BACKGROUND/RATIONALE:
Diabetes affects 25% of Department of Veterans Affairs (VA) patients and is among the leading causes of morbidity and mortality. Self-management, including healthy eating, being physically active, and taking medications, is critical to preventing diabetes complications, but many Veterans do not adhere to self-management recommendations. Enhancing the quality and quantity of existing social support resources is a promising strategy to improve self-management among Veterans, as self-management behaviors are influenced by a patient's social network. However, little is known about Veterans' existing social support resources for self-management, how to best leverage social support to facilitate self-management, and whether there are differences by gender.

OBJECTIVE(S):
The proposed research will adapt and pilot test a virtual intervention that includes Veterans with diabetes and support persons, which aims to reduce unsupportive and enhance supportive behaviors to facilitate Veterans' self-management.

Aim 1. Characterize social support resources, perceptions of supportive and unsupportive behaviors related to diabetes self-management, and facilitators and barriers to engaging in a partnered self-management intervention.

Aim 2. Identify support person perceptions of supportive and unsupportive behaviors for Veterans' self-management and facilitators and barriers to engaging in a partnered self-management intervention.

Aim 3. Evaluate feasibility, acceptability, and preliminary clinical improvement of a partnered diabetes self-management intervention in a single-arm pilot trial (n=20 men, n=20 women) employing a mixed methods approach.

METHODS:
Aim 1 will utilize individual qualitative telephone interviews with Veterans (n=32) to characterize social support resources for self-management. Aim 2 will involve individual qualitative telephone interviews with support persons identified by Veterans in Aim 1 (e.g., spouses, adult children, and friends; n=16) to understand their perceptions of helpful and harmful support. Lastly, Aim 3 will use both qualitative and quantitative methods to pilot test modifications to an existing partnered self-management intervention and evaluate feasibility, acceptability, and preliminary clinical improvement in self-management behaviors and hemoglobin A1c (HbA1c) overall and by gender.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Diabetes is highly prevalent among Veterans with profound impacts on health and wellbeing. Innovative, Veteran-centric interventions are needed to improve diabetes self-management. The proposed research has the potential to fill this gap, particularly for women Veterans who are often included in very limited numbers in VA intervention studies. If effective, this strategy could be tailored to other chronic diseases or disease prevention. The project aims align with VA's Blueprint for Excellence strategies of anticipating and meeting the unique needs of Veterans; delivering high-quality, Veteran-centered care; and advancing personalized, proactive, and patient-driven care.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX002189-01A1
Link: https://reporter.nih.gov/project-details/9288448

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PUBLICATIONS:

