This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. African Americans with type 2 diabetes suffer high rates of heart disease. Risk factors for heart disease, such as high blood sugar, blood pressure, and cholesterol, can be controlled through medical management and changes in lifestyle behaviors. Taking care of diabetes and changing lifestyle behaviors can be difficult. Problem solving is one self-management tool deemed important for effective self-care of diabetes and for overcoming barriers to making the lifestyle changes essential for preventing or managing heart disease. But, methods for training problem solving and decision making for managing health have not been well established. This study will test a new questionnaire for measuring health-related problem-solving abilities and a new problem-solving training applied to self-management of diabetes and heart disease risk factors in African Americans with type 2 diabetes.
The specific aims are: 1) to assess the validity and reliability of a questionnaire of effective vs. ineffective health-related problem-solving ability (Health Problem-Solving Scale), 2) to develop a new intervention to teach health-related problem-solving skills to ineffective problem solvers, and 3) to conduct a pilot study with a sample of participants who have a high risk for heart disease AND ineffective health-related problem-solving skills, to test whether a brief vs. an intensive health problem-solving training improves problem solving ability, health behaviors, and heart disease risk factors. Participants are urban African Americans with type 2 diabetes. The research will be conducted in two parts, Health Problem-Solving Scale development (Study 1) and Health Problem-Solving Intervention (Study 2). Eligibility criteria for Study 1 include Low CVD Risk Profile (defined in this research proposal as optimal control of blood pressure, cholesterol, and blood sugar), or a High CVD Risk Profile (defined as high blood pressure, and/or high cholesterol, and/or high blood sugar). Participants will complete the Health Problem-Solving Scale and additional tests of problem solving and behavior. Upon completion of the Health Problem-Solving Scale questionnaire validation study, 60 participants who meet criteria for high CVD risk, and who score with a range of ineffective problem solving on the Health Problem-Solving Scale, will be participants in Study 2, the problem-solving training study. Participants will be randomly assigned, like flipping a coin, into either a Minimal Intervention group or an Intensive Intervention group. The Minimal Intervention group will receive Heart Disease Risk Education class + Brief Health Problem-Solving Training (2 weekly group sessions and 1 telephone follow-up). The Intensive Intervention Group will receive the Heart Disease Risk Education class + Intensive Health Problem-Solving Training (9 weekly group sessions and 1 telephone follow-up). At baseline and at 6 months after the intervention groups have ended, participants will have their blood sugar (HbA1c), cholesterol, and blood pressure assessed. In addition, they will complete questionnaires about problem solving, self-management adherence, knowledge, health behaviors, progress toward CVD risk management goals, and quality of life.
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