SALUD-M: Acceptance Based Coping Skills for Hispanic/Latinx Military Patients With Type 2 Diabetes (SALUD-M)
Supporting Access for Latinx Underserved in Diabetes Management (SALUD-M): An Equity-Driven Study of Acceptance Based Coping Skills for Hispanic/Latinx Military Patients With Type 2 Diabetes Mellitus
People of Hispanic or Latino/a/x ("H/L") ethnicity, including US military servicemembers, Veterans, and their families, experience a higher prevalence of type 2 diabetes and more challenges managing diabetes than non-Hispanic White populations. Uncontrolled diabetes is linked with lower quality of life, diabetes-related emotional distress, and severe medical problems. There are many reasons for this difference, including lack of culturally appropriate and bilingual Spanish healthcare services. Additionally, military patients may have additional barrier accessing behavioral health care, which an important part of treatment for many people with diabetes, such as stigma and unique schedule challenges.
Therefore, this study aims to overcome these barriers and improve healthcare and health outcomes for H/L military patients. The investigators will test a values-based behavior change program, delivered using video telehealth by a bilingual English-Spanish language health coach. The 10-week Acceptance Based Coping (ABaCo) skills program includes 7 virtually-delivered lessons and was developed by the study team in partnership with civilian community health workers and patients. This study will test the helpfulness of ABaCo delivered by a health coach fluent in English and Spanish to military H/L patients. This randomized controlled trial will examine changes in physical and mental health over 6 months for those who receive ABaCo, compared to those who receive usual healthcare. This project will also identify steps for implementing the ABaCo program in other military treatment facilities.
The ultimate goal of this study is to establish a helpful, easy-to-access, widely available program for H/L military patients with type 2 diabetes that improves quality of life and blood sugar control, and lowers distress about diabetes. This study will also identify best approaches to providing ABaCo in military treatment facilities, providing lessons learned to other large healthcare systems.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Hispanic/Latino/a/x ("H/L") populations, including US military and Veteran patients, experience a higher prevalence of type 2 diabetes mellitus (T2DM) and more challenges with glycemic control than non-Hispanic White populations. Poor glycemic control is linked with lower quality of life, diabetes-related distress and devastating medical complications. Contributors to this health disparity are multifaceted and include a lack of culturally appropriate and language-concordant healthcare. Additionally, in military populations, significant schedule demands and stigma about behavioral health care and may preclude optimal diabetes treatment.
This study will address these barriers by testing a values-based behavior change program, delivered by a bilingual English-Spanish health coach, to enhance diabetes care for H/L military patients. The 10-week Acceptance Based Coping (ABaCo) skills program includes 7 virtually-delivered lessons and was developed by the study team in partnership with civilian community health workers and patients and could improve care for H/L military patients with T2DM.
The study aims are to: (1) Examine the effectiveness of ABaCo delivered by a health coach to military H/L patients through a randomized controlled trial and (2) Identify barriers and facilitators to implementation at the patient and clinic levels and assess the acceptability and feasibility of implementing ABaCo in a military treatment facility.
If successful, this study will establish an accessible and effective self-management-enhancement program that improves quality of life, psychological health and glycemic control for H/L military patients with T2DM; and identify implementation factors informing future scalability and sustainability of ABaCo at military treatment facilities.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Amanda Leal
- Telefonnummer: 240-673-8951
- E-mail: amanda.leal3.ctr@health.mil
Studiesteder
-
-
Texas
-
San Antonio, Texas, Forenede Stater, 78234
- Rekruttering
- Brooke Army Medical Center
-
Kontakt:
- Amanda Leal
- Telefonnummer: 240-673-8951
- E-mail: amanda.leal3.ctr@health.mil
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Patients ages 18-70
- Diagnosis of T2DM
- Current HbA1c (drawn within 6 months) of 7% or greater (may be taking oral agents or injectables for diabetes control)
- Evidence of avoidance coping (score <48.4 [published mean] on the Acceptance and Action Diabetes Questionnaire) or poor self-management skills (score < published mean on 2+ subscales of the Summary of Diabetes Self-Care, Activities)
- Self-described as Hispanic/Latino/Latina/Latinx
- Preferred language of English or Spanish, (g) receiving care at the study site clinic.
Exclusion Criteria:
- End-stage renal disease (on dialysis)
- A medical condition or life circumstance that would contraindicate participation
- Proliferative diabetic retinopathy precluding participation
- Inability to read/comprehend the informed consent process or study instructions
- Pregnant or planning to become pregnant in the next 6 months.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Sundhedstjenesteforskning
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Acceptance Based Coping (ABaCo) Skills Program
Participants randomized to the active intervention will undergo individual virtual classes once a week for 6 weeks (~30mins), a booster (review) class at week 10, and one follow-up class at 6 months post enrollment, for a total of 7 virtual calls. These virtual visits will be with a health coach trained and supervised in providing the ABaCo skills training program. All participants will continue to receive DTAU through the military healthcare system. ABaCo Weekly Topic Overview: Week 1:Understanding avoidance coping; identifying valued life areas Week 2: Building social support; using assertive communication Week 3: Accepting difficult thoughts & feelings; making meaningful choices Week 4: Noticing & letting go of unhealthy patterns; developing new life stories Week 5: Connecting to what matters in the present; committing to values Week 6: Reinforcing changes |
The ABaCo program is a brief, bilingual and culturally appropriate educational program delivered virtually, based on the principles of Focused Acceptance and Commitment Therapy (ACT).
