For adults with diabetes, regular self-care behaviors (i.e., diet, exercise, and medication adherence) prevent disease-related complications and premature death. However, patients with low socioeconomic status, low health literacy, and high levels of family stress are less likely to maintain self-care behaviors and more likely to have uncontrolled glycemia. Even in settings with equivalent access and care (e.g., federally qualified health centers-FQHCs), African American and Hispanic patients are less adherent to self-care behaviors and have worse glycemic control than Whites, suggesting behavioral barriers to self-care play a critical role. Family support may be an untapped resource with potential to reduce racial and socioeconomic disparities among adults with diabetes. Family support for diabetes self-care (e.g., reminding patients to take or refill medication, planning healthy meals, participating in exercise with the patient, problem-solving with the patient when barriers to self-care arise) increases the likelihood that patients perform regular self-care, and can improve clinical outcomes for patients with low income, low health literacy, and high stress. However, it remains unclear how family member behaviors influence patient self-care and clinical outcomes, and how race or comorbid depression might moderate the effects of family member behaviors on patients'self-care behaviors. To explore these issues, the principal investigator (PI) will partner with and extend an ongoing study of diabetes medication adherence in a low-income, racially diverse sample of patients with type 2 diabetes (T2DM). The proposed plan will prepare the PI for success as an independent investigator who can develop and implement effective family interventions for adults with diabetes in community health organizations. The PI's immediate goals are to (1) develop proficiency with advanced quantitative methods to explore complex relationships cross-sectionally and contribute to the knowledge base on family support for adults with diabetes, (2) combine quantitative and qualitative methods to understand differences in the role of family support based on race, and (3) gain experience partnering with a FQHC and working with providers to conduct clinically relevant research. Through the proposed training plan, the PI will become an established researcher in the area of family support for diabetes self-care, and will gain training in translating research findings to be implementable in community health care contexts. She will submit a K01 proposal to develop and pilot a family intervention in a FQHC based on findings from the proposed research strategy. To meet these goals, the PI has developed a training plan that integrates advanced didactic course work, participation in local and national research meetings/conferences, a mentored research experience (including data collection at a FQHC), and active involvement in an extremely supportive and innovative research environment (which includes an NIDDK- funded Diabetes Center for Translational Research, a Clinical and Translational Science Award, and a Community-Engaged Research Core).

Public Health Relevance

Engaging family members in self-care behaviors of adults with diabetes may reduce health disparities and decrease the likelihood of intergenerational patterns of obesity and diabetes-related behaviors. This F32 award will allow the PI to gain expertise in family support for diabetes self-care to advance the knowledge base, and develop and pilot a family intervention for adults with diabetes and low socioeconomic status.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZDK1-GRB-R (O1))
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Castle, Arthur
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Vanderbilt University Medical Center
Internal Medicine/Medicine
Schools of Medicine
United States
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Mayberry, Lindsay Satterwhite; Egede, Leonard E; Wagner, Julie A et al. (2015) Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support. J Behav Med 38:363-71
Osborn, Chandra Y; Mayberry, Lindsay Satterwhite; Wagner, Julie A et al. (2014) Stressors may compromise medication adherence among adults with diabetes and low socioeconomic status. West J Nurs Res 36:1091-110
Mayberry, Lindsay S; Rothman, Russell L; Osborn, Chandra Y (2014) Family members' obstructive behaviors appear to be more harmful among adults with type 2 diabetes and limited health literacy. J Health Commun 19 Suppl 2:132-43
Mayberry, Lindsay S; Osborn, Chandra Y (2014) Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention. Diabetes Care 37:1246-53
Mayberry, Lindsay Satterwhite; Osborn, Chandra Y (2014) Family involvement is helpful and harmful to patients' self-care and glycemic control. Patient Educ Couns 97:418-25
Osborn, Chandra Y; Mayberry, Lindsay Satterwhite; Wallston, Kenneth A et al. (2013) Understanding patient portal use: implications for medication management. J Med Internet Res 15:e133