Telephone Delivered Behavioral Skills Intervention for Blacks with T2DM

为患有 T2DM 的黑人提供电话行为技能干预

• 批准号: 7881452
• 负责人: Leonard E. Egede
• 金额: $ 51.71万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7881452
• 关键词: Accounting; Address; African American; Behavioral; Blood Glucose Self-Monitoring; Blood specimen; Caring; Cessation of life; Complications of Diabetes Mellitus; Diabetes Mellitus; Diet; Educational Intervention; Electronics; Event; Food; Frequencies; Glycosylated hemoglobin A; Goals; Health system; High Prevalence; Intervention; Knowledge; Lipids; Literature; Measures; Metabolic Control; Monitor; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patients; Pharmaceutical Preparations; Physical activity; Population; Provider; Quality of Care; Questionnaires; Randomized; Research Design; Resources; Risk; Self Management; System; Telephone; Testing; cost; cost effectiveness; design; efficacy testing; empowerment; ethnic minority population; follow-up; health care service utilization; high risk; improved; lifestyle intervention; medication compliance; patient population; primary outcome; programs; public health relevance; secondary outcome; skills; skills training; treatment as usual

DESCRIPTION (provided by applicant): Blacks (African Americans) with Type 2 diabetes (T2DM) have higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to Whites. Poor outcomes in Blacks with T2DM can be attributed to patient, provider, and health systems level factors. Provider and health system factors account for <10% of variance in major diabetes outcomes. Key differences appear to be at the patient level. Of the patient level factors, consistent differences between Blacks and Whites with T2DM have been found in diabetes knowledge, self-management skills, empowerment, and perceived control. A variety of interventions to improve diabetes self-management have been tested including: 1) knowledge interventions; 2) lifestyle interventions; 3) skills training interventions; and 4) patient activation and empowerment interventions. Most of these interventions have been tested individually, but rarely have they been tested in combination, especially among Blacks who have the greatest burden of diabetes related complications. This study provides a unique opportunity to address this gap in the literature. Using a 2x2 factorial design, this study will test the efficacy of separate and combined telephone-delivered, diabetes knowledge/information and motivation/behavioral skills training intervention in high risk Blacks with poorly controlled T2DM (HbA1c e9%). The primary objective is to test the separate and combined efficacy of a telephone-delivered diabetes knowledge/information intervention and motivation/behavioral skills training intervention in improving HbA1c levels in Blacks with T2DM using a 2x2 factorial design. The secondary objectives are: 1) To determine whether patients randomized to the telephone-delivered diabetes knowledge/information intervention, the motivation/behavioral skills training intervention or the combined intervention will have greater improvement in physical activity, diet, medication adherence, and self-monitoring of blood glucose at 12 months of follow-up compared to usual care; and 2) To determine the cost-effectiveness of each telephone intervention separately, and then in combination. The primary outcome is HbA1c level at 12 months of follow-up. The secondary outcomes are cost-effectiveness of each telephone intervention separately, and then in combination, and change in physical activity, diet, medication adherence, and self-monitoring of blood glucose over 12 months of follow-up. The long-term goal of the project is to achieve improvement in diabetes-related outcomes in this patient population. PUBLIC HEALTH RELEVANCE: Blacks or African Americans have greater risk of and are more likely to die from type 2 diabetes (T2DM). Major barriers to effective diabetes care for Blacks include poor diabetes knowledge, self-management skills, empowerment, and perceived control. Few prior studies have tested interventions to address these barriers in combination, especially among Blacks who have the greatest burden of diabetes related complications. This study provides a unique opportunity to address this gap in the literature by testing the efficacy of separate and combined telephone-delivered, diabetes knowledge and motivation/behavioral skills training intervention in high risk Blacks with poorly controlled T2DM. The findings of this study, if successful, will provide new information on how to improve quality of care for diabetes in ethnic minorities and reduce the disproportionate burden of diabetes complications and deaths in this population.

描述（由申请人提供）： 与白人相比，患有 2 型糖尿病 (T2DM) 的黑人（非裔美国人）糖尿病患病率更高、代谢控制更差、并发症和死亡风险更高。患有 T2DM 的黑人的不良预后可归因于患者、提供者和卫生系统层面的因素。医疗服务提供者和卫生系统因素对主要糖尿病结局差异的影响小于 10%。主要差异似乎存在于患者层面。在患者层面的因素中，黑人和白人 T2DM 在糖尿病知识、自我管理技能、赋权和感知控制方面存在一致的差异。已经测试了多种改善糖尿病自我管理的干预措施，包括：1）知识干预； 2）生活方式干预； 3）技能培训干预； 4) 患者激活和赋权干预。大多数这些干预措施都是单独测试的，但很少进行组合测试，特别是在糖尿病相关并发症负担最大的黑人中。这项研究为解决文献中的这一空白提供了一个独特的机会。本研究将使用 2x2 析因设计，测试单独和组合的电话传递、糖尿病知识/信息和动机/行为技能培训干预对 T2DM 控制不佳 (HbA1c e9%) 的高风险黑人的有效性。主要目标是使用 2x2 析因设计测试电话提供的糖尿病知识/信息干预和动机/行为技能培训干预在改善患有 T2DM 的黑人 HbA1c 水平方面的单独和联合功效。次要目标是： 1) 确定随机接受电话传递的糖尿病知识/信息干预、动机/行为技能训练干预或联合干预的患者是否会在身体活动、饮食、药物依从性和自我治疗方面有更大的改善。与常规护理相比，随访 12 个月时监测血糖； 2) 分别确定每次电话干预的成本效益，然后综合确定。主要结局是 12 个月随访时的 HbA1c 水平。次要结果是每次电话干预单独和组合的成本效益，以及 12 个月随访期间体力活动、饮食、药物依从性和血糖自我监测的变化。该项目的长期目标是改善该患者群体的糖尿病相关结果。 公共卫生相关性：黑人或非裔美国人患 2 型糖尿病 (T2DM) 的风险更大，也更有可能死于 2 型糖尿病 (T2DM)。黑人有效糖尿病护理的主要障碍包括糖尿病知识匮乏、自我管理技能、赋权和感知控制。此前很少有研究测试了综合解决这些障碍的干预措施，特别是在糖尿病相关并发症负担最重的黑人中。这项研究提供了一个独特的机会，通过测试单独和组合的电话传递、糖尿病知识和动机/行为技能培训干预对 T2DM 控制不佳的高风险黑人的有效性，来解决文献中的这一空白。这项研究的结果如果成功，将为如何提高少数民族糖尿病的护理质量并减少该人群糖尿病并发症和死亡的不成比例的负担提供新信息。