Web-based Training of Peers to Deliver Diabetes Self-Management Support (DSMS)

摘要 本提案的具体目的是测试开发、利用和评估基于网络的 糖尿病自我管理支持（DSMS）培训计划，是文化上为非洲裔美国人量身定制的 社区有效的自我管理是改善糖尿病预后、避免并发症和 降低成本。对许多非洲国家来说，持续保持自我管理尤其具有挑战性， 美国人糖尿病自我管理教育（DSME）是为了解决自我管理中的这一关键差距而开发的。 管理支持。当文化定制时，DSME在非洲裔美国人中特别有效 社区.然而，DSME的影响并不持久。持续的糖尿病自我管理支持 （DSMS）后，DSME已被用来维持DSME的积极影响。同侪导师（受过培训的外行 个人成功地管理自己的糖尿病）是一种负担得起的和有效的手段， DSMS。同伴导师目前是亲自培训的，这极大地限制了能够 由于缺乏这种培训的可扩展性，因此，我们建议开发和评估一个 对同侪导师进行基于网络的灾害管理和监测系统培训，以代替面对面培训。 为了实现第一阶段的具体目标，我们将开展四项工作： 任务1：进行焦点小组：我们将进行两个焦点小组，每个小组有6名未控制的糖尿病患者 以及两个焦点小组，每个小组有6名糖尿病同伴导师。目标是了解如何翻译 非裔美国人量身定制的面对面培训材料成为一个有效的基于网络的计划。 任务2：为同侪导师开发DSMS培训计划原型：12个基于网络的电子学习模块 将根据Tang等人（2011年）开发并证明有效的模块创建评估。 任务3.对24名受试者进行同伴训练效果评价。招募30名糖尿病同伴导师候选人， 完成基于网络的培训和评估;占流失的20%。应满足的培训标准： 超过80%的导师必须通过所有个人通过标准：1）>80%的糖尿病评分 知识测试，糖尿病知识问卷得分>80%，糖尿病知识问卷平均得分>4。 理解管理实践量表;（2）在6个基于授权的小插曲中的3个上+2，至少+1 （3）自我效能感调查>4分;（4）目标设定模拟及格; a（5）在主动倾听观察量表的改编版本上的平均得分>4。 任务4.评估由同伴导师提供DSMS的可行性：一项两组随机临床试验将 评估在非洲裔美国人中使用网络培训的同行导师在DSME之后提供DSMS的可行性 社区可行性测试：我们预计HbA 1c降低1%的差异将在6个月时持续。 第二阶段计划：为多个多元化群体开发一套类似产品，并进行大型多臂 随机临床试验，以测试同行交付的DSMS的有效性，以支持产品的商业化。

ABSTRACT The Specific Aim of this proposal is to test the feasibility of developing, utilizing, and evaluating a web-based diabetes self-management support (DSMS) training program that is culturally tailored for the African American community. Effective self-management is the key to improving diabetes outcomes, avoiding complications, and reducing costs. Ongoing maintenance of self-management is particularly challenging among many African- Americans. Diabetes self-management education (DSME) was developed to address this critical gap in self- management support. When culturally tailored, DSME can be particularly effective in African American communities. However, the impact of DSME is not long lasting. Ongoing diabetes self-management support (DSMS) after DSME has been used to sustain the positive effects of DSME. Peer mentors (trained lay individuals successfully managing their own diabetes) are an affordable and effective means of delivering DSMS. Peer mentors are currently trained in-person, which greatly limits the number of peer mentors that can be trained due to lack of scalability of such training. Thus we propose the development and evaluation of a web-based DSMS training of peer mentors in lieu of in-person training. To achieve our Phase I Specific Aim, we will carry out four Tasks: Task 1: Conduct focus groups: We will conduct two focus groups with 6 uncontrolled diabetes patients each and two focus groups with 6 diabetes peer mentors each. The goal is to understand how to translate the African American-tailored in-person training material into an effective web-based program. Task 2: Develop DSMS Training Program Prototype for Peer Mentors: 12 web-based, e-Learning modules and assessments will be created based on the modules developed and proven effective by Tang et al. (2011). Task 3. Evaluate Peer Training Efficacy with 24 Subjects. Recruit 30 diabetes peer mentor candidates to complete the web-based training and evaluations; accounting for 20% attrition. Training Criteria to be Met: More than 80% of mentors must pass all of the individual passing criteria: 1) >80% score on the Diabetes Knowledge Test, >80% score on the Diabetes Knowledge Questionnaire, and mean score of >4 on the Understanding Management Practice scale; (2) +2 on 3 of the 6 empowerment-based vignettes and at least +1 on the remaining 3 vignettes; (3) >4 on Self-Efficacy Survey; (4) passing score in Goal-Setting Simulation; and a (5) mean score >4 on an adapted version of the Active Listening Observation Scale. Task 4. Evaluate Feasibility of DSMS Delivered by Peer Mentors: A two-arm randomized clinical trial will assess the feasibility of using web-trained peer mentors to deliver DSMS after DSME in the African American community. Test of Feasibility: We expect a 1% difference in HbA1c reduction to be sustained at 6 months. Phase II Plans: Develop a set of similar products for multiple diversity groups and conduct a large multi-arm randomized clinical trial to test efficacy of peer-delivered DSMS to support commercialization of the product.