McKenzie K Roddy, Andrew J Spieker, Robert A Greevy, Lyndsay A Nelson, Cynthia Berg, Lindsay S Mayberry
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引用次数: 0
摘要
背景：观察发现，家庭和社会支持对糖尿病最佳自我管理很重要；然而，针对家庭/社会支持的干预措施并非一贯有效。一种新颖的糖尿病特异性家庭功能类型学提供了对基线家庭功能类型进行分类的机会，以确定家庭干预可能对哪些人有效。目的：我们通过基线类型的家庭事后功能检查干预的效果，以了解干预的不同益处。方法：参与者随机分为两组，一组接受常规强化治疗，另一组接受为期9个月、提供移动电话、以家庭为中心的自我护理支持干预。纳入了参与随机临床试验（RCT）并提供基线数据的2型糖尿病成人（N = 318）。我们使用一种经过验证的、调查管理的类型评估工具确定了参与者的糖尿病特异性家庭功能类型。我们调查了类型和参与（例如，参加辅导课程和回复短信）以及心理社会（例如，幸福感和糖尿病困扰）和治疗中期和后期血糖结果之间的关系。结果：尽管整体参与度很高，但不同类型的参与度和效果存在差异。Want More Involvement受益最大；“低参与度”满意度显示出早期的改善逐渐减弱；协作型和乐于助人型是高度参与的，但从干预中获得的好处很少；和批判性参与的人受益最少，可能会受到一些伤害。结论：我们证明了一种新的糖尿病特异性家庭功能类型学的效用，以解释对以家庭为中心的干预的反应变异性。这项工作的发现回答了在精确行为医学中对系统级考虑的呼吁，并为未来量身定制的干预措施驱动假设生成。注册：较大的RCT在ClinicalTrials.gov注册（NCT04347291）。
Diabetes-specific family functioning typology associated with intervention engagement and effects: secondary analyses from a randomized controlled trial.
Background: Observationally, family and social support are important for optimal diabetes self-management; however, interventions targeting family/social support have not consistently been effective. A novel, diabetes-specific family functioning typology offers the opportunity to classify types of baseline family functioning to determine for whom family interventions may be effective.
Purpose: We examined the effects of an intervention by baseline type of family functioning post hoc, to inform differential benefit from interventions.
Methods: Participants were randomized to enhanced treatment as usual or a 9-month, mobile phone-delivered, family-focused, self-care support intervention. Adults with type 2 diabetes (N = 318) who participated in the randomized clinical trial (RCT) and provided baseline data were included. We determined participants' diabetes-specific family functioning types at baseline using a validated, survey-administered, typology assessment tool. We investigated the associations between type and engagement (eg, attending coaching sessions and responding to text messages) and psychosocial (eg, well-being and diabetes distress) and glycemic outcomes at mid- and post-treatment.
Results: Despite overall high engagement, there was variability across types in engagement and effects. Want More Involvement benefited the most; Satisfied with Low Involvement showed early improvements that waned; Collaborative & Helpful were highly engaged but derived minimal benefits from the intervention; and Critically Involved benefitted the least and may have experienced some harm.
Conclusions: We demonstrated the utility of a novel diabetes-specific family functioning typology to explain variability in response to a family-focused intervention. Findings from this work answer the calls for systems-level consideration in precision behavioral medicine and drive hypothesis generation for future, tailored interventions.
Registration: The larger RCT is registered with ClinicalTrials.gov (NCT04347291).
期刊介绍：
Annals of Behavioral Medicine aims to foster the exchange of knowledge derived from the disciplines involved in the field of behavioral medicine, and the integration of biological, psychosocial, and behavioral factors and principles as they relate to such areas as health promotion, disease prevention, risk factor modification, disease progression, adjustment and adaptation to physical disorders, and rehabilitation. To achieve these goals, much of the journal is devoted to the publication of original empirical articles including reports of randomized controlled trials, observational studies, or other basic and clinical investigations. Integrative reviews of the evidence for the application of behavioral interventions in health care will also be provided. .
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