Journal Articles

1. Carpenter SM, Shetty A, Hetzel SJ, Garza K, Porter LS, Gray KE, Shaw RJ, Lewis MA, Mao L, Pabich S, Johnson HM, Yancy WS, Elwert F, Voils CI. A non-randomized comparison of engagement and outcomes for in-person versus virtual delivery of the Partner2Lose weight management trial. Obesity science & practice. 2024 Aug 1; 10(4):e778. [view]
2. Goldstein KM, Bastian LA, Duan-Porter W, Gray KE, Hoggatt KJ, Kelly MM, Wilson SM, Humphreys K, Klap R, Yano EM, Huang GD. Accelerating the Growth of Evidence-Based Care for Women and Men Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jun 25; 29 Suppl 1:S2-S5. [view]
3. Katon JG, Callegari LS, Bossick AS, Fortney J, Gerber MR, Lehavot K, Lynch KE, Ma E, Smith R, Tartaglione E, Gray KE. Association of Depression and Post-Traumatic Stress Disorder with Receipt of Minimally Invasive Hysterectomy for Uterine Fibroids: Findings from the U.S. Department of Veterans Affairs. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2020 Sep 1; 30(5):359-365. [view]
4. Callegari LS, Katon JG, Gray KE, Doll K, Pauk S, Lynch KE, Uchendu US, Zephyrin L, Gardella C. Associations between Race/Ethnicity, Uterine Fibroids, and Minimally Invasive Hysterectomy in the VA Healthcare System. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jan 1; 29(1):48-55. [view]
5. Gray KM, Ocfemia MCB, Wang X, Li J, Nesheim SR. Characteristics and Care Outcomes Among Persons Living With Perinatally Acquired HIV Infection in the United States, 2015. Journal of acquired immune deficiency syndromes (1999). 2019 Sep 1; 82(1):17-23. [view]
6. Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Medical care. 2019 Dec 1; 57(12):930-936. [view]
7. Nesheim SR, Linley L, Gray KM, Zhang T, Shi J, Lampe MA, FitzHarris LF. Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014. Journal of acquired immune deficiency syndromes (1999). 2018 Jan 1; 77(1):23-30. [view]
8. Campbell SB, Gray KE, Hoerster KD, Fortney JC, Simpson TL. Differences in functional and structural social support among female and male veterans and civilians. Social psychiatry and psychiatric epidemiology. 2021 Mar 1; 56(3):375-386. [view]
9. Gray KE, Silvestrini M, Ma EW, Nelson KM, Bastian LA, Voils CI. Gender differences in social support for diabetes self-management: A qualitative study among veterans. Patient education and counseling. 2023 Feb 1; 107:107578. [view]
10. Gray KE, Hoerster KD, Reiber GE, Bastian LA, Nelson KM. Multiple domains of social support are associated with diabetes self-management among Veterans. Chronic Illness. 2019 Dec 1; 15(4):264-275. [view]
11. Voils CI, Shaw RJ, Gavin KL, Hetzel SJ, Lewis MA, Pabich S, Johnson HM, Elwert F, Mao L, Gray KE, Yuroff A, Garza K, Yancy WS, Porter LS. Outcomes from Partner2Lose: a randomized controlled trial to evaluate 24-month weight loss in a partner-assisted intervention. BMC public health. 2024 Jul 20; 24(1):1948. [view]
12. Nesheim SR, FitzHarris LF, Lampe MA, Gray KM. Reconsidering the Number of Women With HIV Infection Who Give Birth Annually in the United States. Public health reports (Washington, D.C. : 1974). 2018 Nov 1; 133(6):637-643. [view]
13. Painter JM, Gray K, McGinn MM, Mostoufi S, Hoerster KD. The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2016 Oct 1; 25(10):2657-2667. [view]
14. Gray KE, Ma EW, Callegari LS, Magnusson SL, Tartaglione EV, Christy AY, Katon JG. Understanding Variation in Availability and Provision of Minimally Invasive Hysterectomy: A Qualitative Study of Department of Veterans Affairs Gynecologists. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2020 May 1; 30(3):200-206. [view]
15. Carey CM, Katon JG, Bossick AS, Gray KE, Doll KM, Christy AY, Callegari LS. Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration. Health equity. 2022 Dec 16; 6(1):909-916. [view]
16. Gray KE, Katon JG, LeBlanc ES, Woods NF, Bastian LA, Reiber GE, Weitlauf JC, Nelson KM, LaCroix AZ. Vasomotor symptom characteristics: are they risk factors for incident diabetes? Menopause (New York, N.Y.). 2018 May 1; 25(5):520-530. [view]
17. Nelson K, Fennell T, Gray KE, Williams JL, Lutton MC, Silverman J, Jain K, Augustine MR, Kopf W, Taylor L, Sayre G, Vanderwarker C. Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks. Contemporary clinical trials. 2018 Oct 1; 73:61-67. [view]
18. Hoerster KD, Gray K, Raffa SD. Weight Management and Healthy Lifestyles. JAMA internal medicine. 2020 Oct 1; 180(10):1403-1404. [view]

DRA: Diabetes and Other Endocrine Conditions
DRE: Prognosis, TRL - Applied/Translational
Keywords: none
MeSH Terms: none