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

项目总结(探索正念在美洲原住民社区中的适应以解决糖尿病问题) 美洲原住民患糖尿病、出现并发症和死于糖尿病的比率较高(1)(2)(3)。几个因素可能影响糖尿病的健康差异，包括土著文化对糖尿病的信仰和对西药的不信任导致不良的健康行为(3)(4)。此外，众所周知，压力会在生理上加剧糖尿病的影响，并通过与压力相关的不良健康行为(5)(6)(7)，在土著社区中，日常压力的影响可能会因历史压力而加剧(8)。 正念-冥想可能是一种有效的手段，通过加强对糖尿病治疗方案的关注，减少心理和生理压力，并鼓励良好的健康行为。 虽然先前的研究表明，正念练习在土著社区可能是受欢迎的(11)(12)(13)，但关于正念干预如何适应土著文化传统的过程仍然知之甚少。我们建议(A)在K99的第一阶段与部落成员密切合作，以建立对正念研究的信任和支持；(B)在K99的第二阶段，开发核心的原住民专用MBSR课程，其可选模块可以针对部落特定的定制；以及(C)在R00阶段，使用双臂可行性试验进一步开发核心的原住民专属正念课程，并评估我们在成人糖尿病患者中进行研究设计的可行性。主要结果是对可行性和可接受性的衡量。次要结果包括糖尿病治疗的行为和生理指标。我们希望这些数据将激励对正念的有效性进行R01级别的检查，以此作为改善糖尿病管理和减少土著社区糖尿病并发症的一种手段。K99/R00是最终目标的第一步，目的是将正念项目与原住民冥想练习相结合，作为一种整体解决原住民健康差距的手段。在一个臭名昭著地对西医表现出不信任的人群中，这些努力可能会被证明尤其重要。

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.