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NRI 18-234 – HSR Study

NRI 18-234
Tailored Approaches to Reduce Distress and Improve Self-Management for Veterans with Diabetes (TARDIS)
Allison Lewinski, PhD
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: September 2020 - March 2025


Background: Diabetes self-management is critical to sustaining optimal health following diagnosis. Diabetes distress (DD) is a crucial factor that influences a Veteran’s engagement in diabetes self- management. DD is distinct from depression, and includes four domains (i.e., regimen, emotional, interpersonal, healthcare provider). The presence of DD negatively impacts engagement in self-management and HbA1c. Despite interventions aimed at decreasing DD, these interventions have shown minimal lasting effects. One reason may be because interventions do not tailor information to an individual’s DD. Significance/Impact: This proposal will be the first to examine the impact of correlating factors on DD, and then design and test a self-management intervention tailored upon a Veteran’s DD type. This proposal addresses the [VHA Strategic Plan Priority areas of utilizing resources more efficiently and improving the timeliness of services, and the HSR&D Research Priorities of Population Health/Whole Health and Primary Care Practice. This proposal’s findings can improve both care delivery and health outcomes of Veterans, as we will help facilitate the Veteran’s linkage to ubiquitous, existing VHA and community services]. Innovation: This proposal will develop an intervention that targets sub-optimal T2D self-management by providing tailored self-management information in conjunction with connections to supportive services. We will identify how, and to what extent, DD and its factors, influence a Veteran’s self-management behaviors. Specific Aims: Aim 1 will examine the association of [psychosocial factors (depression, PTSD), environmental factors (finances, support), self-management behaviors, and HbA1c with DD. These Aim 1 data will inform the identification of modifiable factors and selection of the population] for a diabetes self- management intervention for Veterans with T2D. Aim 2 will describe self-management challenges and preferred learning strategies [to inform the intervention components and delivery approach for Veterans with T2D. Obtaining in-depth perceptions of DD type, self-management strategies and challenges, and learning preferences is essential to tailoring intervention components]. The purpose of Aim 3 is to design & pilot test an innovative, tailored T2D self-management information and supportive services intervention for Veterans with T2D, to promote engagement in self-management behaviors. In Aim 3 we will determine the feasibility and acceptability of the intervention for Veterans with T2D. Methodology: This proposal uses an explanatory, sequential mixed-methods design to describe DD in a sample of Veterans who receive care at Durham. In Aim 1 we will survey Veterans (n = 200), and balance enrollment by HbA1C (< 9 or ≥ 9) and medication use (insulin, no insulin). In Aim 2 we will conduct semi- structured interviews with a sub-sample (n = ~36) of Veterans surveyed in Aim 1. We will balance enrollment by HbA1C, medication use, and DD level as operationalized by the Diabetes Distress Scale (low, moderate, high). In Aim 3 we will develop and refine the intervention using findings from Aims 1 & 2 and strategies successfully used by co-mentors. To develop the intervention we will conduct semi-structured interviews with stakeholders (n = ~20: physicians, nurses, administrators) to review components (e.g., learning approaches, relevant VA/community resources) to ensure relevancy. We will modify components and the delivery strategy as needed. Then, we will test the intervention with 30 Veterans to evaluate [feasibility and acceptability], and utilization of recommended supportive services, using quantitative and qualitative approaches. Implementation/Next Steps: The next steps include dissemination of findings about DD, and its correlates, and the development of an IIR. This IIR will be a Phase III efficacy trial and will be sufficiently powered to test the effects of providing self-management information and connections to supportive services tailored to a Veteran’s DD to improve HbA1c.

