Evaluation of the effectiveness of Ajjmuurur Baamḷe DSMES in the RMI

Ajjmuurur Baamá¸e DSMES 在 RMI 中的有效性评估

• 批准号: 10364952
• 负责人: Pearl Mcelfish
• 金额: $ 64.49万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364952
• 关键词: Acquired Blindness; Address; Adherence; Affect; Aftercare; Arkansas; Behavior; Behavioral; Blood Pressure; Body mass index; Cardiometabolic Disease; Communities; Community Health Aides; Complications of Diabetes Mellitus; Data; Diabetes Mellitus; Distress; Education; Educational Curriculum; Evaluation; Family; Family member; Fasting; Free Association; Funding; Glycosylated hemoglobin A; Goals; Health; Health Expenditures; Healthcare; Indigenous; Intervention; Kidney Failure; Knowledge; Life Expectancy; Lipids; Lower Extremity; Marshall Islands; Measures; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Pacific Islands; Participant; Patient-Focused Outcomes; Patients; Periodicity; Persons; Physicians; Population; Prevalence; Process; Quality of life; Randomized; Research; Resources; Risk Factors; Self Efficacy; Self Management; Services; United States; United States National Institutes of Health; Waiting Lists; Work; arm; base; behavior change; behavioral adherence; cardiometabolic risk; community based participatory research; community organizations; comparison group; cultural values; diabetes educator; diabetes self-management; effectiveness evaluation; effectiveness testing; empowerment; experience; family influence; family support; fasting glucose; glycemic control; health care service; health disparity; heart disease risk; improved; innovation; limb amputation; medication compliance; minority communities; motivational enhancement therapy; post intervention; primary outcome; public health relevance; treatment group; waist circumference

ABSTRACT Health disparities in the Republic of the Marshall Islands (RMI) are striking with extremely high rates of diabetes and other cardiometabolic diseases. Documented rates of type 2 diabetes mellitus (T2DM) in the RMI range from 20%-50%. This is significantly higher than global (8.5%) and US (11%) rates. The extreme disparities in the RMI are exacerbated by a lack of research, lack of funding, a lack of services, and a lack of culturally-appropriate interventions. Residents of the RMI experience unique barriers to self-management of T2DM, as well as possess unique cultural assets that can be leveraged to help mitigate these barriers. The research team worked with the Marshallese community in Arkansas to develop and evaluate a culturally- adapted family model of DSMES (Ājjmuurur Baamḷe DSMES). Ājjmuurur Baamḷe DSMES is based on a collectivist approach, incorporates Marshallese cultural practices, and uses “talk story” as a conversational, rhythmic, and culturally preferred way of sharing knowledge. Ājjmuurur Baamḷe DSMES includes family members as participants and focuses on family motivational interviewing, family goal setting, and family behavioral change with specific focus on education about supportive and nonsupportive family behaviors. The curriculum is assets based and it works to overcome barriers facing Marshallese patients by leveraging culturally specific facilitators of healthy behavior change. Our central hypothesis is that persons who receive the Family Model DSMES "Ājjmuurur Baamḷe" will have improved HbA1c (primary outcome), blood pressure, lipids, BMI, increased knowledge, self-efficacy, empowerment, and quality of life, along with decreased diabetes-related complications and diabetes-related distress. This study's objective is to conduct a cluster RCT using a wait-list control to evaluate the effectiveness of Ājjmuurur Baamḷe DSMES when delivered in faith- based organizations (FBOs) by Community Health Workers (CHWs). Our specific aims are: 1. Test the effectiveness of Ājjmuurur Baamḷe DSMES to improve diabetes-related outcomes among Marshallese patients; 2. Evaluate the effect of Ājjmuurur Baamḷe DSMES on family members; and 3. Conduct an indigenous evaluation to understand the extent to which the intervention adheres to Pacific Islander cultural values and evaluate the cultural appropriateness of the research. Data will be collected from patients (Aim 1) and their family members (Aim 2) at baseline, immediately post-intervention (12 weeks), at four months and twelve months post-intervention. An indigenous evaluation (Aim 3) will be conducted at six months and each year thereafter to document and inform process improvement efforts in study implementation. While the Marshallese are a small population, this population is underrepresented in research, and they are experiencing a health crisis that must be addressed. The proposed study offers a promising intervention that has the potential to affect substantially health disparities experienced by Marshallese and other Pacific Islanders in the USAPI.

摘要 马歇尔群岛共和国的健康差距十分惊人， 糖尿病和其他心脏代谢疾病。RMI中记录的2型糖尿病（T2 DM）发生率 范围从20%-50%。这明显高于全球（8.5%）和美国（11%）的发生率。极端 由于缺乏研究、缺乏资金、缺乏服务和缺乏 适当的文化干预。马绍尔群岛的居民在自我管理方面遇到了独特的障碍， T2 DM，以及拥有独特的文化资产，可以用来帮助减轻这些障碍。的 一个研究小组与阿肯色州的马绍尔社区合作，开发和评估一个文化- 适应家庭模式的DSMES（DJJJMUURUR BAAM BASEE DSMES）。DJJJMUURUR BAAM BASHE DSMES基于一个 集体主义方法，结合马绍尔文化习俗，并使用“谈话故事”作为对话， 有节奏的，文化上喜欢的分享知识的方式。Djjjmuurur Baam Bae DSMES包括家庭 成员作为参与者，并侧重于家庭动机访谈，家庭目标设定，和家庭 行为改变，特别注重关于支持和不支持家庭行为的教育。的 课程以资产为基础，通过利用 健康行为改变的特定文化促进者。我们的中心假设是， 家庭模型DSMES“BJJJMUURUR BAAM BJEE”将改善HbA 1c（主要结果），血压， 血脂、BMI、知识增加、自我效能、赋权和生活质量，沿着降低 糖尿病相关并发症和糖尿病相关痛苦。本研究的目的是进行一项随机对照试验 使用等待列表控制来评估jjmuurur Baam e DSMES在诚信交付时的有效性- 社区卫生工作者（CHW）。我们的具体目标是：1.测试 * 在马绍尔群岛患者中，改善糖尿病相关结果的DSMES的有效性; 2.评估家庭成员对家庭健康的影响; 3.进行一次土著 进行评估，以了解干预措施在多大程度上符合太平洋岛民的文化价值观， 评估研究的文化适当性。将从患者（目标1）及其 基线、干预后即刻（12周）、4个月和12个月时的家庭成员（目标2） 干预后几个月。每年每六个月进行一次土著评价（目标3） 随后记录并告知研究实施过程中的改进工作。而 马绍尔人是一个小的人口，这一人口在研究中代表性不足，他们正在经历 这是一个必须解决的健康危机。这项拟议的研究提供了一种有希望的干预措施， 对马绍尔群岛人和其他太平洋岛民在健康方面的巨大差距产生重大影响的可能性 USAPI。