Exploring the Adaption of Mindfulness in Native American Communities to Address Diabetes

项目概要（探索美国土著社区正念的适应性以解决糖尿病问题） 美洲原住民有较高的合同率，经历并发症，和死亡，由于糖尿病（1）（2）（3）。有几个因素可能会影响糖尿病的健康差异，包括对糖尿病的本土文化信仰和对西医的不信任，导致不良的健康行为（3）（4）。此外，众所周知，压力会加剧糖尿病的生理影响，并通过与压力相关的不良健康行为（5）（6）（7），日常压力的影响可能会因原住民社区的历史压力而加剧（8）。 正念冥想可能是一种有效的手段，以减少心理和生理压力，以及通过高度重视糖尿病管理协议鼓励良好的健康行为（9）（10）. 虽然以前的研究表明，正念练习可能是受欢迎的原住民社区（11）（12）（13），仍然很少有人知道适应正念干预土著文化传统的过程。我们建议：（A）与部落成员密切合作，在K99的第一阶段发展对正念研究的信任和支持;（B）在K99的第二阶段开发一个核心的本土特定MBSR课程，其中包含可以定制为部落特定的可选模块;以及（C）在R 00阶段，使用双臂可行性试验，进一步开发核心的本土特定的正念课程与定制模块，并评估我们的研究设计在糖尿病成人中的可行性。主要结果是可行性和可接受性的措施。次要结果包括糖尿病管理的行为和生理标志物。我们希望这些数据将激励R 01级检查正念作为改善糖尿病管理和减少土著社区糖尿病并发症的手段的有效性。这个K99/R 00是将正念计划与本土实践相结合的最终目标的初步步骤，作为全面解决本土健康差异的一种手段。这些努力可能会被证明在一个对西医表现出臭名昭著的不信任的人群中特别重要。

PROJECT SUMMARY (Exploring the Adaption of Mindfulness in Native American Communities to Address Diabetes) Native Americans have higher rates of contracting, experiencing complications from, and death due to diabetes (1)(2)(3). Several factors may influence health disparities in diabetes, including Native cultural beliefs about diabetes and distrust of western medicine resulting in poor health behaviors (3)(4). Further, as stress is known to exacerbate the effects of diabetes physiologically and through poor health behaviors associated with stress (5)(6)(7), the effects of daily stress may be compounded by historical stress in Native communities (8). Mindfulness-meditation may be an effective means to reduce psychological and physiological stress as well as encourage good health behaviors through heightened attention to diabetes management protocols (9)(10). Although previous studies have indicated that mindfulness practices may be welcome in Native communities (11)(12)(13), there is still little known about the process of adapting mindfulness interventions to Native cultural traditions. We propose to (A) work closely with tribal members to develop trust and support for mindfulness research in the first phase of the K99, (B) develop a core Native-specific MBSR class with optional modules that can be tailored to be Tribe-specific in the second phase of the K99, and (C) in the R00 phase, use two- armed feasibility trials to further develop the core Native-specific mindfulness class with tailored modules and to assess the feasibility of our study design among diabetic adults. Primary outcomes are measures of feasibility and acceptability. Secondary outcomes include behavioral and physiological markers of diabetes management. We hope that these data will motivate an R01-level examination into the efficacy of mindfulness as a means to improve diabetes management and reduce complications due to diabetes in Native communities. This K99/R00 is the preliminary step in the ultimate goal of integrating mindfulness programs with Native contemplative practices as a means to holistically address Native health disparities. These efforts may prove particularly important in a population that has shown a notorious distrust for western medicine.