Tailored Approaches to Reduce Distress and Improve Self-Management for Veterans with Diabetes (TARDIS)

为患有糖尿病的退伍军人减轻痛苦并改善自我管理的定制方法 (TARDIS)

• 批准号: 10884151
• 负责人: Allison Lewinski
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10884151
• 关键词: Active Learning; Address; Administrator; Adult; Area; Attitude; Behavior; Caring; Case Study; Chronic Disease; Communities; Community Services; Complex; Complications of Diabetes Mellitus; Coping Skills; Data; Depth Perception; Development; Diabetes Mellitus; Diagnosis; Distress; Doctor of Philosophy; Education; Emotional; Enrollment; Ensure; Environmental Risk Factor; Equilibrium; Feeling; Frequencies; Gender; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Health; Health Personnel; Health Status; Healthcare; Individual; Information Management; Insulin; Intervention; Interview; Learning; Mental Depression; Mentors; Methodology; Methods; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Outcome; Patient Care; Pharmaceutical Preparations; Phase; Physicians; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Provider; Psychosocial Factor; Qualitative Methods; Race; Recommendation; Regimen; Research Priority; Resources; Sampling; Scientist; Self Management; Services; Social support; Strategic Planning; Stress; Structure; Support Groups; Surveys; Testing; Training; Unhealthy Diet; Veterans; acceptability and feasibility; arm; care delivery; career; cost; design; diabetes control; diabetes distress; diabetes self-management; diet and exercise; efficacy trial; experience; glycemic control; improved; innovation; intervention refinement; learning strategy; medical specialties; novel; personalized approach; pilot test; population health; preference; primary care practice; psychosocial; service intervention; service providers; sex; skills; skills training; sociodemographics; whole health

Background: Diabetes self-management is critical to sustaining optimal health following diagnosis. Diabetes distress (DD) is a crucial factor that influences a Veteran’s engagement in diabetes self- management. DD is distinct from depression, and includes four domains (i.e., regimen, emotional, interpersonal, healthcare provider). The presence of DD negatively impacts engagement in self-management and HbA1c. Despite interventions aimed at decreasing DD, these interventions have shown minimal lasting effects. One reason may be because interventions do not tailor information to an individual’s DD. Significance/Impact: This proposal will be the first to examine the impact of correlating factors on DD, and then design and test a self-management intervention tailored upon a Veteran’s DD type. This proposal addresses the [VHA Strategic Plan Priority areas of utilizing resources more efficiently and improving the timeliness of services, and the HSR&D Research Priorities of Population Health/Whole Health and Primary Care Practice. This proposal’s findings can improve both care delivery and health outcomes of Veterans, as we will help facilitate the Veteran’s linkage to ubiquitous, existing VHA and community services]. Innovation: This proposal will develop an intervention that targets sub-optimal T2D self-management by providing tailored self-management information in conjunction with connections to supportive services. We will identify how, and to what extent, DD and its factors, influence a Veteran’s self-management behaviors. Specific Aims: Aim 1 will examine the association of [psychosocial factors (depression, PTSD), environmental factors (finances, support), self-management behaviors, and HbA1c with DD. These Aim 1 data will inform the identification of modifiable factors and selection of the population] for a diabetes self- management intervention for Veterans with T2D. Aim 2 will describe self-management challenges and preferred learning strategies [to inform the intervention components and delivery approach for Veterans with T2D. Obtaining in-depth perceptions of DD type, self-management strategies and challenges, and learning preferences is essential to tailoring intervention components]. The purpose of Aim 3 is to design & pilot test an innovative, tailored T2D self-management information and supportive services intervention for Veterans with T2D, to promote engagement in self-management behaviors. In Aim 3 we will determine the feasibility and acceptability of the intervention for Veterans with T2D. Methodology: This proposal uses an explanatory, sequential mixed-methods design to describe DD in a sample of Veterans who receive care at Durham. In Aim 1 we will survey Veterans (n = 200), and balance enrollment by HbA1C (< 9 or ≥ 9) and medication use (insulin, no insulin). In Aim 2 we will conduct semi- structured interviews with a sub-sample (n = ~36) of Veterans surveyed in Aim 1. We will balance enrollment by HbA1C, medication use, and DD level as operationalized by the Diabetes Distress Scale (low, moderate, high). In Aim 3 we will develop and refine the intervention using findings from Aims 1 & 2 and strategies successfully used by co-mentors. To develop the intervention we will conduct semi-structured interviews with stakeholders (n = ~20: physicians, nurses, administrators) to review components (e.g., learning approaches, relevant VA/community resources) to ensure relevancy. We will modify components and the delivery strategy as needed. Then, we will test the intervention with 30 Veterans to evaluate [feasibility and acceptability], and utilization of recommended supportive services, using quantitative and qualitative approaches. Implementation/Next Steps: The next steps include dissemination of findings about DD, and its correlates, and the development of an IIR. This IIR will be a Phase III efficacy trial and will be sufficiently powered to test the effects of providing self-management information and connections to supportive services tailored to a Veteran’s DD to improve HbA1c.

