For patients with diabetes, glucose lowering agents (GLA) improve glycemic control (HbA1c), and prevent disease-related complications, and premature death. Patient adherence to prescribed regimens is necessary to reap these benefits, and studies suggest adherence is poor, ranging from 36% to 85% adherence to oral GLAs;however, fewer patients using insulin report poor adherence. Existing technologies (e.g., cell phones, Internet reminders, patient web portals) could be leveraged to provide medication adherence reminders and support to patients with diabetes and, in turn, improve clinical outcomes. This proposal describes a career development plan that will prepare the principal investigator (PI) for success as an independent investigator who can leverage various technologies to design and evaluate diabetes self-care interventions. The proposal describes a research strategy in which the PI will use Vanderbilt's patient web portal (PWP) to deliver a theory-based GLA adherence promotion intervention. As a social/health psychologist with training in health behavior change, the PI will acquire complementary, new skills for developing and using technology through this K01. The PI's immediate goal is to use a PWP to deliver an Information-Motivation-Behavioral skills (IMB) focused GLA adherence intervention to patients with diabetes. To meet this goal, the PI has proposed a career development plan that integrates advanced didactic course work, participation in local and national meetings/seminars/workshops/conferences, a mentored research experience, and active involvement in an extremely supportive research environment. This environment includes an NIDDK funded Diabetes Research and Training Center (DRTC), nationally known Department of Biomedical Informatics, state-of-the-art patient PWP, NIH funded CTSA, Center for Health Services Research (CHSR), and Program on Effective Health Communication (EHC). The research specific aims are to: (1) conduct elicitation research with diabetes patients and providers to identify barriers to using a PWP and other technologies for diabetes and medication management;(2) design a GLA adherence intervention delivered via an existing PWP, test for usability with diabetes patients, and refine the intervention prior to evaluation;and (3) perform a randomized controlled trial to test the effect of the intervention on multiple measures of adherence and HbA1c at 3- and 6-months. In addition, the PI will test whether the intervention enhances critical determinants of adherence behavior based on the IMB model, and whether changes in IMB elements map onto improvements in adherence and HbA1c across time. Lastly, the PI will test potential moderators of the effect of the IMB elements on adherence. Leveraging technology in the proposed research will augment the PI's existing training in the design and evaluation of behavior change interventions. Most importantly, it will accelerate her career as a successful independent investigator well equipped to design and evaluate cutting-edge, theoretically grounded interventions with broad application to both the field of diabetes behavioral research and clinical care.
Behavioral informatics shows great promise in our current and future clinical and research climate. This K01 award will allow the PI to gain expertise in using technology to design, deliver and evaluate feasible and sustainable diabetes behavioral interventions.
|Nelson, Lyndsay A; Mulvaney, Shelagh A; Johnson, Kevin B et al. (2017) mHealth Intervention Elements and User Characteristics Determine Utility: A Mixed-Methods Analysis. Diabetes Technol Ther 19:9-17|
|Mayberry, Lindsay S; Mulvaney, Shelagh A; Johnson, Kevin B et al. (2017) The MEssaging for Diabetes Intervention Reduced Barriers to Medication Adherence Among Low-Income, Diverse Adults With Type 2. J Diabetes Sci Technol 11:92-99|
|Osborn, Chandra Y; Kripalani, Sunil; Goggins, Kathryn M et al. (2017) Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients. J Health Care Poor Underserved 28:499-513|
|Nelson, Lyndsay A; Coston, Taylor D; Cherrington, Andrea L et al. (2016) Patterns of User Engagement with Mobile- and Web-Delivered Self-Care Interventions for Adults with T2DM: A Review of the Literature. Curr Diab Rep 16:66|
|Mayberry, Lindsay Satterwhite; Bergner, Erin M; Chakkalakal, Rosette J et al. (2016) Self-Care Disparities Among Adults with Type 2 Diabetes in the USA. Curr Diab Rep 16:113|
|Osborn, C Y; Mayberry, L S; Kim, J M (2016) Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults. J Clin Pharm Ther 41:256-9|
|Nelson, Lyndsay A; Mayberry, Lindsay S; Wallston, Kenneth et al. (2016) Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes. JMIR Hum Factors 3:e23|
|Nelson, Lyndsay A; Mulvaney, Shelagh A; Gebretsadik, Tebeb et al. (2016) The MEssaging for Diabetes (MED) intervention improves short-term medication adherence among low-income adults with type 2 diabetes. J Behav Med 39:995-1000|
|Nelson, Lyndsay A; Bethune, Magaela C; Lagotte, Andrea E et al. (2016) The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence. JMIR Hum Factors 3:e13|
|Heerman, W J; Wallston, K A; Osborn, C Y et al. (2016) Food insecurity is associated with diabetes self-care behaviours and glycaemic control. Diabet Med 33:844-50|
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