comparative effectiveness of family vs. individually focused diabetes education and support

Conditions: Diabetes Mellitus; High Blood Pressure; High Blood Sugar; Hypertension

Summary: the objective of this study is to compare the effectiveness of a novel program-family support for health action (fam-act) - to individual patient-focused diabetes self-management education and support (i-dsmes).

fam-act uses three innovative approaches to enhance the impact of family support on diabetes management for adults with diabetes (awds): 1. coach family supporters in regular discussions about awds' diabetes progress and goals that uses empathetic and autonomy-supportive communication, 2. coach family supporters in practical roles that support diabetes-specific tasks tailored to awds' personal goals, 3. leverage family support in the setting of other types of social support for awds (support from other awds and their family members and community health workers (chws)) fam-act will be developed and implemented in culturally-concordant ways, in partnership with the community participating in the program. adults with type 2 diabetes and either poor glycemic or blood pressure control will be randomized together with a support person (a chosen adult family member or friend) to receive either fam-act or more traditional chw-led patient-focused i-dsmes over 6 months. see our published protocol (deverts et al 2022; full citation in references section) for additional details on the protocol including any changes made after the study started.

Eligibility criteria:
patient inclusion criteria: 1. have a diagnosis of type 2 diabetes 2. most recent hba1c done in the 3 months prior to screening phone call \>= 7.5% 3. plan to use recruiting site for health care over the next 12 months after enrollment 4. must be able to identify a family member or friend who is willing to be involved in their health care patient exclusion criteria: 1. diagnosis (active or prior) of alzheimer's disease or dementia 2. preferred language is not english or spanish 3. diagnosis (active or prior) of schizophrenia or other psychotic/delusional disorder in chass emr problem list as of screening call date 4. diagnosis of gestational diabetes without any other diabetes diagnoses 5. diagnosed with diabetes at age \< 21 years 6. pregnant or planning to become pregnant in the next 12 months 7. concerns that may make it difficult to participate (ongoing health issues, personal events, etc.) 8. have a life-limiting severe illness (e.g. chronic obstructive pulmonary disease requiring oxygen) support person inclusion criteria: 1. able to attend intervention sessions in person or remotely via online video-conferencing 2. at least 21 years old support person exclusion criteria: 1. does not speak english or spanish 2. receives pay for caring for the patient 3. has self-reported serious mental illness (schizophrenia) 4. has a life-limiting severe illness (e.g. chronic obstructive pulmonary disease requiring oxygen) 5. has significant cognitive impairment (alzheimer's disease or dementia) 6. lives in a nursing home or long-term care facility 7. concerns that may make it difficult to participate (ongoing health issues, personal events, etc.)

Keywords: diabetes patient activation self management education self management behavior autonomy support social support caregiver family support glycemic control