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

• 批准号: 8112317
• 负责人: DEBORAH A. ELLIS
• 金额: $ 22.8万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-15 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8112317
• 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; secondary outcome; standard care; successful intervention; therapy development; three-arm study; treatment adherence

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，相当大比例的青少年及其家人没有遵循医生向他们提供的治疗慢性疾病的建议。患有 1 型糖尿病的青少年的疾病管理不善会导致代谢控制不佳，进而导致糖尿病并发症。尤其是非洲裔美国青少年，被发现在治疗依从性和代谢控制方面出现问题的风险明显更高。尽管有这些发现，但开发有效干预措施以改善少数族裔 1 型糖尿病青少年疾病管理的研究极其有限。很少有针对青少年的研究证明行为干预可以改善代谢控制。然而，促进父母参与糖尿病护理可能是一条更富有成果的途径。我们小组最近的研究表明，父母对青少年日常糖尿病护理的监督和监测是疾病管理和代谢控制的重要预测因素。目前还没有发表直接针对父母监测作为改善糖尿病青少年疾病管理手段的干预措施的临床试验。本研究的目的是开发并初步验证一种干预措施，以提高父母监督和监测青少年疾病管理行为的动机，该干预措施可以提供给开始过渡到青少年疾病的年轻、城市、高风险非裔美国青少年的父母。独立自理。将制定伴随干预措施，以提高年轻人改善糖尿病护理的积极性。拟议的干预措施简短（三个疗程），以机会为导向（在孩子定期安排诊所随访时向家长提出），基于动机访谈的原则，并通过经过验证的、引人入胜且简单的方式进行-使用基于计算机的方法。拟议的研究包括开发阶段（根据专家反馈制定干预措施，然后与家长进行可行性测试）和试点验证阶段（使用 90 名 10-13 岁非裔美国青少年的 1 型青少年父母样本进行试点临床试验）糖尿病）。将从一家为多元化人群提供服务的大型城市教学医院招募家庭。 RCT 的参与者将被随机分配到父母加青少年条件（均接受三个计算机提供的激励课程加上标准的多学科医疗护理）、仅父母条件（父母接受激励课程，青少年接受注意力控制加上标准护理）或注意力控制（父母和青少年接受注意力控制和标准护理）。如果成功，该干预措施有可能以相对较低的成本改善患有糖尿病的少数民族青少年的生活质量，并通过纳入糖尿病诊所的常规医疗预约来广泛覆盖这些青少年。 公共卫生相关性：过去二十年进行的疾病管理研究表明，相当大比例的青少年和家庭没有遵循医生向他们提供的治疗医疗状况的建议。许多研究已经证明父母参与对于促进最佳青少年糖尿病管理的重要性，但迄今为止还没有发表直接针对父母监测的干预措施的临床试验。如果成功，我们旨在改善家长监测的计算机提供的干预措施有可能以相对较低的成本改善患有糖尿病的少数族裔青少年的生活质量，并通过纳入糖尿病诊所的常规医疗预约来广泛覆盖这些青少年和家庭。