The Impact of Reflective Motivation on the Effect of a Shared Decision Making Intervention for Diabetes Prevention

反思动机对糖尿病预防共同决策干预效果的影响

• 批准号: 10826790
• 负责人: OBIDIUGWU KENRIK, DURU
• 金额: $ 19.3万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10826790
• 关键词: Address; Adherence; Administrative Supplement; Adopted; Adoption; Affect; Area; Behavior; Behavioral; Belief; Body Weight decreased; Caring; Control Locus; Data; Decision Aid; Decision Making; Diabetes Mellitus; Diabetes prevention; Eating; Effectiveness; Effectiveness of Interventions; Enrollment; Equipoise; Face; Gestational Diabetes; Glycosylated hemoglobin A; Health; Health Benefit; Health system; Healthcare; High Risk Woman; Incidence; Individual; Infrastructure; Intervention; Knowledge; Life Style; Maintenance; Mediation; Mediator; Metformin; Modeling; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Parents; Participant; Patient Preferences; Patients; Pattern; Pharmaceutical Preparations; Physical activity; Population; Prediabetes syndrome; Prevention strategy; Process; Recording of previous events; Risk; Risk Factors; Self Efficacy; Testing; Therapeutic Equivalency; Time; Woman; Work; behavior change; compare effectiveness; diabetes prevention program; evidence base; experience; follow-up; high risk; improved; improved outcome; lifestyle intervention; lifetime risk; multidisciplinary; personalized decision; preference; prevent; preventive intervention; primary outcome; programs; risk perception; secondary outcome; shared decision making; tool; treatment arm; treatment as usual; uptake; willingness

PROJECT SUMMARY/ABSTRACT Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes (T2DM). Evidence from the Diabetes Prevention Program (DPP) indicates that lifestyle change and metformin use in this population are clinically equivalent, each reducing the incidence of T2DM by approximately 50%; women with a GDM history thus face a preference-sensitive decision between these evidence-based alternatives. Shared decision making (SDM) is an attractive approach for addressing the patients’ choice between two alternatives, using a decision aid to make the decision explicit, describe the available options with equipoise, elicit patient preferences, and helping patients make an informed decision that is right for them. To our knowledge, there are no existing studies evaluating SDM for diabetes prevention among women with a history of GDM. Moreover, understading mechanisms of action of such an intervention will contribute to our understanding of the “how, why and for whom” this intervention is effective, in turn improving our ability to harness behavior change strategies to improve outcomes for women at high risk for T2DM, and increasing knowledge of how to aid behavior adoption and maintenance during and after similar diabetes prevention interventions. Our team has extensive experience with a team-based SDM approach for diabetes prevention, and our prior work showed that this approach leads to increased uptake of an evidence-based diabetes prevention strategy and sustained weight loss at 12-month follow-up in a broader population with prediabetes. In this administrative supplement, we aim to use new and existing data collected in the parent R01 to evaluate components of reflective motivation, based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model of behavior, as mediators and moderators of the SDM intervention for diabetes prevention among women with a history of GDM within two health systems (UCLA and Intermountain). Our Specific Aims are as follows: To test components of reflective motivation (perceived risk, perceived control [locus of control + self-efficacy]) as modifiers of the effectiveness of an SDM intervention for diabetes prevention on primary (weight loss at 12 months) and secondary (physical activity, eating patterns, treatment engagement) outcomes among overweight/obese women with a GDM history and hemoglobin A1c between 5.7-6.4% enrolled in the parent RCT; and To test components of reflective motivation (patient activation) as mediators of the effectiveness of an SDM intervention for diabetes prevention on primary and secondary outcomes among women enrolled in the parent RCT. Our application presents a unique opportunity to study mechanisms of a robust behavior change intervention in an existing rigorous project addressing a critical area of unmet need in diabetes prevention for women with history of GDM, leveraging our health system infrastructure and our collaborative, multidisciplinary team with a strong record of accomplishment in diabetes prevention.

项目概要/摘要 有妊娠糖尿病 (GDM) 病史的女性患 2 型糖尿病的风险很高 (T2DM) 糖尿病预防计划 (DPP) 的证据表明生活方式的改变和二甲双胍 在该人群中使用的药物在临床上是等效的，每种药物都可将 T2DM 的发病率降低约 50%； 因此，有 GDM 病史的女性面临着在这些基于证据的选择之间做出偏好敏感的决定。 共享决策（SDM）是解决患者选择问题的一种有吸引力的方法。 在两种选择之间，使用决策辅助工具使决策明确，描述可用的选项 平衡，了解患者的偏好，并帮助患者做出适合他们的明智决定。 据我们所知，目前尚无研究评估 SDM 在患有糖尿病的女性中预防糖尿病的作用 此外，了解这种干预的作用机制将有助于我们的研究。 了解这种干预“如何、为何以及对谁”有效，从而提高我们的能力 利用行为改变策略来改善 T2DM 高危女性的治疗结果，并增加 了解如何在类似的糖尿病预防期间和之后帮助采取和维持行为 干预措施。 我们的团队在基于团队的 SDM 方法预防糖尿病方面拥有丰富的经验，并且我们之前 研究表明，这种方法可以提高循证糖尿病预防策略的采用率 在本次管理中，在更广泛的糖尿病前期人群中，12 个月的随访中体重持续下降。 补充，我们的目标是使用在父 R01 中收集的新数据和现有数据来评估 反思性动机，基于能力、机会、动机和行为 (COM-B) 模型 行为作为 SDM 干预措施的中介者和调节者，以预防女性糖尿病 两个卫生系统（UCLA 和 Intermountain）中 GDM 的历史 我们的具体目标如下： 进行测试。 反思动机的组成部分（感知风险、感知控制[控制点+自我效能]）为 SDM 干预对初级糖尿病预防（12 岁时体重减轻）有效性的修正 月）和次要（体力活动、饮食模式、治疗参与）结果 有 GDM 病史且父母血红蛋白 A1c 介于 5.7-6.4% 之间的超重/肥胖女性 随机对照试验；以及测试反思动机（患者激活）的组成部分作为有效性的中介 针对糖尿病预防的 SDM 干预措施对注册妇女的主要和次要结果的影响 我们的应用程序提供了研究稳健行为机制的独特机会。 对现有严格项目进行变革干预，解决糖尿病未满足需求的关键领域 利用我们的卫生系统基础设施和我们的协作、 多学科团队在糖尿病预防方面取得了良好的成就。