External Links for this Project

NIH Reporter

Grant Number: IK3HX002815-01A2

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Journal Articles

  1. Lewinski AA, Crowley MJ, Miller C, Bosworth HB, Jackson GL, Steinhauser K, White-Clark C, McCant F, Zullig LL. Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake. Medical care. 2021 Jun 1; 59(Suppl 3):S242-S251. [view]
  2. Lewinski AA, Shapiro A, Gierisch JM, Goldstein KM, Blalock DV, Luedke MW, Gordon AM, Bosworth HB, Drake C, Lewis JD, Sinha SR, Husain AM, Tran TT, Van Noord MG, Williams JW. Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods. Systematic reviews. 2020 Apr 25; 9(1):92. [view]
  3. Rushton S, Lewinski AA, Hwang S, Zullig LL, Ball Ricks KA, Ramos K, Gordon A, Ear B, Ballengee LA, Brahmajothi MV, Moore T, Blalock DV, Williams JW, Cantrell SE, Gierisch JM, Goldstein KM. Barriers and facilitators to the implementation and adoption of improvement coaching: A qualitative evidence synthesis. Journal of Clinical Nursing. 2023 Jan 1; 32(1-2):3-30. [view]
  4. Yang Q, Hatch D, Crowley MJ, Lewinski AA, Vaughn J, Steinberg D, Vorderstrasse A, Jiang M, Shaw RJ. Digital Phenotyping Self-Monitoring Behaviors for Individuals With Type 2 Diabetes Mellitus: Observational Study Using Latent Class Growth Analysis. JMIR mHealth and uHealth. 2020 Jun 11; 8(6):e17730. [view]
  5. Ballengee LA, Rushton S, Lewinski AA, Hwang S, Zullig LL, Ricks KAB, Ramos K, Brahmajothi MV, Moore TS, Blalock DV, Cantrell S, Kosinski AS, Gordon A, Ear B, Williams JW, Gierisch JM, Goldstein KM. Effectiveness of Quality Improvement Coaching on Process Outcomes in Health Care Settings: A Systematic Review. Journal of general internal medicine. 2022 Mar 1; 37(4):885-899. [view]
  6. Byrd JT, Daniels CL, Flores DD, Kayle M, Lewinski AA, Smith JB, Xu H, Tanabe PJ. Establishing a research racial justice task force to improve diversity, equity, and inclusion in nursing research. Nursing Outlook. 2022 Aug 10; 70(5):758-761. [view]
  7. Pérez-Aldana CA, Lewinski AA, Johnson CM, Vorderstrasse AA, Myneni S. Exchanges in a Virtual Environment for Diabetes Self-Management Education and Support: Social Network Analysis. JMIR diabetes. 2021 Jan 25; 6(1):e21611. [view]
  8. German J, Kobe EA, Lewinski AA, Jeffreys AS, Coffman C, Edelman D, Batch BC, Crowley MJ. Factors Associated With Diabetes Distress Among Patients With Poorly Controlled Type 2 Diabetes. Journal of the Endocrine Society. 2023 Mar 6; 7(5):bvad031. [view]
  9. Goldstein K, Perry KR, Lewinski A, Walsh CW, Shepherd-Banigan M, Bosworth HB, Weidenbacher HJ, Blalock D, Zullig LL. How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients. BMJ (Clinical research ed.). 2022 Aug 5; 12:. doi:10.1136/ bmjopen-2022-062261. [view]
  10. Drake C, Batchelder H, Lian T, Cannady M, Weinberger M, Eisenson H, Esmaili E, Lewinski A, Zullig LL, Haley A, Edelman D, Shea CM. Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework. BMC health services research. 2021 Sep 17; 21(1):975. [view]
  11. Lewinski AA, Rushton S, Van Voorhees E, Boggan JC, Whited JD, Shoup JP, Tabriz AA, Adam S, Fulton J, Gordon AM, Ear B, Williams JW, Goldstein KM, Van Noord MG, Gierisch JM. Implementing remote triage in large health systems: A qualitative evidence synthesis. Research in nursing & health. 2021 Feb 1; 44(1):138-154. [view]
  12. Lewinski AA, Bosworth HB, Goldstein KM, Gierisch JM, Jazowski S, McCant F, White-Clark C, Smith VA, Zullig LL. Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project. Contemporary clinical trials communications. 2021 Mar 1; 21(1):100705. [view]
  13. Walsh C, Sullivan C, Bosworth HB, Wilson S, Gierisch JM, Goodwin KB, Mccant F, Hoenig H, Heyworth L, Zulman DM, Turvey C, Moy E, Lewinski AA. Incorporating TechQuity in Virtual Care Within the Veterans Health Administration: Identifying Future Research and Operations Priorities. Journal of general internal medicine. 2023 Jul 1; 38(9):2130-2138. [view]
  14. Lewinski AA, Jazowski SA, Goldstein KM, Whitney C, Bosworth HB, Zullig LL. Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review. Patient education and counseling. 2022 Dec 1; 105(12):3381-3388. [view]
  15. Lewinski AA, Vaughn J, Diane A, Barnes A, Crowley MJ, Steinberg D, Stevenson J, Yang Q, Vorderstrasse AA, Hatch D, Jiang M, Shaw RJ. Perceptions of Using Multiple Mobile Health Devices to Support Self-Management Among Adults With Type 2 Diabetes: A Qualitative Descriptive Study. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2021 Sep 1; 53(5):643-652. [view]
  16. Zullig LL, Lewinski AA, Woolson SL, White-Clark C, Miller C, Bosworth HB, Burleson SC, Garrett MP, Darling KL, Crowley MJ. Research-practice partnerships: Adapting a care coordination intervention for rural Veterans over 3 years at multiple sites. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2023 Jun 1; 39(3):575-581. [view]
  17. Alexopoulos AS, Soliman D, Lewinski AA, Strawbridge E, Steinhauser K, Edelman D, Crowley MJ. Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study. Journal of diabetes and its complications. 2023 Jan 1; 37(1):108364. [view]
  18. Lewinski AA, Walsh C, Rushton S, Soliman D, Carlson SM, Luedke MW, Halpern DJ, Crowley MJ, Shaw RJ, Sharpe JA, Alexopoulos AS, Tabriz AA, Dietch JR, Uthappa DM, Hwang S, Ball Ricks KA, Cantrell S, Kosinski AS, Ear B, Gordon AM, Gierisch JM, Williams JW, Goldstein KM. Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review. Journal of medical Internet research. 2022 Aug 26; 24(8):e37100. [view]
  19. Lewinski AA, Shapiro A, Bosworth HB, Crowley MJ, McCant F, Howard T, Jeffreys AS, McConnell E, Tanabe P, Barcinas S, Coffman CJ, King HA. Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews. The science of diabetes self-management and care. 2021 Oct 1; 47(5):391-403. [view]

DRA: Health Systems, Diabetes and Other Endocrine Conditions
DRE: Technology Development and Assessment, TRL - Applied/Translational
Keywords: Career Development, Diabetes
MeSH Terms: None at this time.

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