ACT, a type of behavior therapy, empowers patients to engage in values-consistent activities, even in the context of great distress or adversity.
ACT facilitates behavior change and good health outcomes by focusing on patient values and targeting avoidance coping (i.e., "experiential avoidance").
Thus, the ABaCo program was designed to help patients increase acceptance of difficult thoughts, feelings and experiences (e.g., cravings, diabetes-related distress, etc), ultimately helping them to care for their diabetes in a personally meaningful way, aligned with their valued life areas.
ABaCo is delivered virtually over 6 consecutive weeks (1hr/each lesson) with a booster lesson at week 10.
Andre navne:
|
|
Ingen indgriben: Diabetes Treatment as Usual (DTAU)
Participants randomized into the diabetes treatment as usual (DTAU) control condition will continue to receive DTAU in the military healthcare system.
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Hba1c (Glycated hemoglobin)
Tidsramme: Baseline, 24 weeks
|
Average blood glucose levels in past 3 months; higher percentages reflect higher levels (worse glycemic control).
|
Baseline, 24 weeks
|
|
Patient-Reported Outcomes Measurement Information System Global Health 10 (PROMIS Global-10)
Tidsramme: Baseline, 6 weeks, 10 weeks, 24 weeks
|
10 Likert-scale items validated in English and Spanish assess global health-related quality of life in two areas: Physical and Global Mental Health, including functioning, emotional distress, interference, and overall quality of life, from Excellent to Poor.
Scores range from 4-20 and are typically converted to T-scores; higher scores represent better health related quality of life.
|
Baseline, 6 weeks, 10 weeks, 24 weeks
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Diabetes Distress Scale
Tidsramme: Baseline, 6 weeks, 10 weeks, 24 weeks
|
17 Likert-type scale validated in English and Spanish; diabetes-related distress with subscales Emotional Burden, Physician Distress, Regimen Distress, Interpersonal Distress.
The final score and subscale scores are calculated as averages (means) ranging from 1-6; higher scores indicate greater diabetes distress.
|
Baseline, 6 weeks, 10 weeks, 24 weeks
|
|
Summary of Diabetes Self-Care Activities
Tidsramme: Baseline, 6 weeks, 10 weeks, 24 weeks
|
12-item Likert-type scale validated in English and Spanish, measuring engagement in recent self-care activities: medication adherence, glucose testing, diet, exercise, foot care, smoking, and general diabetes self-care.
The SDSCA can be scored multiple ways; study investigators developed a composite score representing engagement in self-care activities over the past 7 days.
Scores are averaged and range from 0 to 7; higher scores indicate a greater frequency of engagement in self-care activities.
|
Baseline, 6 weeks, 10 weeks, 24 weeks
|
|
Acceptance & Action Diabetes Questionnaire
Tidsramme: Baseline, 6 weeks, 10 weeks, 24 weeks
|
11 Likert-type items (10 in Spanish), validated in English and Spanish, assess acceptance of distressing diabetes thoughts/feelings and their interference.
Scores range from 11 to 55, with higher scores indicating poorer diabetes acceptance/greater experiential diabetes-related avoidance.
|
Baseline, 6 weeks, 10 weeks, 24 weeks
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Acceptability of the intervention: participant interviews & satisfaction ratings
Tidsramme: 10 weeks (post-intervention)
|
Semistructured interviews include 3 Likert-type scale items previously used by the research team to assess participant satisfaction: ease of learning, overall satisfaction, and likelihood of recommending.
Scores range from 0-10 with higher scores indicating greater acceptability.
|
10 weeks (post-intervention)
|
|
Self-Compassion Scale - Short Form
Tidsramme: Baseline, 6 weeks, 10 weeks, 6 months
|
12 Likert scale items assess self-compassion with scores ranging from 12-60; higher scores represent greater self-compassion.
|
Baseline, 6 weeks, 10 weeks, 6 months
|
|
Three-Item Loneliness Scale (UCLA-3)
Tidsramme: Baseline, 6 weeks, 10 weeks, 6 months
|
3-item Likert scale measuring loneliness; scores range from 3-9, with higher scores indicating greater loneliness.
|
Baseline, 6 weeks, 10 weeks, 6 months
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Kathryn E Kanzler, PsyD, Baylor College of Medicine
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- K08012023KH
- 7-23-ICTSBMH-0 (Andet bevillings-/finansieringsnummer: American Diabetes Association)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
IPD-delingstidsramme
IPD-delingsadgangskriterier
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- ICF
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .