This competing renewal project will systematically develop and evaluate a psychosocial intervention program to increase regimen adherence among persons 65 years of age or older who have Type II (noninsulin-dependent) diabetes mellitus. Few psychosocial interventions have been developed for Type II diabetes and we know of none designed for older individuals. Based upon our findings concerning social learning factors related to regimen adherence among persons with Type II diabetes (e.g., self- efficacy, barriers to adherence, problem-solving skills), we have recently developed a group intervention program to modify these variables. An initial developmental phase consisting of interviews with elderly participants in our current research, further data analyses, focus groups, and small-scale pilot work will allow us to adapt our current intervention to meet the needs and concerns of the elderly. In particular, we will include intervention components to address depression, which is prevalent among the elderly with chronic illnesses, and personal models of illness. The resulting intervention will then be evaluated against a delayed treatment control condition. Multiple measures within each of the following categories will be collected to evaluate: adherence to dietary (caloric intake, fiber and fat consumption) and exercise self-care behaviors; process/mediating variables; and secondary outcomes (e.g., glycemic control, life satisfaction). Based upon the results of this study, a second outcome study will be conducted in which a revised intervention is compared to an educationally based diabetes education program designed to control for social interaction, therapist contact and amount of information presented. This research will contribute significantly to the design and understanding of psychosocial intervention programs for diabetes and have implications for the health care of the elderly with other chronic diseases.
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