The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness

Frontiers in Psychology

Psychology

Patrick J. O'Connor¹  Michael D. Evans²  Lillian Gelberg³  Mark Linzer⁴  Andrew M. Busch⁵  Victor M. Montori⁶  Michele Heisler⁷  Zobeida Bonilla⁸  John Connett⁸  Ella Strother⁹  Becky R. Ford⁹  Katherine Diaz Vickery^1,10  Edward Adair^1,11  Susan Gust^1,11 

[1] Center for Chronic Care Innovation, HealthPartners Institute, Bloomington, MN, United States;Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States;Department of Family Medicine, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, United States;Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States;Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States;The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States;Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States;Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States;School of Public Health, University of Minnesota, Minneapolis, MN, United States;The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States;Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States;The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States;Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States;The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States;The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States;

关键词: diabetes;    health equity;    homelessness;    behavioral trials;    behavioral activation trauma;    behavioral activation;   

DOI  :  10.3389/fpsyg.2023.1225777

 received in 2023-05-19, accepted in 2023-08-08,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionCompared to stably housed peers, people experiencing homelessness (PEH) have lower rates of ideal glycemic control, and experience premature morbidity and mortality. High rates of behavioral health comorbidities and trauma add to access barriers driving poor outcomes. Limited evidence guides behavioral approaches to support the needs of PEH with diabetes. Lay coaching models can improve care for low-resource populations with diabetes, yet we found no evidence of programs specifically tailored to the needs of PEH.MethodsWe used a multistep, iterative process following the ORBIT model to develop the Diabetes Homeless Medication Support (D-HOMES) program, a new lifestyle intervention for PEH with type 2 diabetes. We built a community-engaged research team who participated in all of the following steps of treatment development: (1) initial treatment conceptualization drawing from evidence-based programs, (2) qualitative interviews with affected people and multi-disciplinary housing and healthcare providers, and (3) an open trial of D-HOMES to evaluate acceptability (Client Satisfaction Questionnaire, exit interview) and treatment engagement (completion rate of up to 10 offered coaching sessions).ResultsIn step (1), the D-HOMES treatment manual drew from existing behavioral activation and lay health coach programs for diabetes as well as clinical resources from Health Care for the Homeless. Step (2) qualitative interviews (n = 26 patients, n = 21 providers) shaped counseling approaches, language and choices regarding interventionists, tools, and resources. PTSD symptoms were reported in 69% of patients. Step (3) trial participants (N = 10) overall found the program acceptable, however, we saw better program satisfaction and treatment engagement among more stably housed people. We developed adapted treatment materials for the target population and refined recruitment/retention strategies and trial procedures sensitive to prevalent discrimination and racism to better retain people of color and those with less stable housing.DiscussionThe research team has used these findings to inform an NIH-funded randomized control pilot trial. We found synergy between community-engaged research and the ORBIT model of behavioral treatment development to develop a new intervention designed for PEH with type 2 diabetes and address health equity gaps in people who have experienced trauma. We conclude that more work and different approaches are needed to address the needs of participants with the least stable housing.

【 授权许可】

Unknown   
Copyright © 2023 Vickery, Ford, Gelberg, Bonilla, Strother, Gust, Adair, Montori, Linzer, Evans, Connett, Heisler, O'Connor and Busch.