Among African American women with diabetes who have inadequate glycemic control (A1c>8%) who receive care in community clinics in Los Angeles County, we propose to evaluate the impact of an intervention that identifies and supports intrinsic motivation for improved diabetes control through combined in-person, phone, and SMS contact and also, for one arm of the study, a behavioral economics intervention that uses monetary incentives to reward improved glycemic control. The randomized controlled trial (RCT), a multicomponent intervention to boost intrinsic motivation for improved glycemic control will randomize patients within participating clinics to one of three groups;1) Usual care ((""""""""Control"""""""" condition), 2) An intervention to boost intrinsic motivation to lower A1c through in-person visits, telephone calls, and tailored text messages delivered by cell phone (""""""""IM/SMS"""""""" condition), and 3) An intervention that adds periodic monetary incentives, whose size depends on the degree of reduction in A1c, and lottery participation to boost motivation to participate in diabetes self care and reach A1c goals (""""""""IM/SMS+lncentives"""""""" condition). We will assess the effect ofthe IM/SMS and IM/SMS+lncentives interventions on glycemic control over a 12 month period and determine whether improvements in Ale compared to the control arm are sustained for 6 additional months after the SMS and monetary incentives are discontinued. We will also assess the costs of the interventions and their effect on resource use. The primary study outcome is change in A1c. To gain insights into possible mechanisms forthe impact ofthe intervention, we will also assess the effects of the intervention on self-management behaviors, patient activation, changes in medication regimens, number of physician visits, weight, quality of life, trust in the health care system, participants'self-reported experiences with the intervention, and spillover effects ofthe intervention on blood pressure control. We hypothesize that, compared with the control group, women in the IM/SMS or the IM/SMS+incentive arms will have lower A1c levels (and will be more likely to achieve the target A1c of 7.0%), both while the interventions are in place and 6 months after the regular contact and monetary incentives are discontinued. We also hypothesize that glycemic control will be better at 12 months forthe IM/SMS+lncentive group than the IM/SMS group, but will be similar 6 months after the interventions are discontinued.

Public Health Relevance

Diabetes is a major public health problem that is associated with substantial health disparities for African American women compared to African American men or white men and women. This project will incorporate new technology whose use is high among African Americans (cell phone text message reminders) and strategies from the emerging field of behavioral economics to encourage and support self care behaviors that lead to improvements in diabetes control.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Comprehensive Center (P60)
Project #
5P60MD006923-03
Application #
8610182
Study Section
Special Emphasis Panel (ZMD1)
Project Start
Project End
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of California Los Angeles
Department
Type
DUNS #
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Mays, Vickie M; Juster, Robert-Paul; Williamson, Timothy J et al. (2018) Chronic Physiologic Effects of Stress Among Lesbian, Gay, and Bisexual Adults: Results From the National Health and Nutrition Examination Survey. Psychosom Med 80:551-563
Liang, Di; Mays, Vickie M; Hwang, Wei-Chin (2018) Integrated mental health services in China: challenges and planning for the future. Health Policy Plan 33:107-122
Assari, Shervin (2018) Educational Attainment Better Protects African American Women than African American Men Against Depressive Symptoms and Psychological Distress. Brain Sci 8:
Assari, Shervin; Mistry, Ritesh; Caldwell, Cleopatra Howard (2018) Perceived Discrimination and Substance Use among Caribbean Black Youth; Gender Differences. Brain Sci 8:
Assari, Shervin (2018) Suicide Attempts in Michigan HealthCare System; Racial Differences. Brain Sci 8:
Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen et al. (2018) Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015. Healthcare (Basel) 6:
Montgomery, Tiffany M; Mays, Vickie M; Heilemann, MarySue V et al. (2018) Acceptability and Feasibility of a Sexual Health Intervention for Young Adult Black Women. J Obstet Gynecol Neonatal Nurs 47:862-873
Assari, Shervin (2018) Race, Intergenerational Social Mobility and Stressful Life Events. Behav Sci (Basel) 8:
Cochran, Susan D; Björkenstam, Charlotte; Mays, Vickie M (2017) Sexual orientation differences in functional limitations, disability, and mental health services use: Results from the 2013-2014 National Health Interview Survey. J Consult Clin Psychol 85:1111-1121
Mays, Vickie M; Jones, Audrey L; Delany-Brumsey, Ayesha et al. (2017) Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites. Med Care 55:173-181

Showing the most recent 10 out of 32 publications