Acceptance Based Coping (ABC) Skills Delivered by Promotores for Hispanic/Latino Patients with T2DM

项目总结/摘要 博士Kathryn Kanzler正在申请以患者为导向的研究职业发展奖（K23）。 这笔赠款将提供密集的培训和时间，以获得必要的技能和知识，以实现 她的长期目标是成为一名独立的临床研究者，研究可扩展的行为治疗， 健康差异和改善糖尿病患者的预后。坎兹勒博士是一位临床健康心理学家 在美国空军担任临床医师和教育工作者。建立在坚实的基础上，额外的培训 在健康差异、临床研究和设计、2型糖尿病（T2 DM）和传播方面寻求， 执行科学。拟议的培训将在多学科导师的指导下完成， 培训顾问主要在德克萨斯大学健康科学中心圣安东尼奥。活动包括 课程作业、指导阅读、研讨会、讲习班和导师会议。这项研究有助于 解决西班牙裔/拉丁裔糖尿病人群对更多干预措施的迫切需求。尽管继续 生物医学的进步，糖尿病和相关并发症继续在西班牙裔/拉丁裔中造成更高的死亡率。 社区，那里有40%的死亡可能性比非西班牙裔白人。避免 应对已经成为阻止最佳血糖控制的关键因素，但解决 回避应对，如接受和承诺疗法（ACT），受到语言和文化的限制， 护理的障碍，以及标准的传播做法（例如，ACT通常由许可证提供 专业设置中的提供者）。在初级保健小组中服务的社区卫生工作者（“宣传员”）可以 提供ACT治疗糖尿病的关键要素，以及减轻自我管理的其他障碍，例如 资源有限、语言差异和健康素养低。这种任务转移模式允许 符合文化特点和可获得的护理。ACT-接受型应对（ABC） 技能监督Promotores可以提供方便和文化上适当的治疗，在首选的 患者的语言本研究旨在发展一套可接受且可行的促销广告传播ABC 使用REP先决条件和实施前步骤的西班牙裔/拉丁裔干预方案，（a） 访谈和焦点小组（第1阶段）的定性和定量数据;（B）重复小样本 beta测试（第2阶段）。第二个目的是为更大规模的务实试验做准备， 一项试点随机试验，通过：评估招募和保留;建立评估方法 干预的忠实性和完整性;参与多层次的利益攸关方;估计潜在的规模 对选定机制和成果的影响。这一系列的研究有潜力改善血糖控制 和西班牙裔/拉丁裔T2 DM患者的生活质量。该奖项将为一项研究奠定基础 可扩展的干预计划，通过改善糖尿病结果来减少健康差距。

Project Summary/Abstract Dr. Kathryn Kanzler is applying for a Mentored Patient-Oriented Research Career Development Award (K23). This grant would provide intensive training and time to gain necessary skills and knowledge toward achieving her long-term goal of being an independent clinical investigator of scalable behavioral treatments to reduce health disparities and improve outcomes for patients with diabetes. Dr. Kanzler is a clinical health psychologist with experience as a clinician-educator in the US Air Force. Building on a strong foundation, additional training is sought in health disparities, clinical research and design, type 2 diabetes (T2DM), and dissemination and implementation science. Proposed training will be accomplished with guidance of multidisciplinary mentors and training advisors largely based at the University of Texas Health Science Center San Antonio. Activities include coursework, directed readings, seminars, workshops, and mentor meetings. The proposed study helps address an urgent need for more interventions for the Hispanic/Latino diabetes population. Despite continued biomedical advances, diabetes and related complications continue to take a higher toll in the Hispanic/Latino community, where there is 40% greater likelihood of death compared to non-Hispanic whites. Avoidance coping has emerged as a key factor in preventing optimal glycemic control, but interventions that address avoidance coping, such as Acceptance and Commitment Therapy (ACT), are limited by language and cultural barriers to care, as well as standard dissemination practices (e.g., ACT is usually provided by licensed providers in specialty settings). Community health workers (“Promotores”) serving on primary care teams could deliver key elements of ACT for diabetes, in addition to mitigating other barriers to self-management, such as limited resources, language differences, and low health literacy. This task-shifting paradigm allows for culturally-tailored and accessible care. Task-shifting core skills of ACT–Acceptance Based Coping (ABC) skills—to supervised Promotores could provide accessible and culturally appropriate treatment in the preferred language of patients. This study aims to develop an acceptable and feasible Promotores-delivered ABC intervention program for Hispanics/Latinos using REP pre-conditions and pre-implementation steps, in (a) qualitative and quantitative data from interviews and focus groups (Phase 1); and (b) repeated small-sample beta-tests (Phase 2). The second aim, in preparation for a larger pragmatic trial, is to demonstrate feasibility in a pilot randomized trial through: evaluating recruitment and retention; establishing methods of assessing intervention fidelity and integrity; engaging multi-level stakeholders; and estimating the magnitude of potential impact on selected mechanisms and outcomes. This line of research has potential to improve glycemic control and quality of life for Hispanic/Latino patients with T2DM. This award will lay the foundation for a research program of scalable interventions that reduce health disparities through improved diabetes outcomes.