Addressing Marshallese Immigrant Barriers to Diabetes Self-Management through Family DSMES

摘要 COVID-19感染，住院和死亡在美国的种族和民族群体中存在差异 美国，对少数民族社区的影响不成比例。西北阿肯色州（华盛顿和本顿 县）是美国的“COVID-19热点”，该地区报告了如此明显的种族/民族差异 美国疾病控制和预防中心（CDC）来到阿肯色州西北部， 在2020年6月和7月进行调查，然后美国国立卫生研究院派出调查人员在早期 2020年8月。疾病预防控制中心2020年7月的报告记录了阿肯色州西北部45%的成人病例 在西班牙裔/拉丁裔患者中，19%为夏威夷土著/太平洋岛民（NHPI）患者。 西班牙裔/拉丁裔和NHPI分别只占两个县人口的17%和2.4%。 阿肯色州西北部的COVID-19死亡人数在种族和民族之间也存在差异。NHPI死亡人数 据估计，每10万人中有200多人死亡，远远高于该县5.10人的总死亡率。 100 K，以及每100 K 4.03白人的死亡率。迫切需要增加COVID-19 测试和准备未来的疫苗接种试验，特别是对NHPI和西班牙裔/拉丁裔社区， 阿肯色州西北部。目前检测的采用率很低，不到5%，我们的需求评估发现， 确定的首选地点是具有免下车测试的诊所， 住宅区和社区。我们将采用以社区为基础的参与式研究方法， 通过社会生态模型（SEM）来确定将产生最大影响的测试策略。我们 具体目标是：目标1：充分利用和充分参与我们长期以来以社区为基础的伙伴关系， 增加COVID-19检测并为未来的疫苗接种试验做好准备;目标2：实施和评估获取 以及两种社区驱动的COVID-19检测方法的采用策略，以了解有效性， 目标2a：评价哪些检测点在接触特定人群方面最有效; 基于年龄、种族/族裔和性别的弱势群体;目标2b：研究 健康影响测试行为和首选测试地点;目标2c：进行实施研究， 记录实施基于社区的测试方法的促进因素和障碍;目标3：充分 与RADx-UP协调和数据收集中心（CDCC）和其他RADx-UP站点合作。的 拟议的研究目标直接建立在我们的合作需求评估和建议，从我们的 社区和科学咨询委员会（CSAB）。我们目前的基础设施和合作伙伴关系 持续了七年多，并通过当地， 机构和联邦支持。我们有信心，我们可以利用这些伙伴关系，以应对新冠肺炎- 19项缓解工作，包括潜在的疫苗和/或治疗实施工作。

ABSTRACT COVID-19 infections, hospitalizations, and deaths are disparate across racial and ethnic groups in the United States (US), disproportionately impacting minority communities. Northwest Arkansas (Washington and Benton Counties) is a “COVID-19 Hot Spot” in the US, with the region reporting such stark racial/ethnic disparities related to COVID-19 that the Centers for Disease Control and Prevention (CDC) came to Northwest Arkansas to investigate in June and July 2020 and then the National Institutes of Health sent investigators in early August 2020. The CDC's July 2020 report documented that 45% of all adult cases in Northwest Arkansas were among Hispanic/Latinx patients and 19% were Native Hawaiian/Pacific Islander (NHPI) patients. Hispanic/Latinxs and NHPIs, only account for 17% and 2.4% of the two-county population, respectively. COVID-19 deaths in Northwest Arkansas were also disparate across race and ethnicity. NHPI deaths were estimated to be more than 200 per 100K —much higher than the overall death ratio for the county of 5.10 per 100K, as well as the death ratio for Whites of 4.03 per 100K. There is an urgent need to increase COVID-19 testing and prepare for future vaccination trials, especially for the NHPI and Hispanic/Latinx communities of Northwest Arkansas. The uptake of current testing is low, less than 5%, and our needs assessment found the top preferred locations identified were clinics with drive-through testing and drive-through testing in targeted housing complex and neighborhood. We will use a community-based participatory research approach guided by the Social Ecological Model (SEM) to target testing strategies that will have the greatest impact. Our specific aims are: Aim 1: leverage and fully engage our long-standing community-based partnerships to increase COVID-19 testing and prepare for future vaccination trials; Aim 2: implement and evaluate access and uptake strategies of two community-driven COVID-19 testing approaches to understand effectiveness and impact for vulnerable populations; Aim 2a: evaluate which testing sites are most effective in reaching specific vulnerable populations based on age, race/ethnicity, and sex; Aim 2b: examine how social determinants of health influence testing behaviors and preferred testing location; Aim 2c: conduct an implementation study to document facilitators and barriers to implementation of community-based testing methods; and Aim 3: fully collaborate with the RADx-UP Coordinating and Data Collection Center (CDCC) and other RADx-UP sites. The proposed study aims are built directly on our collaborative needs assessment and recommendations from our Community and Scientific Advisory Board (CSAB). Our current infrastructure and partnerships have been sustained for more than seven years and have been highly productive across multiple projects through local, institutional, and federal support. We are confident that we can leverage these partnerships to address COVID- 19 mitigation efforts, including potential vaccine, and/or therapeutic implementation efforts.