Dr. Kristen Gray, PhD, MS is a Postdoctoral Fellow at the Seattle HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care and a Senior Fellow in the Department of Health Services in the University of Washington School of Public Health. Her research reflects a commitment to understanding and mitigating health disparities among women Veterans (WVs). The proposed Career Development Award (CDA) will provide Dr. Gray with the additional training and skills needed to build a successful career as an independent VA health services researcher developing and testing behavioral health interventions for WVs. KEY ELEMENTS OF THE RESEARCH PLAN: The goal of the proposed CDA is to develop and pilot test the feasibility, acceptability, and preliminary clinical improvement of a virtual diabetes self-management intervention tailored to men and women Veterans and their support persons. The intervention will be dyadic, including Veterans and their support persons, and will focus on enhancing supportive and reducing unsupportive behaviors in order to improve Veterans' self-management behaviors and disease outcomes. Examination of gender differences in outcomes is a key focus of the proposal because: (1) the VA Evidence- based Synthesis program recently identified a gap in knowledge of gender differences in non-pharmacologic diabetes interventions, and (2) VA trials of self-management interventions have included few or no women, precluding examination of gender differences, The specific aims of the proposal are to: (1) characterize women and men Veterans' social support resources, perceptions of supportive and unsupportive behaviors related to diabetes self-management, and facilitators and barriers to engaging in a partnered self-management intervention through qualitative telephone interviews; (2) identify support person perceptions of supportive and unsupportive behaviors for Veterans' self- management and facilitators and barriers to engaging in a partnered self-management intervention through qualitative interviews; and (3) evaluate feasibility, acceptability, and preliminary clinical improvement of a partnered diabetes self-management intervention in a single-arm pilot trial. Based on findings from Aims 1 and 2, the intervention will be tailored to facilitate recruitment and retention of Veterans and support persons in the Aim 3 pilot study. An equal number of men and women Veterans will be enrolled in the pilot to enable examination of gender differences in feasibility, acceptability, and clinical improvement. The resulting product will be a refined intervention, which will be tested in a larger, multi-site randomized controlled trial. TRAINING: In order to accomplish CDA and career goals, Dr. Gray will seek additional training to strengthen her health services research skills in: 1) qualitative methods, 2) health behavior change, and 3) trial design. She will also begin introductory training in implementation science. She will participate in coursework at the University of Washington, local and national trainings, clinical shadowing, and other professional activities to achieve these training goals. MENTORS: Dr. Gray is supported in her training and research by a diverse and well-qualified set of mentors, including experts in diabetes (Dr. Karin Nelson), qualitative methods (Dr. Corrine Voils); behavioral randomized controlled trials (Drs. Lori Basian and Voils), and virtual health care (Dr. John Fortney). Additional CDA consultants will provide guidance in chronic disease self-management interventions (Dr. Michele Heisler). IMPACT: This CDA will accelerate Dr. Gray's independence as a VA health services investigator dedicated to advancing the health of WVs. The research proposed, in combination with the mentorship and training, will provide the necessary experience and knowledge to cultivate an independent program of health services research focused on developing and testing behavioral health interventions for WVs.

Public Health Relevance

Diabetes affects 25% of Department of Veterans Affairs (VA) patients and requires extensive self- management, including healthy eating, being physically active, and taking medications. However, Veterans' self-management is often suboptimal, compelling efforts to improve these behaviors. Enhancing the quality of existing social support resources is a promising strategy, as the majority of self-management takes place outside the clinical setting. Therefore, the proposed research will adapt and pilot test a virtual intervention that includes Veterans and support persons and aims to reduce unsupportive (e.g., criticism) and enhance supportive behaviors to facilitate Veterans' self-management. The research will determine whether the intervention is feasible and acceptable to Veterans and support persons and leads to improved behaviors. Because women have poorer self-management, disease control, and health outcomes than men, and receive less social support, gender differences will be examined, which have largely been ignored in VA interventions.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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HSR&D Career Development Award (CDA0)
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VA Puget Sound Healthcare System
United States
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Nelson, Karin; Fennell, Tiffanie; Gray, Kristen E et al. (2018) Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks. Contemp Clin Trials 73:61-67
Gray, Kristen E; Katon, Jodie G; LeBlanc, Erin S et al. (2018) Vasomotor symptom characteristics: are they risk factors for incident diabetes? Menopause 25:520-530
Gray, Kristen E; Hoerster, Katherine D; Reiber, Gayle E et al. (2018) Multiple domains of social support are associated with diabetes self-management among Veterans. Chronic Illn :1742395318763489
Katon, Jodie G; Gray, Kristen; Callegari, Lisa et al. (2017) Trends in hysterectomy rates among women veterans in theĀ US Department of Veterans Affairs. Am J Obstet Gynecol 217:428.e1-428.e11