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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01DK087894-03
Application #
8433470
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
Project Start
2011-04-15
Project End
2016-02-29
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
3
Fiscal Year
2013
Total Cost
$141,904
Indirect Cost
$10,511
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
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Kammer, Jamie R; Hosler, Akiko S; Leckman-Westin, Emily et al. (2016) The association between antidepressant use and glycemic control in the Southern Community Cohort Study (SCCS). J Diabetes Complications 30:242-7
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
Mayberry, Lindsay Satterwhite; Harper, Kryseana J; Osborn, Chandra Y (2016) Family behaviors and type 2 diabetes: What to target and how to address in interventions for adults with low socioeconomic status. Chronic Illn 12:199-215
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
Nelson, Lyndsay A; Mulvaney, Shelagh A; Gebretsadik, Tebeb et al. (2016) Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes. J Am Med Inform Assoc 23:12-8
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
Osborn, Chandra Y; Gonzalez, Jeffery S (2016) Measuring insulin adherence among adults with type 2 diabetes. J Behav Med 39:633-41
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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