eHealth: Second Life Impacts Diabetes Education & Self-Management (SLIDES)

描述（由申请人提供）：需要创新和媒介来帮助和增强慢性病患者的自我管理能力，以：消除医疗保健障碍;适应有限的健康素养;提供可持续的，具有成本效益的患者教育和支持;并超越无效的，非交互式的健康行为干预。Web 2.0等通信技术的进步是满足这些需求的一种手段。最初的研究表明，虚拟环境，通过重复，实践，反馈和应用促进社会互动，导致上级学习和技能转移。因此，我们建议使用虚拟环境“第二人生”开发和测试一种有理论基础、基于技术的生物行为干预措施，以促进糖尿病的自我管理。糖尿病影响2360万美国成年人，其中大多数患有2型糖尿病（T2 DM）。众所周知，代谢控制可以降低糖尿病发病率和死亡率，但它仍然是美国第六大死亡原因。患有T2 DM的个体提供99%的自身护理，使得糖尿病自我管理（DSM）（例如饮食、运动）成为控制的组成部分。利用患者-提供者互动的定制DSM干预措施具有令人鼓舞的短期效果。然而，这种频繁的互动是无法实现的，而且成本高昂。互联网干预有可能捕捉患者-提供者互动的动态，但迄今为止仍然是“平面”和单向异步通信。虚拟环境，如第二人生是一个潜在的解决方案，通过互动，同步通信，知识应用程序，并在一个身临其境的环境中的社交网络捕捉病人提供者的动态。我们建议，一个虚拟的糖尿病社区（SLIDES）与T2 DM成人，医疗保健专业人员和同行之间的实时互动是可行的，并有可能影响代谢控制和心理社会介质。这项试点研究采用了一组，前中期后措施研究设计，以评估参与SLIDES，其中包括互动DSM教育，支持和资源的可行性，可用性和效果。SLIDES社区将由社区中心、健身房、杂货店和其他地点组成，每个地点都允许交互式知识应用。基于此设计，我们的具体目标是：（1）使用第二人生开发沉浸式糖尿病社区（SLIDES），并通过分析过程数据评估可行性;（2）确定参与SLIDES干预对代谢控制和潜在心理社会中介变量的初步影响，作为未来干预研究的效应大小和方差的基础。如果我们的方法是有希望的，我们将在未来的研究中进行实验性的有效性测试。由于对虚拟环境中健康干预的可接受性和有效性知之甚少，本研究构成了了解它们如何促进自我管理的重要步骤。创新的计划，如SLIDES有潜力改善医疗保健的普及，在一个容易传播的替代护理模式，促进具有成本效益的资源利用。

DESCRIPTION (provided by applicant): Innovations and mediums to assist and empower patients in chronic illness self-management are needed to: eliminate barriers to healthcare; accommodate limited health literacy; provide sustainable, cost-effective patient education and support; and move beyond ineffective, non-interactive health behavior interventions. Advances in communication technology such as the Web 2.0 are a means to fill these needs. Initial studies suggest that virtual environments, which promote social interaction via repetition, practice, feedback, and application, lead to superior learning and skill set transfer. Therefore, we propose to develop and test a theoretically grounded, technologically-based, bio-behavioral intervention using the virtual environment, Second Life to facilitate self- management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2DM). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains the 6th leading cause of death in the U.S... Individuals with T2DM provide 99% of their own care, making diabetes self- management (DSM) (e.g. diet, exercise) integral to control. Tailored DSM interventions utilizing patient- provider interaction have had encouraging short-term effects. However, this frequent interaction is unattainable and costly. Internet interventions have the potential to capture the dynamics of patient-provider interaction, but to date remain "flat" and unidirectional with asynchronous communication. Virtual environments such as Second Life are a potential solution to capturing patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. We propose that a virtual diabetes community (SLIDES) with real-time interaction among adults with T2DM, healthcare professionals, and peers is feasible and has the potential to influence metabolic control and psychosocial mediators. This pilot study utilizes a one group, pre-mid-post measure study design to evaluate the feasibility, usability, and effect of participation in SLIDES, which includes interactive DSM education, support, and resources. The SLIDES community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our specific aims are: (1) Develop an immersive diabetes community (SLIDES) using Second Life and assess the feasibility by analyzing process data; and (2) Determine the preliminary effects of participation in the SLIDES intervention on metabolic control and potential psychosocial mediating variables as a basis for effect sizes and variance in future intervention studies. If our approach is promising, we will pursue experimental efficacy testing in future studies. As little is known about the acceptability and efficacy of health interventions in a virtual environment, this study constitutes important steps to understand how they promote self-management. Innovative programs such as SLIDES have potential for improving healthcare access in an easily disseminated alternative model of care that promotes cost-effective resource utilization.