包括目标设定，自我监测， 个人定制的反馈和社区支持，并解决了拉丁美洲人通常提到的障碍，如缺乏交通，语言障碍和缺乏支持，因此， 有很大的潜力，以增加体力活动的糖尿病拉丁美洲人。此外，基于网络的格式减轻了工作人员和参与者的负担，增加了参与者的参与，鉴于近年来拉丁美洲人使用互联网的人数大幅增加，这种格式是适当的。最后，基于网络的格式可以允许在初级保健中广泛传播，使其成为一种潜在的低成本，高覆盖率的方法，用于在高危人群中促进重要的疾病管理行为。

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.