West Virginians have one of the highest prevalence of comorbid diabetes and hypertension in the United States, which poses an enormous disease and economic burden in this medically underserved state. Self- management of these conditions are an essential component of comprehensive disease management. The majority of self-management programs in West Virginia are clinic or hospital-based, disease specific, short- term, and provide limited participant interactions. The proposed study aims to fill this need by implementing a new and creative community-based, culturally appropriate, and cost-effective Diabetes and Hypertension Self-Management program (DHSMP) among adults with comorbid diabetes and hypertension. The DHSMP is adapted from the Diabetes Prevention Program (DPP) and AADE-7 self-care behaviors, and tailored for rural and socio-economically disadvantaged populations, using the community based participatory approach. The DHSMP will be administered by trained Health Coaches and will involve communication between them and the participants to provide continuous feedback and reinforcement of self-management strategies and health education messages. We will use a randomized controlled trial (RCT) comparing the 12-week DHSMP to an enhanced usual care (EUC) control group and conduct rigorous cost-effectiveness analyses. The DHSMP builds on the PI?s successful prior community-based lifestyle intervention studies in rural Appalachia and rural India. Seventy adults with comorbid T2DM and HTN will be recruited and randomized to 12-week DHSMP intervention (n=35) or an EUC control group (n=35) in two geographically separated Appalachian communities in WV. EUC participants will be waitlisted to receive DHSMP after 3 months.
Specific aims will test the hypotheses that the participants randomized to receive the 12-week DHSMP will have significantly greater improvements in self-efficacy, and reductions in HbA1c and blood pressure as well as reduction in weight, and improvements in diet, physical activity, health?related quality of life and social support at 3 and 6 months as compared to the EUC control group. We anticipate that the DHSMP will be cost- effective. Data on demographic, life-style factors, costs, anthropometric measures and clinical indicators will be collected during baseline and post intervention periods (3 and 6 months). The results will inform the development and translation of large-scale community interventions to promote self-management of co-morbid chronic conditions in this medically underserved and rural Appalachian population.
/Relevance The proposed study will assess the impact of an adapted, evidence-based 12-week self- management program with trained Health Coaches on bio-behavioral measures and costs in community settings in rural Appalachia. Participants will consist of individuals with comorbid diabetes and hypertension. Findings will help to develop sustainable programs to reach the triple aims of ?better health, better care and lower costs? in Appalachia and beyond.