Computer Motivational Interventions to Improve Diabetes Care in Minority Youth

描述（由申请人提供）：在过去二十年中进行的疾病管理研究表明，相当大比例的青少年及其家庭不遵循医生给他们的慢性病治疗建议。青年1型糖尿病患者疾病管理不善导致代谢控制不良，进而导致糖尿病并发症。尤其是非洲裔美国青少年，在坚持治疗和代谢控制方面的问题风险明显更高。尽管有这样的发现，研究开发有效的干预措施，以改善1型糖尿病少数民族青少年的疾病管理是非常有限的。很少有针对青少年的研究表明行为干预可以改善代谢控制。然而，促进父母参与糖尿病护理可能是一个更富有成效的途径。我们小组最近的研究表明，父母对青少年日常糖尿病护理的监督和监测是疾病管理和代谢控制的重要预测指标。目前还没有公开的临床试验，直接针对父母监测作为改善青少年糖尿病患者疾病管理的一种手段。本研究的目的是开发并初步验证一种干预措施，以增加父母监督和监测青少年疾病管理行为的动机，这种干预措施可以提供给年轻的、城市的、高风险的非裔美国青少年的父母，他们开始向独立的自我照顾过渡。将制定一项配套干预措施，以提高青少年改善糖尿病护理的积极性。建议的干预是简短的（三个疗程），机会驱动的（在孩子定期的门诊随访时呈现给父母），基于动机访谈的原则，并通过一种经过验证的，引人入胜的，易于使用的基于计算机的方法进行。拟议的研究包括一个开发阶段（根据专家反馈开发干预措施，然后与父母进行可行性测试）和一个试点验证阶段（试点临床试验，使用90名10-13岁患有1型糖尿病的年轻非洲裔美国青少年的父母）。家庭将从一个为不同人群服务的大型城市教学医院招募。随机对照试验的参与者将被随机分配到父母加青少年组（双方都接受三次计算机提供的激励课程加上标准的多学科医疗护理）、父母只接受父母加青少年组（父母接受激励课程，青少年接受注意力控制加标准护理）或注意力控制组（父母和青少年接受注意力控制加标准护理）。如果成功，该干预措施有可能以相对较低的成本改善患有糖尿病的少数民族青少年的生活质量，并通过将其纳入糖尿病诊所的常规医疗预约，广泛影响这些青少年。

DESCRIPTION (provided by applicant): Studies of illness management conducted over the past twenty years suggest that substantial percentages of adolescents and their families do not follow recommendations given to them by physicians for the treatment of chronic medical conditions. Poor illness management in youth with type 1 diabetes leads to poor metabolic control, which in turn leads to diabetes complications. African-American adolescents in particular have been found to be at significantly higher risk for problems with treatment adherence and metabolic control. Despite such findings, research to develop effective interventions to improve illness management among minority adolescents with type 1 diabetes is extremely limited. Few studies targeting adolescents have demonstrated that behavioral interventions can improve metabolic control. However, facilitating parental involvement in diabetes care may be a more fruitful path. Recent research by our group has shown that parental supervision and monitoring of adolescents' daily diabetes care is a significant predictor of illness management and metabolic control. There have been no published clinical trials of interventions that have directly targeted parental monitoring as a means of improving illness management in adolescents with diabetes. The purpose of the present study is to develop and preliminarily validate an intervention to increase parental motivation for supervision and monitoring of youth illness management behaviors that can be provided to parents of young, urban, high-risk African American adolescents who are beginning to transition to independent self-care. A companion intervention will be developed to increase youth motivation for improving diabetes care. The proposed intervention is brief (three sessions), opportunity-driven (presented to parents at the time of their child's regularly scheduled clinic follow-up visits), based on the principles of Motivational Interviewing, and delivered via a proven, engaging, and easy-to-use computer-based approach. The proposed study includes a development phase (development of the intervention with expert feedback, followed by feasibility testing with parents) and a pilot validation phase (pilot clinical trial using a sample of 90 parents of young African American adolescents aged 10-13 with type 1 diabetes). Families will be recruited from a large, urban teaching hospital that serves a diverse population. Participants in the RCT will be randomly assigned to parent plus youth condition (both receive three computer-delivered motivational sessions plus standard multidisciplinary medical care) parent only condition (parent receives motivational session and youth receives attention control plus standard care) or an attention control (parent and youth receive attention control plus standard care). If successful, the intervention has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth through integration into routine medical appointments in diabetes clinics. PUBLIC HEALTH RELEVANCE: Studies of illness management conducted over the past twenty years suggest that substantial percentages of youth and families do not follow recommendations given to them by physicians for the treatment of medical conditions. Many studies have demonstrated the importance of parental involvement for promoting optimal adolescent diabetes management, but to date there have been no published clinical trials of interventions that directly targeted parental monitoring. If successful, our computer-delivered intervention aimed at improving parental monitoring has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth and families through integration into routine medical appointments in diabetes clinics.