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

摘要 在美国，新冠肺炎的感染、住院和死亡在种族和民族之间是不同的 (美国)，对少数族裔社区的影响不成比例。阿肯色州西北部(华盛顿州和本顿 县)是美国的“新冠肺炎热点”，该地区的种族/民族差异如此明显 与新冠肺炎有关的疾病预防控制中心来到阿肯色州西北部 在2020年6月和7月进行了调查，然后美国国立卫生研究院在早些时候派出了调查人员 2020年8月。疾控中心2020年7月的报告记录了阿肯色州西北部45%的成人病例是 在西班牙裔/拉丁裔患者中，19%是夏威夷土著/太平洋岛民(NHPI)患者。 西班牙裔/拉丁裔和NHPI分别只占两县人口的17%和2.4%。 阿肯色州西北部的新冠肺炎死亡人数也因种族和民族而异。NHPI死亡人数为 据估计，每10万人中有200多人死亡--远远高于该县5.10%的总体死亡率 100K，以及白人每100K中4.03的死亡率。当务之急是增加新冠肺炎 进行测试并为未来的疫苗接种试验做准备，特别是在#年的NHPI和西班牙裔/拉丁裔社区 阿肯色州西北部。目前测试的接受率很低，不到5%，我们的需求评估发现 确定的首选地点是在目标地区进行得来速测试和得来速测试的诊所 住宅综合体和社区。我们将采用以社区为基础的参与式研究方法 以社会生态模型(SEM)为目标的测试策略将产生最大的影响。我们的 具体目标是：目标1：充分利用和充分利用我们基于社区的长期伙伴关系，以 增加新冠肺炎检测并为未来的疫苗接种试验做准备；目标2：实施和评估可获得性 和采用两种社区驱动的新冠肺炎测试方法，以了解有效性和 对弱势人群的影响；目标2a：评估哪些考点在达到特定目标方面最有效 基于年龄、种族/族裔和性别的弱势群体；目标2b：审查社会决定因素如何 影响健康的检测行为和首选检测地点；目标2c：开展实施研究，以 记录以社区为基础的测试方法的促进者和障碍；以及目标3：充分 与RADx-UP协调和数据收集中心(CDCC)及其他RADx-UP站点协作。这个 建议的研究目标直接建立在我们的协作需求评估和我们的 社区和科学咨询委员会(CSAB)。我们目前的基础设施和伙伴关系一直是 保持了七年多的时间，通过当地、 机构和联邦政府的支持。我们相信，我们能够利用这些合作伙伴关系来应对COVID- 19项缓解努力，包括潜在的疫苗和/或治疗实施努力。

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.