Computer Motivational Interventions to Improve Diabetes Care in Minority Youth

描述（由申请人提供）：过去二十年进行的疾病管理研究表明，相当大比例的青少年及其家人不遵循医生为治疗慢性疾病而向他们提出的建议。1型糖尿病患者的疾病管理不善导致代谢控制不良，这反过来又导致糖尿病并发症。特别是非洲裔美国青少年被发现在治疗依从性和代谢控制问题的风险显着更高。尽管有这样的发现，研究开发有效的干预措施，以改善少数民族青少年1型糖尿病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路径。我们小组最近的研究表明，父母监督和监测青少年的日常糖尿病护理是疾病管理和代谢控制的重要预测因素。目前还没有发表的干预措施的临床试验，直接针对父母的监测，作为改善糖尿病青少年疾病管理的一种手段。本研究的目的是开发和初步验证的干预措施，以增加父母的动机，监督和监测的青少年疾病管理行为，可以提供给父母的年轻，城市，高风险的非洲裔美国青少年开始过渡到独立的自我照顾。将制定一项伴随干预措施，以增加青年改善糖尿病护理的动力。建议的干预是简短的（三个会话），机会驱动（在他们的孩子定期安排的诊所随访时向父母展示），基于动机访谈的原则，并通过一个经过验证的，引人入胜的，易于使用的基于计算机的方法提供。拟议的研究包括一个开发阶段（开发专家反馈的干预措施，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条件（均接受三次计算机提供的激励会议加标准多学科医疗护理）、仅父母条件（父母接受激励会议，青少年接受注意力控制加标准护理）或注意力控制（父母和青少年接受注意力控制加标准护理）。如果成功，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，并通过纳入糖尿病诊所的常规医疗预约，广泛接触这些青年。 公共卫生相关性：过去20年进行的疾病管理研究表明，相当大比例的青年和家庭没有遵循医生向他们提出的医疗建议。许多研究已经证明了父母参与对促进最佳青少年糖尿病管理的重要性，但迄今为止还没有发表直接针对父母监测的干预措施的临床试验。如果成功的话，我们旨在改善父母监测的计算机提供的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，并通过纳入糖尿病诊所的常规医疗预约，广泛接触这些青少年和家庭。

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.