Optimizing an Adaptive Self-care Support Intervention for Adults with Type 2 Diabetes Leveraging their Social Relationships

Project Summary/Abstract Successful management of type 2 diabetes (T2D) requires daily self-care behaviors which largely occur within the context of patients’ social relationships. Chronic diseases, like T2D, have high levels of heterogeneity in response to self-care support interventions, suggesting a sequential, individualized approach may maximize benefits for the largest proportion of patients. Adaptive interventions mirror clinical care by applying a series of “if-then” decision rules that dictate which intervention components are delivered over time, according to how individuals respond. They are especially well suited to the management of chronic conditions. To date, all adaptive interventions for chronic disease management are delivered individually; none have involved social support. Adaptive interventions leveraging social relationships could reduce heterogeneity in response to self- care support interventions and better meet the needs of adults with T2D. During this K23 award, the principal investigator (PI) will address these gaps in the extant literature while participating in a mentored training experience that will prepare her for success as an independent investigator who develops and tests adaptive interventions to improve the health and well-being of adults with T2D by leveraging the power of social support. Specific training goals include: (1) deepen knowledge in behavioral diabetes research, (2) develop skills in qualitative and mixed methods, (3) apply Multiphase Optimization Strategy (MOST) framework to develop and optimize adaptive interventions, and (4) lead a clinical trial and strengthen responsible conduct of research skills. The proposed research includes two specific aims. Aim 1: The PI will adapt components of an evidence- based family-focused self-care support intervention to target peer-support rather than family-support. Adults with T2D (n=30) will be recruited to participate in focus groups and iterative rounds of testing to refine the peer- support components prior to evaluation. A community engagement studio will advise protocols and recruitment. Aim 2: The PI will recruit and randomize 60 adults with T2D to a pilot sequential multiple assignment randomized trial (SMART) to test the acceptability and feasibility of random assignment to multiple social- support focused interventions. The PI will report on the feasibility and acceptability of this innovative approach to adaptive interventions as well as conduct interviews with participants to further improve the interventions through a robust mixed-methods evaluation. Improvements, if needed, will be made prior to proposing a fully powered SMART to optimize the adaptive interventions. At the conclusion of this work, the PI will have robust preliminary data on the feasibility and acceptability of optimization methodology in adults with T2D, namely multiple randomizations to social support-focused interventions, to inform a R01-funded SMART. This unique expertise will accelerate the PI’s independent research career as an expert in adaptive interventions for adults with T2D. Moreover, it will help the PI reach her ultimate goal of developing and testing adaptive interventions to improve health and well-being of adults with T2D leveraging their social relationships.