For adults with type 2 diabetes mellitus (T2DM), successful self-management requires daily self-care behaviors, which can be made easier or more difficult by family members' behaviors. Family members who perform diabetes-specific supportive behaviors (e.g., reminding patients to take medications, exercising with the patient) often also perform behaviors that make adults' self-care more difficult (e.g., sabotaging the patients' self-care attempts or nagging/arguing about self-care). Targeting family members' disease-specific behaviors may be effective for improving patients' adherence. However, few family interventions for adults with T2DM have been successful in improving patients' outcomes, and family interventions are often time-intensive and poorly attended by patients at highest risk of non-adherence (minority groups with low socioeconomic status; SES). It remains unclear whether intervention content can equip adult patients with the necessary skills to identify and manage supportive and obstructive diabetes-specific family behaviors. Furthermore, longitudinal evidence is conspicuously absent; we do not yet know if the relationships between family members' diabetes- specific behaviors and patients' diabetes management (i.e., adherence to self-care behaviors and glycemic control) are unidirectional or reciprocal over time. During this K01 award, the principal investigator (The candidate) will address these gaps in the extant literature while participating in a mentored training experience that will prepare her for success as an independent investigator who identifies sustainable approaches to family interventions that improve the health and well-being of adults with T2DM and their family members in at-risk populations. Specific training goals include developing expertise in: family-focused intervention content for adults' diabetes management, behavioral randomized controlled trials (RCTs), delivering intervention content via mobile phone technology, and longitudinal analysis. The proposed plan integrates didactic coursework and training, a mentored research experience (including hands- on experience with an NIDDK R01-funded behavioral RCT), participation in local and national meetings/seminars/workshops/conferences, and active involvement in a robust and extremely supportive research environment. This environment includes NIDDK-funded Center for Diabetes Translational Research and Diabetes Research & Training Center, a NIH Clinical & Translational Science Award, a Center for Health Services Research, a Center for Health Behavior and Health Education, AHRQ-funded programming in patient-centered outcomes research, and the Meharry-Vanderbilt Community Engaged Research Core which facilitates the active engagement of patients and community clinics in research. In addition, one of the candidate's co- mentors is the director of the multi-disciplinary Consortium for Life-span BioBehavioral Family Health Research at the University of Utah, and will provide the candidate will access to associated resources and relevant collaborations. The proposed research includes three specific aims.
Aim 1 : The candidate will build on findings from her research with the target population (i.e., a racially/ethnically diverse, low SES patient population) to develop family- focused intervention content to equip patients with skills to ask for needed supportive behaviors from family members and to redirect and/or disengage from obstructive family behaviors. Intervention content will be delivered exclusively via basic mobile phone technology (i.e., text messages and voice communications) to enhance reach, participation, and retention. Adult T2DM patients and an adult family member will be recruited for three iterative rounds of usability testing to refine the intervention prior to evaluation. The intervention will be evaluate in a 3-month trial nested within her mentor's larger RCT.
Aim 2 : The candidate will analyze the extent to which changes in patients' diabetes self-efficacy, self-care behaviors, and glycemic control were occasioned by changes in family members' diabetes-specific behaviors (i.e., the targeted mechanism), and will evaluate the acceptability of delivering intervention content to family members via text messages.
Aim 3 : Finally, the candidate will analyze the longitudinal relationships between patient-reported diabetes-specific family behaviors and patients' self-care and outcomes, assessed at regular intervals over a 12-month period. This career development plan presents a natural extension of the candidate's research and training to date, and leverages findings from her NIDDK-funded F32 to inform the development of family interventions for adults with T2DM. Upon completion of this plan, the candidate will have expertise in developing and delivering family-focused behavioral intervention in a low SES patient population via technology and in using longitudinal data analysis to evaluate effects of intervention content on health behaviors and outcomes. In combination with findings from the specific aims, this unique expertise will accelerate the candidate's independent research career as an expert in family interventions for adults with T2DM, and will help her reach her ultimate goals of developing and evaluating scalable family interventions to improve health and quality of life for adults with T2DM and their family members.
Mobile health technology holds promise for delivering intervention content to adults with diabetes and low socioeconomic status and their family members. This K01 award will allow the candidate to gain expertise in leveraging technology to deliver family-focused intervention content to improve the social context in which adults perform diabetes self-care and in evaluating intervention effects on patients' diabetes outcomes.
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