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）与考虑功能障碍和生活质量降低有关。 每天都在自我管理行为（例如体育锻炼，依从性）中持续参与， 需要监测血糖以维持日常功能，生活质量和葡萄糖控制。 但是，大多数退伍军人不符合每日自我管理目标，尤其是体育锻炼。这是 有问题，因为体育活动是T2D自我管理的基石，代表了基本 功能的组成部分。自我管理发生在患者自己的环境的背景下。那， 医疗访问中的评估可能会错过自我管理行为的大量变异性 以及影响自我管理的合并症状和社会背景因素的每日波动。 指导该建议的概念模型是基于临时自我调节理论的，并认为 因为T2D通常是渐近的，所以自我管理差的后果和一致的好处 当下的自我管理并不重要。对于具有T2D的退伍军人，合并症的症状，例如情绪， 痛苦和压力是自我管理的常见时间变化的瞬时障碍 影响身体活动。社会环境是与自我管理有关的另一组良好的因素 在患有T2D的人中。关于T2D自我管理的障碍和促进者的大多数研究是横断面的 并假设合并症的症状和上下文因素是静态的。当前的研究没有解决 这些合并症症状和社会背景因素影响体育锻炼的时变性质 以及个人内部的其他自我管理行为。那是当前建议的总体目的是 了解每天，时间变化的因素（合并症状，社会环境）与 退伍军人以及影响体育锻炼，T2D自我管理，日常功能和生活质量。 我们将注册95（5个测试参与者，分析样本90名）的退伍军人，并将使用 生态瞬时评估（EMA），一种实时数据收集的方法。参与者将获得5个 瞬时EMA调查和每天每天进行1次EMA调查，其中退伍军人将报告有关合并症 症状（情绪，压力，疼痛，PTSD），社会支持，社会互动，体育锻炼和其他自我 在14天的自然环境中，在其自然环境中随机进行管理行为 采样期。加速度测定法还将评估体育活动。使用这些数据，我们将解决4个目标：目标 1）使用EMA检查每日合并症状之间的人体内变化关系（抑郁症 情绪，压力，疼痛，PTSD）以及当今进行体育活动的时间；目标2）使用EMA检查 人内社会背景因素（社会支持，社交互动）和每天花费的时间进行身体 活动;探索性目的1）探索其他人内随时间变化的因素，社会的关系 上下文因素，人群之间的人群和T2D特定特征以及T2D自我管理 可能影响日常运作和生活质量的行为；和探索目标2）利用密集型 纵向数据，使用网络分析探索研究变量之间的临时关系。 该CDA的成功完成将为申请人提供必要的培训和数据 追求VA的优点，以进一步研究T2D自我的现实障碍和促进者的复杂性 管理。当前研究的结果将有助于开发评估工具和临床 干预措施。根据本研究开发的评估工具可以为临床决策提供信息 考虑到医疗任命之外发生的自我管理的障碍。临床 应用程序包括量身定制的自适应技术支持的干预措施，可提供合适的类型和 在适当的时候，通过适应个人的内部和上下文状态，支持数量。