Research in the Health Behavior Change Lab addresses diabetes prevention and risk reduction and related behavioral,  psychosocial  and community issues. Examples of relevant HBCL projects are listed below:

 LIVING WITH THE DEMANDS OF DIABETES AND RELATED RISKS

       Diabetes self-care behaviors and associations with well-being.

Several studies examining diabetes self-management and quality of life are in progress or have been completed in the Health Behavior Change Lab. Studies include:

•  Reliability and validity of a measure of diabetes self-management behaviors and barriers.

                 Participants include nearly 200 adults with type 1 diabetes and 600 adults with type 2 diabetes receiving care at a diabetes care clinic.

• Depressive symptomology and associations with self-care and health outcomes in diabetes.

              Rates of depression appear to be nearly twice as high in people living with diabetes relative to the general population. This study examines depressive symptomology and other measures of distress in a clinic sample. Stability of symptomology over the course of a year was examined in a subsample of participants.

                 (Supported in part by Primary Care Research Support, HRSA, University of Louisville Department of Medicine).

•    Community levels of support and associations with diabetes self-care and quality of life.

               As part of a clinic-based Lab dissertation project (Rothschild), a supplemental project examined levels of community, neighborhood and provider support and their associations with specific domains of diabetes self-management behaviors and mental  and physical well-being.

•  Cognitive-behavioral intervention to optimize self-care and coping in diabetes.

PHYSICAL ACTIVITY ADOPTION AND MAINTENANCE AND HEALTH RISK REDUCTION

        Barriers to exercising safely when living with diabetes.

 Several studies in the HBCL have examined exercise behavior and it's challenges in adults living with diabetes. Studies include:

• Fear of hypoglycemia and exercise avoidance in adults with type 1 diabetes.

              Physical activity is an important part of the diabetes regimen. Regular exercise promotes optimal glycemic control and reduces cardiovascular risks which are increased in diabetes. Individuals with type 1 diabetes who maintain tight glycemic control have an increased risk of hypoglycemia. This study examined the relationship between fear of hypoglycemia, anxiety and avoidance of physical activity.

       (Funded by a University of Louisville Intramural Research Incentive Grant).

• Home-based maintenance of strength training in older veterans with type 2 diabetes with peripheral neuropathy.

               This pilot study followed a cohort of older male veteran’s with type 2 diabetes and peripheral neuropathy following their participation in a hospital-based strength training intervention. Maintenance of activity, barriers, pain, falls and related health risks were prospectively tracked.

        Physical activity and functional well-being.

 The HBCL has interests in primary, secondary and tertiary care, including the role of physical activity in risk-reduction, disease prevention and optimization of functional status in individuals with chronic health issues. Several theoretically-based studies of physical activity spanning this continuum have been conducted. Studies include:

• Evaluation of the Relapse Prevention Model and exercise maintenance in community-based exercisers. 

                 The Relapse Prevention Model as applied to the assessment of physical activity related constructs was examined in relation to exercise history and maintenance of activity over time.

• Evaluation of contributors to functional status in low-income, urban older women.

               The objective of this study was to evaluate functional fitness level of low income, urban-dwelling older women and the contributions of weight change, pain during activity, depressive symptomology relative to measures of fitness in predicting dependence in activities of daily Pain, depressive symptomology, and weight change explained a greater proportion of the variance in dependence in ADLs than did fitness performance measures. Results highlight the poor fitness experienced by these urban-dwelling older women and the substantial role of pain, dysphoria, and weight in the degree of independence in daily activities.

    (Funded by a University of Louisville Intramural Research Incentive Grant).

• Environmental intervention to Increase Physical Activity Levels in Low Income Women.

                 This study was conducted in conjunction with colleagues in the University of Louisville School of Nursing.  The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol and perception of physical activity were observed. Significant intervention group increases from pretest to posttest were found related to nurse practitioner support, friend support, and more positive physical activity environment at the community center.  In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

            (Funded by NIH (NIDDK, NHLBI Co-sponsors, Speck PI).

CHANGING COMMUNITY AND HEALTH PROVIDER APPROACHES TO REDUCE RISKS AND PROMOTE HEALTH AND QUALITY OF LIFE

          Community

• Community Assessment of Psychosocial and community-environmental aspects of diabetes awareness, self-care behaviors and health in African American men in Louisville’s West End.

              The Health Behavior Change lab is currently conducting a clinical-community research study in partnership with the University of Louisville Community Signature Partnership Program. The aim is to evaluate psychosocial and community-environmental aspects of diabetes awareness, self-care behaviors and health in African American men in Louisville’s West End. Participants will be recruited from community settings such as barbershops that have community outreach activities and ties to the study Community Partners. This project is  a partnership with  the Louisville Metro Department of Health and  Wellness  Center for Health Equity.

  (Funded by the University of Louisville Signature Partnership Initiative).

•  Validation of a Diabetes Self-Management Survey with Minority and Underserved Adults with Type 2 Diabetes.

               Diabetes disproportionately affects minority and medically underserved adults, however few health-specific measures have been validated in these populations. This study is an evaluation of the psychometric properties of a measure that assesses self-care behaviors, diabetes-specific perceptions and barriers to optimal care in an ethnically and geographically diverse sample of adults with type 2 diabetes. A secondary aim is to evaluate the psychosocial variables that are associated with diabetes self-management and quality of life.

  (Funded by a University of Louisville Intramural Research Incentive Grant).

     Health Providers

• Training medical students in optimal strategies for behavior change and risk reduction.

•  Training clinical psychology doctoral students and medical residents in behavioral approaches to primary care. 

              In conjunction with colleagues from the Department of Psychological and Brain Sciences (Drs. Woodruff-Borden and Newton) and Department of Medicine (Drs. Mitchell and Capter), the Louisville Integrated Primary Care Training Program provided training for interdisciplinary health trainees in integrated primary behavioral health care. This program emphasized four shared psychosocial determinants that have been associated with physical health status: Victimization and potentially traumatic stress exposure, emotional functioning, social relationship functioning, and illness representations, within the broader context of providing care for individuals who are underserved and economically disadvantaged.

(Funded by HRSA, Woodruff-Borden, PI).