Roddy McKenzie K, Spieker Andrew J, Greevy Robert A, Nelson Lyndsay A, Berg Cynthia, Mayberry Lindsay S
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States.
Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN 37203,United States.
Ann Behav Med. 2025 Jan 4;59(1). doi: 10.1093/abm/kaae070.
Observationally, family and social support are important for optimal diabetes self-management; however, interventions targeting family/social support have not consistently been effective. A novel, diabetes-specific family functioning typology offers the opportunity to classify types of baseline family functioning to determine for whom family interventions may be effective.
We examined the effects of an intervention by baseline type of family functioning post hoc, to inform differential benefit from interventions.
Participants were randomized to enhanced treatment as usual or a 9-month, mobile phone-delivered, family-focused, self-care support intervention. Adults with type 2 diabetes (N = 318) who participated in the randomized clinical trial (RCT) and provided baseline data were included. We determined participants' diabetes-specific family functioning types at baseline using a validated, survey-administered, typology assessment tool. We investigated the associations between type and engagement (eg, attending coaching sessions and responding to text messages) and psychosocial (eg, well-being and diabetes distress) and glycemic outcomes at mid- and post-treatment.
Despite overall high engagement, there was variability across types in engagement and effects. WantMoreInvolvement benefited the most; Satisfied withLowInvolvement showed early improvements that waned; Collaborative &Helpful were highly engaged but derived minimal benefits from the intervention; and CriticallyInvolved benefitted the least and may have experienced some harm.
We demonstrated the utility of a novel diabetes-specific family functioning typology to explain variability in response to a family-focused intervention. Findings from this work answer the calls for systems-level consideration in precision behavioral medicine and drive hypothesis generation for future, tailored interventions.
The larger RCT is registered with ClinicalTrials.gov (NCT04347291).
观察表明，家庭和社会支持对于优化糖尿病自我管理很重要；然而，针对家庭/社会支持的干预措施并不总是有效。一种新颖的、针对糖尿病的家庭功能类型学为分类基线家庭功能类型提供了机会，以确定家庭干预措施对哪些人可能有效。
我们事后根据基线家庭功能类型研究了一种干预措施的效果，以为干预措施的差异效益提供信息。
参与者被随机分配到强化常规治疗组或为期9个月、通过手机提供的、以家庭为重点的自我护理支持干预组。纳入了参与随机临床试验（RCT）并提供基线数据的2型糖尿病成年人（N = 318）。我们使用经过验证的、通过调查 administered的类型学评估工具在基线时确定参与者的糖尿病特异性家庭功能类型。我们研究了类型与参与度（例如，参加指导课程和回复短信）以及治疗中期和后期的心理社会（例如，幸福感和糖尿病困扰）及血糖结果之间的关联。
尽管总体参与度较高，但不同类型在参与度和效果方面存在差异。“希望更多参与”受益最大；“对低参与度满意”显示出早期改善但逐渐减弱；“协作且有帮助”参与度很高，但从干预中获得的益处最小；“极度参与”受益最少，可能还受到了一些伤害。
我们证明了一种新颖的糖尿病特异性家庭功能类型学在解释对以家庭为重点的干预措施反应差异方面的实用性。这项工作的结果回应了精准行为医学中系统层面考虑的呼声，并推动了未来量身定制干预措施的假设生成。
更大规模的RCT已在ClinicalTrials.gov（NCT04347291）上注册。
