Approximately 29.1 million (9.3%) adults in the US have type 2 diabetes (T2DM).1 T2DM is associated with significant complications including premature coronary artery disease, kidney disease, stroke, and blindness.1 Estimates show that prevalence of T2DM is 17% higher in rural dwellers compared to their urban counterparts.2 For example, the prevalence of T2DM for adults in Kentucky's rural Appalachian counties is 13.6%,3 compared to the overall state prevalence of 10.6% 3. Appropriate self-care behaviors are necessary for optimal clinical outcomes in T2DM 4-6 and account for 90% of the variance in glycemic control 7. Yet, self-care among T2DM is notoriously poor in general and even worse in rural-dwellers. Without attention to improving self-care in this population, we are facing an epidemic of T2DM complications in rural areas of the US. The impact of living with T2DM in rural communities is compounded in the aging population. The prevalence of T2DM increases with age and an estimated 25% of older adults (?65 years) have T2DM 8. Older adults living with T2DM have more difficulty than younger people adhering to self-care regimens and social/environment factors account for up to 85% of their self-care nonadherence.6,9-13 Notable social/environment factors include competing social demands, lack of social support (SS), and stress.14-17 Social support plays a particularly significant role in older adults with T2DM. The extent and type of SS available in rural communities can positively or negatively impact self-care in those diagnosed with T2DM. 18-25 To better understand the effects of the social environment in communities where older rural dwelling adults reside and to lay the foundation for interventions, social network analysis (SNA) will be used to determine social support network structures. By using SNA, social support structures can be developed and relationships between individuals within a social network can be evaluated. 26 The overall objective of this study is to improve T2DM self-care regimens in older rural dwelling adults by training influential community members to be community health workers and provide social support strategies within an older adults' existing social network that promotes T2DM self-care. The proposed study seeks to:
Aim 1 ?Use social network analysis to identify key players in a rural community to serve as community health workers for those living with T2DM.
Aim 2 ?Use mixed methods to evaluate the impact of social support on T2DM self-care and clinical outcomes and evaluate social networks in rural dwelling older adults with T2DM.
Aim 3 ?Test the feasibility and preliminary effectiveness of a 6-week intervention administered by community health workers with the support of members of older adults' individual social network.
With the high prevalence of type 2 diabetes (T2DM) and an aging population with low adherence to self-care regimens, I seek to improve T2DM self-care in older rural dwelling adults. Social network analysis will be used to identify individuals who are influential in their community who can be trained as community health workers as well as identify individuals within an older rural dwelling adult's personal network who can form a dyad with the older adult and serve as a facilitator for adherence to T2DM self-care regimen via social support. These dyads will participate in a 6-week T2DM self-care intervention with a booster session at 6 months post-intervention.
