Linking Self-Management and Primary Care for Diabetes
This project is funded by NIH/NIDDK.
There is a pressing need for research on behavioral interventions capable of being translated into practice for the self-management of diabetes and other chronic illnesses. It is well-documented that preventive care provided to diabetes patients is suboptimal, and that most patients are especially in need of assistance with behavior- change aspects of diabetes self-management. This study addresses these issues by refining and experimentally evaluating a practical, computer-based (combined Internet and automated telephone) diabetes self-management intervention for primary care patients.
The intervention is designed to facilitate dietary and physical activity practices, medication-taking, and patient activation around diabetes care. A total of 463 type 2 diabetes patients from primary care providers in an HMO setting were randomly assigned to one of three conditions in an effectiveness study: (1) enhanced usual care; (2) a second generation version of our social-ecological, theory-based behavioral intervention plus enhanced interpersonal support; or (3) an entirely automated version of this intervention. The two active interventions each included several innovative components to address reach, low health literacy, change in multiple health behaviors, continued participant involvement over time, social environmental support, and maintenance/relapse prevention strategies. Evaluation is based on the RE-AIM model dimensions of reach, effectiveness, adoption, implementation, and maintenance.
Key outcomes include behavior change (dietary, physical activity, and medication-taking) and the UKPDS multiple risk formula that combines several heart disease risk factors (HbA1c, blood pressure, smoking, and lipids). Key secondary outcomes and process measures include diabetes-specific quality of life, patient activation, and perceived social-environmental support at 6- and 12-month follow-ups, and cost-effectiveness.