Improving Patient Self-Advocacy and Communication with Providers through Diabetes Self-Management Education: A Randomized Controlled Trial

项目总结 西弗吉尼亚州是阿巴拉契亚地区的一个农村州，这个地区以独特的文化特征而闻名，但也有 影响第二类人有效自我管理的权力丧失、劣势和不良的社会决定因素 糖尿病(T2 DM)。西弗吉尼亚州慢性病负担很重，因为该州的慢性病患病率最高 美国的T2 DM(16.2%)。患者-提供者关系中的沟通是慢性病的关键组成部分 疾病管理，并支持预防破坏性的长期并发症。然而，患者 患有T2 DM的人通常不愿公开地与他们的提供者分享他们对自我护理的担忧。这 这项研究旨在测试糖尿病和高血压自我管理计划(DHSMP)的有效性， 西弗吉尼亚州两家以患者为中心的疗养院实施为期12周的团体生活方式干预 患者在医患关系中的自我倡导和沟通 对2型糖尿病患者的管理和治疗偏好。该计划对相关临床(HbA1c， 空腹血糖、血脂)、行为(自我护理)和心理社会(糖尿病困扰)也将是变量 评估这些变量与患者自我倡导和患者提供者之间的关系 本课程将探讨沟通。DHSMP利用健康教练提供团体教育课程和 支持参与者改善自我照顾行为，包括鼓励和增强参与者 自我宣传/向供应商传达他们的需求。使用随机对照试验(RCT)设计 和一种综合的和解释性的顺序混合方法，本研究的目标是： 评估DHSMP在改善患者自我倡导和与医疗服务提供者沟通方面的影响 糖尿病与积极控制组(目标1)的比较，以了解参与者的经历和看法 DHSMP和患者-提供者通过焦点小组就糖尿病自我管理进行沟通的情况和 访谈(目标2a)，并评估自我倡导和患者- 基于各种参与者特征的供应商沟通(目标2b)。这项研究的创新之处在于它 是第一个测试生活方式干预对患者自我倡导和患者提供者的影响的随机对照试验 关于糖尿病护理、管理和相关痛苦的沟通。此外，这项研究将 通过提供以下策略来促进对患者与提供者关系的理解并填补重要空白 解决阿巴拉契亚农村地区糖尿病自我管理的患者与提供者沟通问题 成年人。这笔奖学金还将使Brenna Kirk女士(PI)掌握管理多站点的技能和经验 干预，进行混合方法研究，通过出版物/演示文稿传播成果，并将 增强她对农村慢性病临床管理和治疗方法的了解 在实践中实现卫生公平。因此，研究和培训计划将使柯克女士做好准备 健康差距研究领域的一位领先的行为调查者专注于农村成年人中的糖尿病。

PROJECT SUMMARY West Virginia (WV) is a rural state in Appalachia, a region known for unique cultural traits, but also a history of disempowerment, disadvantage, and poor social determinants that impact effective self-management of type 2 diabetes mellitus (T2DM). WV experiences a high burden of chronic disease as the state has the highest rate of T2DM (16.2%) in the US. Communication in the patient-provider relationship is a key component of chronic disease management and supports the prevention of devastating long-term complications. However, patients living with T2DM are often reluctant to openly share their concerns regarding self-care with their provider. This study aims to test the effectiveness of the Diabetes and Hypertension Self-Management Program (DHSMP), a 12-week group lifestyle intervention implemented in two Patient Centered Medical Homes in WV on improving patients' self-advocacy and communication in the patient-provider relationship regarding their concerns and preferences in management and treatment of their T2DM. The program's impact on relevant clinical (HbA1c, fasting blood glucose, lipids), behavioral (self-care) and psychosocial (diabetes distress) variables will also be assessed and relationships between these variables and patient self-advocacy and patient-provider communication will be explored. The DHSMP utilizes health coaches to deliver group educational sessions and support participants in improving self-care behaviors, including encouraging and empowering participants to self-advocate/communicate their needs to their providers. Using a randomized controlled trial (RCT) design and an integrated and explanatory sequential mixed-method approach, the objectives of this study are: to assess the DHSMP's impact on improving patient self-advocacy and communication with providers regarding diabetes compared to an active control group (Aim 1), to understand participants' experiences and perceptions of the DHSMP and patient-provider communication regarding diabetes self-management via focus groups and interviews (Aim 2a), and to assess differences in experiences/perceptions of self-advocacy and patient- provider communication based on various participant characteristics (Aim 2b). This study is innovative in that it is the first RCT to test the impact of a lifestyle intervention on patient self-advocacy and patient-provider communication regarding diabetes care, management, and related distress. Furthermore, this study will advance understanding of patient-provider relationships and fill an important gap by informing strategies to address patient-provider communication regarding self-management of diabetes among rural Appalachian adults. This fellowship will also equip Ms. Brenna Kirk (PI) with skills and experience in managing a multi-site intervention, conducting mixed-methods research, disseminating results via publications/presentations, and will enhance her understanding of rural clinical management of chronic diseases and approaches for operationalizing health equity in practice. The research and training plan will thus prepare Ms. Kirk to become a leading behavioral investigator in health disparities research focused on diabetes among rural adults.