背景：糖尿病自我管理对于诊断后维持最佳健康至关重要。 糖尿病困扰（DD）是影响退伍军人参与糖尿病自我治疗的关键因素 DD 管理与抑郁症不同，包括四个领域（即养生、情绪、 DD 的存在会对自我管理的参与产生负面影响。 尽管干预措施旨在减少 DD，但这些干预措施的持久性甚微。 原因之一可能是干预措施并未根据个人的 DD 调整信息。 意义/影响：该提案将是第一个检查相关因素对 DD 的影响的提案， 然后根据退伍军人的 DD 类型设计并测试自我管理干预措施。 解决了 [VHA 战略计划的优先领域，即更有效地利用资源和改善 服务的及时性以及 HSR&D 人口健康/整体健康和初级研究的优先事项 护理实践。正如我们所言，该提案的研究结果可以改善退伍军人的护理服务和健康结果。 [将有助于促进退伍军人与无处不在的现有 VHA 和社区服务的联系]。 创新：该提案将开发一种针对次优 T2D 自我管理的干预措施 我们将提供量身定制的自我管理信息以及支持服务。 确定 DD 及其因素如何以及在多大程度上影响退伍军人的自我管理行为。 具体目标：目标 1 将检查[心理社会因素（抑郁、创伤后应激障碍）、 环境因素（财务、支持）、自我管理行为和 HbA1c 以及 DD 这些数据。 将告知可改变因素的识别和人群的选择]对于糖尿病的自我治疗 针对患有 T2D 的退伍军人的管理干预目标 2 将描述自我管理挑战和 首选学习策略[为退伍军人提供干预措施和实施方法 T2D。深入了解 DD 类型、自我管理策略和挑战以及学习。 偏好对于定制干预组件至关重要] 目标 3 的目的是设计和试点测试 为退伍军人提供创新、定制的 T2D 自我管理信息和支持服务干预 T2D，促进自我管理行为的参与，在目标 3 中，我们将确定可行性和有效性。 患有 T2D 的退伍军人的干预措施的可接受性。 方法论：该提案使用解释性、顺序混合方法设计来描述 DD 在目标 1 中，我们将对在达勒姆接受护理的退伍军人进行调查（n = 200），并进行平衡。 根据 HbA1C（< 9 或 ≥ 9）和药物使用（胰岛素、无胰岛素）进行登记。在目标 2 中，我们将进行半研究。 对目标 1 中接受调查的退伍军人子样本（n = ~36）进行结构化访谈。我们将平衡入学情况 通过 HbA1C、药物使用和糖尿病应激量表（低、中、 在目标 3 中，我们将利用目标 1 和 2 的发现以及策略来制定和完善干预措施 为了制定干预措施，我们将与共同导师进行半结构化访谈。 利益相关者（n = ~20：医生、护士、管理人员）审查组成部分（例如，学习方法、 相关的 VA/社区资源）以确保相关性。我们将修改组件和交付策略。 然后，我们将根据需要对 30 名退伍军人进行干预测试，以评估[可行性和可接受性]，以及 使用定量和定性方法利用推荐的支持服务。 实施/后续步骤：后续步骤包括传播有关 DD 的调查结果及其 相关性，并且 IIR 的开发将是一项 III 期疗效试验，并且将是充分的。 有能力测试提供自我管理信息和支持服务连接的效果 专为退伍军人 DD 量身定制，以改善 HbA1c。

项目成果

Patient experiences with a phone-based cardiovascular risk reduction intervention: Are there differences between women and men?

基于电话的心血管风险降低干预措施的患者体验：女性和男性之间有差异吗？

• 发表时间: 2021
• 影响因子: 3.5
• 作者: Goldstein, K M;Zullig, L L;Andrews, S M;Sperber, N;Lewinski, A A;Voils, C I;Oddone, E Z;Bosworth, H B
• 通讯作者: Bosworth, H B

Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.

退伍军人对糖尿病自我管理中糖尿病困扰的解释：认知访谈的发现。

• 发表时间: 2021
• 作者: Lewinski, Allison A;Shapiro, Abigail;Bosworth, Hayden B;Crowley, Matthew J;McCant, Felicia;Howard, Teresa;Jeffreys, Amy S;McConnell, Eleanor;Tanabe, Paula;Barcinas, Susan;Coffman, Cynthia J;King, Heather A
• 通讯作者: King, Heather A