Older Adults Using Social Support to Improve Self-Care (OASIS): Adaption, Implementation, and Feasibility of Peer Support for Older Adults with T2DM in Appalachia

项目总结 在美国，大约有3410万(13%)成年人患有2型糖尿病(T2D)。T2D的患病率为17% 农村居民高于城市居民，T2D的患病率随着年龄的增长而增加， 估计有25%的老年人(≥65岁)被确诊。适当的自我护理是最好的 临床结果，自我护理的可变性占血糖控制差异的90%。总体而言，T2D 自理能力在普通人群中一直很差，但在农村居民和老年人中更是如此。 在肯塔基州的农村地区尤其如此，那里高达23%的阿巴拉契亚社区的成年人 诊断为T2D，其中26.8%是老年人。为了获得最佳的临床结果，社会 环境因素，包括社会支持，在促进T2D自我护理时是不可或缺的。具体地说，同级 支持被证明在改善T2D自理行为方面是有效的；它提供情感支持， 工具性支持和教育，同时也帮助个人发展新的技能。同样，同行支持也有 也被证明可以改善与T2D相关的临床和心理社会结局；然而，有文献表明 这也表明，自我选择的社会支持在试图从事有益健康的活动时可能会受到阻碍。 目前，使用同伴支持的现有循证干预(EBI)尚未被专门用于 优先考虑老年人，特别是那些生活在农村社区的老年人。为了解决这一研究差距，我们有 与地区从业者、阿巴拉契亚地区服务组织的领导人进行形成性研究，以及 居民，通过该流程，我们协作确定了可接受且可行的同行支持EBI- 同伴健康指导(PHC)--改善了临床和心理社会T2D相关结果 在没有居住在农村社区的参与者中，≥也不是65岁。通过这些社区 对话中，我们还确定有必要对EBI进行先验调整，以确保其文化和背景 与区域需求和价值观相关。由于PHC是一种以社区为基础的低成本干预措施，它认为 承诺成为整个阿巴拉契亚肯塔基州的可持续和可扩展的模式，那里的资源往往很稀缺， 但社区债券是有价值的。根据文献和利益相关者的反馈，目标是 建议的研究是使用2x2析因设计来测试适应的PHC成分并确定它们的 促进老年人生活中自我护理行为和改善血糖控制的初步效果 在阿巴拉契亚肯塔基州。析因设计的主要组成部分将是如何选择同伴教练 对于参与者(自选与匹配)和与教练联系的频率(每周一次与每两次 几周)。为了实现这一目标，我们将(1)确定哪些EBI组件与改进的T2D- 居住在阿巴拉契亚肯塔基州的老年人的相关结果和(2)评估务实的可实施性 改编后的EBI。

PROJECT SUMMARY Approximately 34.1 million (13%) adults in the US have type 2 diabetes (T2D). The prevalence of T2D is 17% higher in rural dwellers compared to their urban counterparts, and the prevalence of T2D increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes, and variability in self-care accounts for 90% of the variance in glycemic control. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. This is particularly true in rural Kentucky, where up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are integral when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors; it provides emotional support, instrumental support, and education while also helping individuals develop new skills. Similarly, peer support has also been shown to improve clinical and psychosocial outcomes related to T2D; however, there is literature that also suggests self-selected social support can be obstructive when trying to engage in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used specifically to prioritize older adults, especially those living in rural communities. To address this gap in research, we have conducted formative research with regional practitioners, leaders of service organizations in Appalachia, and residents, and through that process, we collaboratively identified an acceptable and feasible peer support EBI— peer health coaching (PHC)—that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. Through these community conversations, we also determined necessary a priori adaptations to the EBI to ensure its cultural and contextual relevance to regional needs and values. Because PHC is a community-based and low-cost intervention, it holds promise to be a sustainable and scalable model across Appalachian Kentucky where resources are often scant, but community bonds are valued. Informed by literature and feedback from stakeholders, the goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. The main components of the factorial design will be how peer coaches are selected for participants (self-selected vs matched) and frequency of contact with coach (once per week vs every 2 weeks). To achieve this goal, we will (1) determine which EBI components are associated with improved T2D- related outcomes in older adults living in Appalachia Kentucky and (2) evaluate the pragmatic implementability of the adapted EBI.