# Enhancing Diabetes and Hypertension Self-Management for Rural Appalachian Patients  In Patient-Centered Medical Homes

> **NIH NIH R34** · WEST VIRGINIA UNIVERSITY · 2021 · $190,000

## Abstract

West Virginia ranks 1st & 2nd nationally in the prevalence of diabetes and hypertension. Yet many rural patients
with comorbid diabetes and hypertension do not receive self-management support from their providers.
The goal of this R34 planning project is to test the feasibility and acceptability of a culturally-tailored,
multimodal, 6-week modified Diabetes and Hypertension Self-Management Program (M-DHSMP), that will
incorporate evidence-based key elements of diet, physical activity and medication adherence (with medication
therapy management or MTM). The M-DHSMP is an adaptation of the evidence-based curriculum of the
American Association of Diabetes Educator (AADE-7) and the JNC guidelines. Seventy five adults with
comorbid diabetes and hypertension will be recruited from the northern counties of West Virginia and
randomized with a 1:1:1 ratio. We propose to conduct a 3-arm randomized controlled trial (RCT) to compare
the 6-week M-DHSMP core intervention (diet and physical activity; n=25), 6-week M-DHSMP core plus
medication adherence with MTM (n=25) or enhanced usual care (EUC); n=25) in two geographically separated
Patient Centered Medical Homes (PCMH). We will use post-regression decomposition technique derived from
the field of econometrics to examine the extent to which key components (diet, physical activity, and
medication adherence) contribute to the differences in clinical outcomes (HbA1c and blood pressure) between
groups (M-DHSMP core and M-DHSMP core plus medication adherence). In addition, we will use qualitative
focus groups and the RE-AIM evaluation framework to evaluate the reach, efficacy, adoption, sustainability of
behavior changes, and participants’ experience and satisfaction with the program. Measures of behavioral
changes will include dietary intake, physical activity, medication adherence, using surveys, food /activity logs
and prescription filling reports. As in our prior studies, trained Health Coaches (HCs) will administer the
program and provide weekly follow-up coaching, review food/activity logs for continuous feedback and
reinforcement of health education messages. An understanding of the independent and combined effects of
key health behavior components and the role of/adoption of behavior modifications in patients with diabetes
and hypertension can validate self-management interventions models in real-world settings to reduce the
metabolic risk. The longer term effects of the intervention will be evaluated in a subsequent R01 clinical trial.
The project builds on the PI’s successful prior community-based lifestyle intervention studies in rural
Appalachia and rural India.

## Key facts

- **NIH application ID:** 10237312
- **Project number:** 5R34HL141721-03
- **Recipient organization:** WEST VIRGINIA UNIVERSITY
- **Principal Investigator:** RANJITA MISRA
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $190,000
- **Award type:** 5
- **Project period:** 2019-09-15 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10237312

## Citation

> US National Institutes of Health, RePORTER application 10237312, Enhancing Diabetes and Hypertension Self-Management for Rural Appalachian Patients  In Patient-Centered Medical Homes (5R34HL141721-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10237312. Licensed CC0.

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