African Americans with type 2 diabetes carry high burden of cardiovascular disease risk and adverse vascular events such as stroke and peripheral vascular disease. CVD risk factors of suboptimal blood pressure, lipids, and glycemic control are controllable through medical management and lifestyle behavior modification. The traditional primary care medical management model for these chronic CVD risks is inadequate, and models are shifting toward increased disease-related decision-making and self-management on the part of the patient. Yet, precise methods for: 1) identifying patients with ineffective disease-related problem-solving skills, and 2) providing patients with disease-related education that incorporates problem-solving and decision-making skills, have yet to be determined. The proposed study will address this limitation in the literature by testing a measurement tool and a novel training intervention for problem solving as applied to self-management of high CVD risk in African Americans with type 2 diabetes.
The specific aims are to: 1) assess the validity and reliability of an empirically-derived assessment tool of effective vs. ineffective CVD risk-related problem solving ability (the Health Problem Solving Scale, HPSS), 2) develop a novel intervention to teach CVD risk-related problem-solving skills to ineffective problem solvers, and 3) conduct a pilot study with a sample of African Americans with type 2 diabetes who have a high CVD risk profile (suboptimal blood pressure, lipids, and/or HbA1c) AND ineffective CVD risk-related problem-solving skills, as measured by the HPSS. The candidate's career goal is to become an independent researcher in self-management of CVD risk in high-risk African American populations, and to be a leader in the development and translation into practice of novel, theory-driven and empirically based interventions to improve patient self-management of CVD risks. Therefore, the candidate proposes the following two areas of career enhancement training to prepare her for this task: 1) formal coursework and training in cardiovascular epidemiology, research methodology, biostatistics, and behavioral science and health promotion; and 2) research in problem-solving training interventions for high CVD risk African Americans with type 2 diabetes. Results of this intervention will lead to development of a pilot project in year 04 and an R01 proposal in year 05 to investigate the efficacy of a problem-solving intervention in this high-risk population.
