REACH-Es: Adapting a digital health tool to improve diabetes medication adherence among Latino adults

REACH-E：采用数字健康工具来提高拉丁裔成年人糖尿病药物的依从性

基本信息

批准号：
10641103
负责人：
Jacqueline Anne Seiglie
金额：
$ 19.65万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10641103
关键词：
Address Adherence Adult Behavior Therapy Biometry Clinical Clinical Trials Communication Complications of Diabetes Mellitus Conduct Clinical Trials Data Diabetes Mellitus Disparity Education Educational Materials Endocrinologist Epidemiology Evidence based intervention Feedback Focus Groups Glycosylated hemoglobin A Goals Health Technology High Prevalence Individual Insulin Intervention Interview Language Latin America Latino Latino Population Mentored Patient-Oriented Research Career Development Award Mentors Methods National Institute of Diabetes and Digestive and Kidney Diseases Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Outcome Participant Patient Self-Report Patients Perception Pharmaceutical Preparations Physicians Population Prevalence Randomized, Controlled Trials Reporting Research Research Personnel Research Training Self Care Self Efficacy Strategic Planning System Testing Text Messaging Therapeutic Time Training United States Work behavioral adherence career clinically relevant comparison control cost diabetes management diabetes self-management digital health disparity reduction effectiveness/implementation trial ethnic minority ethnic minority population health communication improved improved outcome innovation interest intervention refinement live text mHealth medication compliance medication nonadherence patient engagement patient oriented patient portal response retention rate secondary outcome social disparities standard of care therapy development tool two way texting usability

项目摘要

PROJECT SUMMARY Background: Latino adults have a disproportionate burden of type 2 diabetes and diabetes-related complications. Diabetes medication non-adherence is an important modifiable contributor to suboptimal glycemic management among Latino adults, who are nearly twice as likely to report non-adherence to diabetes medications as non-Hispanic White individuals. Besides language barriers, additional commonly reported barriers that contribute to non-adherence in this population include negative perceptions about insulin use and misunderstanding ongoing need for diabetes medications once HbA1c has improved. Mobile health (mHealth) technology can reduce medication adherence barriers and improve adherence behavior, but mHealth tools that address commonly reported barriers to diabetes medication adherence among Latino adults are lacking. Candidate: I am an endocrinologist born and raised in Latin America; my long-term career goal is to develop scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes. Training: I have received outstanding research training in epidemiology but to achieve my long-term career goal I require additional training in: 1) adaptation of evidence-based interventions, 2) mixed methods, and 3) conduct of clinical trials in mHealth. Mentors: My training and research plans will be overseen by Primary Mentor Dr. Deborah Wexler (type 2 diabetes clinical trials/intervention adaptation) and Co-Mentor Dr. Lindsay Mayberry (mixed methodologist/mHealth clinical trials). Drs. Margarita Alegria (behavioral intervention adaptation to a Latino population), Enrique Caballero (cultural tailoring of diabetes interventions to a Latino population), J. Jaime Miranda (mHealth intervention development/testing in Latino populations), and Tanayott Thaweethai (biostatistics) will provide additional focused expertise. Research: I will adapt REACH, a text message-based mHealth platform with content tailored to address self-reported barriers to diabetes medication adherence (developed by Dr. Mayberry), to a Latino population (REACH-Español) with type 2 diabetes through two specific aims. Aim 1: Adapt and develop REACH-Es content on barriers to diabetes medication adherence with engagement of a diverse group of stakeholders (n=8), qualitative input from Latino adults with type 2 diabetes (n=20-30), and beta testing for intervention refinement with stakeholder input. Aim 2: Conduct a pilot RCT (n=70) to assess feasibility, acceptability, and usability of REACH-Es, as well as intervention targets (diabetes medication adherence and barriers to adherence) comparing REACH-Es to control; secondary outcomes are HbA1c and diabetes self- efficacy. The project will generate preliminary data for an R01 hybrid-effectiveness implementation trial of REACH-Es. The completion of these training and scientific aims will facilitate my transition to becoming an independent physician-investigator focused on developing scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes.

项目概要背景：拉丁裔成年人患有 2 型糖尿病和糖尿病相关疾病的负担不成比例糖尿病药物不依从性是导致不理想的一个重要的可改变的因素。拉丁裔成年人的血糖管理，报告不遵守糖尿病的可能性几乎是拉丁裔成年人的两倍除了语言障碍之外，还经常报告其他问题。导致该人群不遵守胰岛素治疗的障碍包括对胰岛素使用的负面看法和一旦 HbA1c 改善，就会误解对糖尿病药物的持续需求。技术可以减少药物依从障碍并改善依从行为，但移动医疗工具缺乏解决拉丁裔成年人中常见的糖尿病药物依从性障碍。候选人：我是一名在拉丁美洲出生和长大的内分泌科医生；我的长期职业目标是发展；可扩展的、以患者为中心的干预措施，解决糖尿病自我护理方面的差距，以改善患者的预后患有 2 型糖尿病的拉丁裔成年人培训：我接受过出色的流行病学研究培训，但是。为了实现我的长期职业目标，我需要以下方面的额外培训：1）适应基于证据的干预措施，2) 混合方法，以及 3) 进行 mHealth 临床试验：我的培训和指导。研究计划将由主要导师 Deborah Wexler 博士（2 型糖尿病临床试验/干预适应）和联合导师 Lindsay Mayberry 博士（混合方法学家/移动健康临床 Margarita Alegria 博士（拉丁裔人群的行为干预适应），Enrique Caballero （针对拉丁裔人群的糖尿病干预措施的文化定制），J. Jaime Miranda（移动健康干预措施）拉丁裔人群的开发/测试），Tanayott Thaweethai（生物统计学）将提供额外的信息研究：我将采用 REACH，一个基于短信的移动医疗平台，包含内容。旨在解决自我报告的糖尿病药物依从性障碍（由 Mayberry 博士开发），患有 2 型糖尿病的拉丁裔人群 (REACH-Español) 通过两个具体目标实现：适应和发展。 REACH-E 内容涉及糖尿病药物依从性障碍，并吸引了不同群体的参与利益相关者 (n=8)、患有 2 型糖尿病的拉丁裔成人 (n=20-30) 的定性输入以及 β 测试根据利益相关者的意见完善干预措施目标 2：进行试点随机对照试验（n=70）以评估可行性， REACH-E 的可接受性和可用性，以及干预目标（糖尿病药物依从性和依从性障碍）比较 REACH-E 与对照；次要结果是 HbA1c 和糖尿病自我评估该项目将为 R01 混合有效性实施试验生成初步数据。 REACH-E 的完成这些培训和科学目标将有助于我过渡到成为一名独立医生研究员专注于开发可扩展的、以患者为中心的干预措施解决糖尿病自我护理方面的差距，以改善拉丁裔成人 2 型糖尿病患者的预后。