Diabetes Self-Management & Support LIVE (Learning in Virtual Environments)

糖尿病自我管理

• 批准号: 8666813
• 负责人: Constance Margaret Johnson
• 金额: $ 64.82万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8666813
• 关键词: Adult; Affect; Behavior; Behavior Therapy; Behavioral; Bio-Base; Blood Pressure; Body mass index; Caring; Cause of Death; Chronic Disease; Communication; Communities; Diabetes Mellitus; Diet; Distress; Economics; Education; Environment; Family; Feasibility Studies; Feedback; Fruit; Glucose; Glycosylated hemoglobin A; Health; Health Professional; Health behavior; Healthcare; Immersion Investigative Technique; Individual; Intake; Internet; Intervention; Knowledge; Lead; Learning; Life; Lipids; Literature; Location; Long-Term Effects; Measures; Mediating; Mediator of activation protein; Metabolic; Metabolic Control; Modeling; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Education; Patients; Physical activity; Population; Provider; Randomized Controlled Trials; Reporting; Resources; Sampling; Self Efficacy; Self Management; Social Interaction; Social Network; Social support; Solutions; Technology; Testing; Time; Training Support; Translations; Transportation; base; behavior change; cost effective; design; diabetes education; diet and exercise; driving force; experience; fruits and vegetables; group intervention; health care service utilization; health literacy; improved; innovation; mortality; peer; programs; psychosocial; public health relevance; skills; social; virtual; waist circumference

DESCRIPTION (provided by applicant): Interventions to assist 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. Virtual environments (VE) promote social interaction and learning via application and feedback, leading to superior learning and skill set transfer. We propose to test a theoretically grounded, technologically-based, bio-behavioral intervention using a VE to facilitate self-management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2D) (NIDDK, 2009). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains a leading cause of death in the U.S. Individuals with T2D provide a majority 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" with asynchronous communication. VEs are a potential solution to capture patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. Preliminary findings from our R21 (R21LM010727-01) showed that a virtual diabetes community with real-time interaction among adults with T2D, and with healthcare professionals is feasible and has the potential to influence metabolic control and psychosocial mediators. Thus we are proposing a randomized controlled trial to determine whether the effects of participation in a VE that incorporates real-time diabetes self-management training and support will be associated with positive changes in health behaviors. The LIVE community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our primary aim is to (1) determine the effects of providing DSMT/S in a VE on diet and physical activity behavior change in adults with T2D compared to traditional DSMT/S over 12 months. Our secondary aims are: (2) to determine the effects on metabolic outcomes; (3) to assess whether level of engagement and social network formation in LIVE differentially impacts behavioral outcomes; and (4) to examine the potential mediating effects of changes in self-efficacy; diabetes knowledge, diabetes-related distress and social support on behavior change and metabolic outcomes. Should LIVE prove effective in improved self-management of diabetes, similar interventions could be applied to other prevalent chronic diseases. Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of DSMT/S.

描述（由申请人提供）：需要采取干预措施来帮助患者进行慢性病自我管理：消除医疗保健障碍；容纳有限的健康素养；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性健康行为干预措施。通信技术（例如Web 2.0）的进步是满足这些需求的一种手段。虚拟环境（VE）通过应用和反馈来促进社会互动和学习，从而导致出色的学习和技能转移。我们建议使用VE来测试理论上基于技术的，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（T2D）（Niddk，2009年）。已知代谢控制可以降低糖尿病的发病率和死亡率，但在美国患者中，它仍然是最主要的死亡原因，这是他们自身的大部分护理，使糖尿病自我管理（DSM）（例如饮食，运动，运动）可以控制。利用患者提供者互动的量身定制的DSM干预措施具有令人鼓舞的短期影响。但是，这种频繁的互动是无法实现且昂贵的。互联网干预措施有可能捕获患者提供者互动的动态，但迄今为止，与异步通信保持“平坦”。 VE是通过在沉浸式环境中进行互动，同步通信，知识应用和社交网络来捕获患者提供动态的潜在解决方案。我们R21（R21LM010727-01）的初步发现表明，具有T2D成人和医疗保健专业人员实时互动的虚拟糖尿病社区是可行的，并且有可能影响代谢控制和心理社会中介体。因此，我们提出了一项随机对照试验，以确定纳入实时糖尿病自我管理培训和支持的VE参与的影响是否与健康行为的积极变化有关。现场社区将由社区中心，健身房，杂货店和其他地点组成，每个社区都允许进行交互式知识应用。基于此设计，我们的主要目的是（1）与传统的DSMT/s相比，在12个月内，与传统的DSMT/S相比，T2D成年人提供DSMT/S对饮食和体育活动行为的变化的影响。我们的次要目标是：（2）确定对代谢结果的影响； （3）评估参与度和社交网络形成水平是否会影响行为结果； （4）检查自我效能感变化的潜在中介作用；糖尿病知识，与糖尿病有关的困扰以及对行为改变和代谢结果的社会支持。如果活着证明可以有效地改善糖尿病的自我管理，则可以将类似的干预措施应用于其他流行的慢性疾病。在易于传播的护理模型中，诸如现场直播的创新计划有可能改善医疗保健的访问，从而有可能改善DSMT/s的范围。