Computer Motivational Interventions to Improve Diabetes Care in Minority Youth

计算机激励干预措施改善少数民族青少年的糖尿病护理

基本信息

批准号：
8255441
负责人：
DEBORAH A. ELLIS
金额：
$ 19万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-04-15 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8255441
关键词：
Adherence Adolescence Adolescent Adopted Affect African American Attention Behavior Behavior Therapy Caring Child Chronic Client Clinic Clinic Visits Clinical Trials Companions Complications of Diabetes Mellitus Computers Development Diabetes Mellitus Family Feedback Insulin-Dependent Diabetes Mellitus Intervention Literature Low income Medical Metabolic Metabolic Control Methodology Minority Monitor Motivation Parents Participant Pattern Persons Phase Physicians Pilot Projects Population Population Heterogeneity Positioning Attribute Provider Publishing Quality of life Randomized Randomized Clinical Trials Recommendation Recording of previous events Recruitment Activity Regimen Research Sampling Schedule Self Care Self Efficacy Self Management Single Parent Supervision Teaching Hospitals Testing Time Training United States Validation Visit Work Youth aged arm base clinical practice cost diabetes management effective intervention experience follow-up high risk improved independent self care intervention effect medical appointment motivational enhancement therapy motivational intervention multidisciplinary parental involvement parental monitoring primary outcome public health relevance secondary outcome standard care successful intervention therapy development three-arm study treatment adherence

项目摘要

DESCRIPTION (provided by applicant): Studies of illness management conducted over the past twenty years suggest that substantial percentages of adolescents and their families do not follow recommendations given to them by physicians for the treatment of chronic medical conditions. Poor illness management in youth with type 1 diabetes leads to poor metabolic control, which in turn leads to diabetes complications. African-American adolescents in particular have been found to be at significantly higher risk for problems with treatment adherence and metabolic control. Despite such findings, research to develop effective interventions to improve illness management among minority adolescents with type 1 diabetes is extremely limited. Few studies targeting adolescents have demonstrated that behavioral interventions can improve metabolic control. However, facilitating parental involvement in diabetes care may be a more fruitful path. Recent research by our group has shown that parental supervision and monitoring of adolescents' daily diabetes care is a significant predictor of illness management and metabolic control. There have been no published clinical trials of interventions that have directly targeted parental monitoring as a means of improving illness management in adolescents with diabetes. The purpose of the present study is to develop and preliminarily validate an intervention to increase parental motivation for supervision and monitoring of youth illness management behaviors that can be provided to parents of young, urban, high-risk African American adolescents who are beginning to transition to independent self-care. A companion intervention will be developed to increase youth motivation for improving diabetes care. The proposed intervention is brief (three sessions), opportunity-driven (presented to parents at the time of their child's regularly scheduled clinic follow-up visits), based on the principles of Motivational Interviewing, and delivered via a proven, engaging, and easy-to-use computer-based approach. The proposed study includes a development phase (development of the intervention with expert feedback, followed by feasibility testing with parents) and a pilot validation phase (pilot clinical trial using a sample of 90 parents of young African American adolescents aged 10-13 with type 1 diabetes). Families will be recruited from a large, urban teaching hospital that serves a diverse population. Participants in the RCT will be randomly assigned to parent plus youth condition (both receive three computer-delivered motivational sessions plus standard multidisciplinary medical care) parent only condition (parent receives motivational session and youth receives attention control plus standard care) or an attention control (parent and youth receive attention control plus standard care). If successful, the intervention has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth through integration into routine medical appointments in diabetes clinics. PUBLIC HEALTH RELEVANCE: Studies of illness management conducted over the past twenty years suggest that substantial percentages of youth and families do not follow recommendations given to them by physicians for the treatment of medical conditions. Many studies have demonstrated the importance of parental involvement for promoting optimal adolescent diabetes management, but to date there have been no published clinical trials of interventions that directly targeted parental monitoring. If successful, our computer-delivered intervention aimed at improving parental monitoring has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth and families through integration into routine medical appointments in diabetes clinics.

描述（由申请人提供）：过去二十年进行的疾病管理研究表明，很大一部分青少年及其家人没有遵循医生给他们的建议治疗慢性医疗状况的建议。 1型糖尿病青年的疾病管理不良导致代谢控制不佳，进而导致糖尿病并发症。特别是发现非裔美国人青少年的治疗依从性和代谢控制问题的风险明显更高。尽管有这样的发现，但针对1型糖尿病少数族裔青少年的疾病管理进行有效干预措施的研究极为有限。很少有针对青少年的研究表明，行为干预措施可以改善代谢控制。但是，促进父母参与糖尿病护理可能是一条更富有成果的道路。我们小组的最新研究表明，父母的监督和监测青少年的日常糖尿病护理是疾病管理和代谢控制的重要预测指标。尚无对直接针对父母监测作为改善糖尿病青少年疾病管理的手段的干预措施的临床试验。本研究的目的是开发和初步验证一种干预措施，以增加父母的监督和监测青年疾病管理行为的动机，这些行为可以向年轻，城市，高风险的非裔美国青少年的父母提供，他们开始过渡到独立的自我保健。将制定一项伴侣干预措施，以增加青年人的改善糖尿病护理的动力。拟议的干预措施是简短的（三个课程），是机会驱动的（在孩子定期安排的诊所后续访问时向父母提交给父母），基于动机访谈的原则，并通过一种可靠的，引人入胜且易于使用的计算机基于计算机的方法进行交付。拟议的研究包括一个开发阶段（通过专家反馈的干预措施开发，然后与父母进行可行性测试）和试点验证阶段（使用90名年轻非裔美国人青少年的父母为10-13岁的13岁型糖尿病的年轻非裔美国青少年的样本）。家庭将从一家为多样化人口的大型城市教学医院招募。 RCT的参与者将随机分配给父母加上青年状况（两者都会接受计算机交付的动机会议以及标准的多学科医疗保健），只有父母的状况（父母接受动机会议，而青年会接受注意力控制和注意力控制）或注意力控制（父母和青年人都会接受注意力控制）（父母和青少年获得注意力控制和标准护理）。如果成功的话，干预措施有可能以相对较低的成本来改善糖尿病少数族裔青少年的生活质量，并通过将常规的糖尿病诊所的医疗任命融入到糖尿病诊所的医疗任命中。公共卫生相关性：过去二十年进行的对疾病管理的研究表明，很大一部分青年和家庭不遵循医生对医疗状况治疗的建议。许多研究表明，父母参与对于促进最佳青少年糖尿病管理的重要性，但迄今为止，还没有针对直接针对父母监测的干预措施的公开临床试验。如果成功的话，我们旨在改善父母监测的计算机交付干预措施将有可能以相对较低的成本来改善患有糖尿病的少数族裔青少年的生活质量，并通过在糖尿病诊所的常规医疗预约中融入此类青年和家庭。