Older Adults Using Social Support to Improve Self-Care (OASIS): Adaption, Implementation, and Feasibility of Peer Support for Older Adults with T2DM in Appalachia

老年人利用社会支持改善自我保健 (OASIS)：阿巴拉契亚地区 T2DM 老年人同伴支持的适应、实施和可行性

• 批准号: 10637031
• 负责人: Aaron Kruse-Diehr
• 金额: $ 31.88万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637031
• 关键词: Address; Adult; Age; Appalachian Region; Behavior; Clinical; Clinical Trials; Communities; Community Health; Data; Diagnosis; Dimensions; Disease; Education; Effectiveness; Elderly; Emotional; Ensure; Environmental Risk Factor; Evidence based intervention; Familiarity; Feedback; Frequencies; General Population; Glycosylated hemoglobin A; Goals; Health; Individual; Intervention; Kentucky; Literature; Measures; Mission; Modeling; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Overutilization of Health Services; Participant; Practical Robust Implementation and Sustainability Model; Prevalence; Process; Psychosocial Factor; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Rural; Rural Appalachia; Rural Community; Self Care; Social support; Source; Structure; Testing; Vulnerable Populations; acceptability and feasibility; cost; design; diabetes self-management; glycemic control; implementation evaluation; implementation outcomes; implementation strategy; improved; intervention cost; mortality; peer; peer coaching; peer support; post intervention; primary outcome; psychosocial; response; rural dwellers; rural residence; service organization; skills; social; trustworthiness

PROJECT SUMMARY Approximately 34.1 million (13%) adults in the US have type 2 diabetes (T2D). The prevalence of T2D is 17% higher in rural dwellers compared to their urban counterparts, and the prevalence of T2D increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes, and variability in self-care accounts for 90% of the variance in glycemic control. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. This is particularly true in rural Kentucky, where up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are integral when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors; it provides emotional support, instrumental support, and education while also helping individuals develop new skills. Similarly, peer support has also been shown to improve clinical and psychosocial outcomes related to T2D; however, there is literature that also suggests self-selected social support can be obstructive when trying to engage in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used specifically to prioritize older adults, especially those living in rural communities. To address this gap in research, we have conducted formative research with regional practitioners, leaders of service organizations in Appalachia, and residents, and through that process, we collaboratively identified an acceptable and feasible peer support EBI— peer health coaching (PHC)—that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. Through these community conversations, we also determined necessary a priori adaptations to the EBI to ensure its cultural and contextual relevance to regional needs and values. Because PHC is a community-based and low-cost intervention, it holds promise to be a sustainable and scalable model across Appalachian Kentucky where resources are often scant, but community bonds are valued. Informed by literature and feedback from stakeholders, the goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. The main components of the factorial design will be how peer coaches are selected for participants (self-selected vs matched) and frequency of contact with coach (once per week vs every 2 weeks). To achieve this goal, we will (1) determine which EBI components are associated with improved T2D- related outcomes in older adults living in Appalachia Kentucky and (2) evaluate the pragmatic implementability of the adapted EBI.

项目概要 美国大约有 3410 万 (13%) 成年人患有 2 型糖尿病 (T2D)。T2D 的患病率为 17%。 与城市居民相比，农村居民的患病率更高，而且 T2D 的患病率随着年龄的增长而增加， 估计有 25% 的老年人（≥ 65 岁）被诊断为最佳自我护理。 总体而言，T2D 的临床结果和自我护理差异占血糖控制差异的 90%。 普通民众的自我保健能力一直较差，但农村居民和老年人的情况更糟。 在肯塔基州农村地区尤其如此，阿巴拉契亚社区多达 23% 的成年人都曾接受过 被诊断患有 T2D 的人中，26.8% 是老年人。 在促进 T2D 自我护理时，包括社会支持在内的环境因素是不可或缺的，特别是同伴。 支持已被证明可以有效改善 T2D 自我护理行为，它提供情感支持； 工具性支持和教育，同时也帮助个人发展新技能。同样，同伴支持也有帮助。 也被证明可以改善与 T2D 相关的临床和社会心理结果；然而，有文献表明； 还表明，在尝试从事健康活动时，自我选择的社会支持可能会产生阻碍。 目前可用的使用同伴支持的循证干预措施 (EBI) 尚未专门用于 优先考虑老年人，特别是那些生活在农村社区的老年人，为了解决这一研究空白，我们采取了一些措施。 与阿巴拉契亚地区的人道主义者、服务组织的领导人进行了形成性研究， 居民，通过这个过程，我们共同确定了一个可接受且可行的同伴支持 EBI—— 同伴健康辅导 (PHC)——改善了与 T2D 相关的临床和社会心理结果 不居住在农村社区且年龄≥65 岁的参与者。 通过对话，我们还确定了对 EBI 进行必要的先验调整，以确保其文化和背景 由于初级卫生保健是一种基于社区的低成本干预措施，因此它与区域需求和价值观相关。 承诺在资源匮乏的阿巴拉契亚肯塔基州建立一个可持续和可扩展的模型， 但社区纽带受到利益相关者的文献和反馈的重视，这是该组织的目标。 拟议的研究是使用 2x2 因子设计来测试适应的 PHC 组件并确定它们的 促进老年人自我护理行为和改善血糖控制的初步效果 在阿巴拉契亚肯塔基州，因子设计的主要组成部分是如何选择同伴教练。 参与者（自选 vs 匹配）以及与教练联系的频率（每周一次 vs 每 2 次） 为了实现这一目标，我们将 (1) 确定哪些 EBI 组件与改进的 T2D-相关。 居住在肯塔基州阿巴拉契亚的老年人的相关结果，以及（2）评估实用的可实施性 调整后的 EBI。