Real-World Assessment of Daily Functioning in Veterans with Type 2 Diabetes

患有 2 型糖尿病的退伍军人日常功能的真实世界评估

• 批准号: 10589806
• 负责人: Jennalee S Wooldridge
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589806
• 关键词: Accelerometer; Accounting; Assessment tool; Attenuated; Behavior; Behavioral Medicine; Blood Glucose; Caring; Characteristics; Clinical; Clinical Trials; Data; Data Collection; Depressed mood; Development; Diabetes Mellitus; Ecological momentary assessment; Enrollment; Environment; Foundations; Future; Goals; Health Care Visit; Impairment; Individual; Informal Social Control; Intervention; Life; Measures; Medical; Mentors; Methods; Modeling; Monitor; Moods; Nature; Non-Insulin-Dependent Diabetes Mellitus; Pain; Participant; Pathway Analysis; Patients; Persons; Physical activity; Physical assessment; Post-Traumatic Stress Disorders; Quality of life; Recommendation; Reporting; Research; Research Personnel; Risk; Sampling; Self Management; Social Environment; Social Functioning; Social Interaction; Social support; Source; Statistical Data Interpretation; Stress; Surveys; Symptoms; Technology; Testing; Time; Training; Veterans; Visit; acceptability and feasibility; associated symptom; blood glucose regulation; career; clinical application; clinical decision-making; contextual factors; cost; daily functioning; design; diabetes self-management; functional disability; improved; innovation; mHealth; medical appointment; medication compliance; psychologic; recruit; theories

Type 2 diabetes (T2D) is associated with considerable functional impairment and reduced quality of life. Consistent daily engagement in self-management behaviors, such as physical activity, medication adherence, and monitoring blood glucose is required to maintain daily functioning, quality of life, and glucose control. However, most Veterans do not meet daily self-management targets, particularly physical activity. This is problematic as physical activity is a cornerstone of T2D self-management and represents a fundamental component of functioning. Self-management occurs in the context of patients’ own environments. Thus, assessments at healthcare visits likely miss significant amounts of variability in self-management behaviors as well as daily fluctuations in comorbid symptoms and social contextual factors that influence self-management. The conceptual model guiding the proposal is based on temporal self-regulation theory and posits that because T2D is generally asymptomatic, consequences of poor self-management and benefits of consistent self-management are not salient in the moment. For Veterans with T2D, comorbid symptoms such as mood, pain, and stress are common time-varying momentary barriers to self-management that may particularly impact physical activity. Social context is another well-established set of factors related to self-management among people with T2D. Most research on barriers and facilitators of T2D self-management is cross-sectional and assumes comorbid symptoms and contextual factors are static. Current research does not address the time-varying nature in which these comorbid symptoms and social contextual factors impact physical activity and other self-management behaviors within individuals. Thus, the overarching aim of the current proposal is to understand daily, time-varying factors (comorbid symptoms, social context) that are particularly relevant to Veterans and that influence physical activity, T2D self-management, daily functioning, and quality of life. We will enroll 95 (5 test participants and 90 for the analytic sample) Veterans with T2D and will use ecological momentary assessment (EMA), a method of real-time data collection. Participants will receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which Veterans will report on comorbid symptoms (mood, stress, pain, PTSD), social support, social interactions, physical activity and other self- management behaviors, randomly, during pre-programmed intervals in their natural environment over a 14-day sampling period. Accelerometry will also assess physical activity. With these data, we will address 4 aims: Aim 1) Use EMA to examine within-person time-varying relationships among daily comorbid symptoms (depressed mood, stress, pain, PTSD) and within-day time spent doing physical activities; Aim 2) Use EMA to examine within-person social contextual factors (social support, social interactions) and daily time spent doing physical activities; Exploratory Aim 1) Explore relationships among other within-person time-varying factors, social contextual factors, between-person demographic and T2D specific characteristics, and T2D self-management behaviors that may impact daily functioning and quality of life; and Exploratory Aim 2) Leverage intensive longitudinal data to explore temporal relationships among study variables using network analysis. The successful completion of this CDA will provide the applicant with the necessary training and data to pursue a VA Merit to further examine the complexity of real-world barriers and facilitators of T2D self- management. Results from the current study will help to develop both assessment tools and clinical interventions. Assessment tools developed from the present study can inform clinical decision making that takes into account barriers to self-management that occur outside of medical appointments. Clinical applications include tailored, adaptive technology-supported interventions that provide the right type and amount of support, at the right time by adapting to an individual’s changing internal and contextual state.

2 型糖尿病 (T2D) 与严重的功能障碍和生活质量下降有关。 每天坚持自我管理行为，例如体力活动、坚持用药、 需要监测血糖来维持日常功能、生活质量和血糖控制。 然而，大多数退伍军人没有达到日常自我管理目标，特别是体力活动。 这是有问题的，因为体力活动是 T2D 自我管理的基石，代表了一个基本的 自我管理的组成部分发生在患者自己的环境中。 医疗保健就诊时的评估可能会遗漏自我管理行为的大量变化，因为 以及影响自我管理的共病症状和社会背景因素的日常波动。 指导该提案的概念模型基于时间自我调节理论和立场： 因为 T2D 通常是无症状的，自我管理不良的后果和一致的益处 对于患有 T2D 的退伍军人来说，自我管理目前并不重要，共病症状如情绪、 疼痛和压力是自我管理常见的随时间变化的暂时障碍，尤其可能 影响身体活动的因素是另一组与自我管理相关的成熟因素。 大多数关于 T2D 自我管理的障碍和促进因素的研究都是横向的。 并假设共病症状和背景因素是静态的。 这些共病症状和社会背景因素影响身体活动的时间变化性质 以及个人内部的其他自我管理行为。因此，当前提案的总体目标是 了解与以下情况特别相关的日常、随时间变化的因素（共病症状、社会背景） 退伍军人以及影响身体活动、T2D 自我管理、日常功能和生活质量的因素。 我们将招募 95 名患有 T2D 的退伍军人（5 名测试参与者和 90 名分析样本），并将使用 生态瞬时评估（EMA），一种实时数据收集方法，参与者将收到 5 个。 临时 EMA 调查和每天 1 次每日 EMA 调查，其中退伍军人将报告合并症 症状（情绪、压力、疼痛、创伤后应激障碍）、社会支持、社交互动、体力活动和其他自我 在 14 天的自然环境中，在预先设定的时间间隔内随机管理行为 加速度测量还将评估身体活动，利用这些数据，我们将实现 4 个目标： 1) 使用 EMA 来检查日常共病症状（抑郁症）之间的人内随时间变化的关系 目标 2) 使用 EMA 进行检查； 人体内的社会背景因素（社会支持、社交互动）和每天花在体育上的时间 活动；探索性目标 1) 探索其他人体内随时间变化的因素、社会因素之间的关系 背景因素、人与人之间的人口统计和 T2D 特定特征以及 T2D 自我管理 可能影响日常功能和生活质量的行为；以及探索性目标 2) 杠杆强化 使用网络分析探索研究变量之间的时间关系的纵向数据。 成功完成此 CDA 将为申请人提供必要的培训和数据 追求 VA 优点，以进一步研究现实世界中 T2D 自我障碍和促进因素的复杂性 当前研究的结果将有助于开发评估工具和临床。 本研究开发的评估工具可以为临床决策提供信息。 考虑到临床预约之外发生的自我管理障碍。 应用程序包括量身定制的、适应性技术支持的干预措施，提供正确的类型和 通过适应个人不断变化的内部和情境状态，在适当的时间提供一定程度的支持。