title: Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS) for Diabetes.
abstract: BACKGROUND
  Multiple randomized controlled trials (RCTs) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease (CVD) outcomes. The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management; however, evaluation of its impact in minority populations is limited. This study intends to provide early evidence of a theory-driven intervention, Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS), using real-time videoconferencing for education and skills training. We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American (AA) population with poorly controlled type 2 diabetes.
  
  
  METHODS
  The study is a two-arm, pilot controlled trial that randomizes 30 participants to the TABLETS intervention and 30 participants to a usual care group. Blinded outcome assessments will be completed at baseline, 2.5 months (immediate post-intervention), and 6.5 months (follow-up). The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices, with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention materials via videoconferencing slides and a manual of supplementary materials. The primary outcomes are physical activity, diet, medication adherence, and self-monitoring behavior, whereas the secondary outcomes are HbA1c, low-density lipoprotein cholesterol (LDL-C), BP, CVD risk, and quality of life.
  
  
  CONCLUSIONS
  This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven, tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk, low-income AA population with an uncontrolled dyad or triad of CVD risk factors (diabetes with or without hypertension or hyperlipidemia). The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management. The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a subsample of patients with poor diabetes self-management.
  
  
  BACKGROUND
  The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier NCT02128854), available online at: http://clinicaltrials.gov/ct2/show/NCT02128854 .
authors.affiliation: Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, 29425, USA. lynchcp@musc.edu.|Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, 29401, USA. lynchcp@musc.edu.
authors.forename: Cheryl P
authors.initials: CP
authors.lastname: Lynch
authors.affiliation: Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, 29425, USA.
authors.forename: Joni S
authors.initials: JS
authors.lastname: Williams
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, 29401, USA.|College of Nursing and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 19 Hagood Avenue, Suite 1002, MSC 160, Charleston, SC, 29425, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: J Ruggiero
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, 29401, USA.|Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425-0835, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: G Knapp
authors.affiliation: Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, 29425, USA.|Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, 29401, USA.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D001741:Black or African American / Q000523:psychology; D002985:Clinical Protocols; D034201:Computers, Handheld; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D005240:Feasibility Studies; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D010865:Pilot Projects; D011203:Poverty; D012107:Research Design; D040242:Risk Reduction Behavior; D012648:Self Care; D013022:South Carolina; D017216:Telemedicine / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D049269:Videoconferencing