An Adolescent-mediated intervention to improve diabetes prevention and management in Pacific Islander Families

以青少年为媒介的干预措施，以改善太平洋岛民家庭的糖尿病预防和管理

• 批准号: 10367592
• 负责人: Nicola Hawley
• 金额: $ 35.9万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10367592
• 关键词: Active Learning; Address; Adolescent; Adoption; Adult; American; American Samoa; Behavior; Blood Pressure; Body mass index; Caring; Child; Chronic Disease; Communication; Control Groups; Diabetes Mellitus; Diabetes prevention; Diagnosis; Educational Curriculum; End stage renal failure; Exposure to; Face; Family; Family member; Future; Generations; Glycosylated hemoglobin A; Goals; Health; Health behavior change; Home; Household; Individual; Insurance; Intervention; Knowledge; Leadership; Life; Linguistics; Low income; Maintenance; Measures; Mediating; Minority Groups; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Island Americans; Parents; Participant; Personal Communication; Personal Satisfaction; Phase; Population; Prediabetes syndrome; Prevalence; Prevention; Prevention strategy; Primary Health Care; Program Acceptability; Randomized; Randomized Controlled Trials; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Role; Samoan; Self Care; Structure; Testing; Treatment Efficacy; United States; Work; barrier to care; base; behavior change; beneficiary; cardiovascular risk factor; cost; diabetes control; diabetes management; diabetes prevention program; diabetes self-management; disorder risk; efficacy evaluation; efficacy outcomes; ethnic minority population; family structure; feasibility testing; glycemic control; grandparent; group intervention; health care availability; health disparity; health literacy; implementation outcomes; improved; innovation; intervention effect; learning strategy; literacy; mathematical ability; novel; novel strategies; preventive intervention; program costs; programs; scale up; self-management program; skills; social relationships; therapy design; treatment program; treatment strategy; waist circumference

PROJECT SUMMARY The number of individuals diagnosed with Type 2 Diabetes in the United States (US) has more than doubled since 2000 to over 30 million, with an additional 84.1 million living with prediabetes. One minority group at particular risk is Pacific Islanders (PIs), who are at disproportionate risk and face many barriers (structural and cultural) to engaging in prevention or self-care. To address the critical need for diabetes prevention and treatment programs that target PIs, and building on the family-centered culture, our objective is to pilot test and evaluate a randomized controlled trial of an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired, adult family member with diagnosed diabetes. Building on our own prior work we have adapted an efficacious, primary care-based diabetes self-management program for delivery to adolescents. Specifically, we refined intervention content to focus on behaviors that contributed to glycemic control in prior iterations of the program, adapted the content to target adolsecents as agents of change by adding communication and leadership skills, and incorporated experiential learning activities. We will examine the efficacy of the intervention with a pilot randomized controlled trial. We will randomize n=160 dyads (an adolescent (without diabetes) and a parent/grandparent diagnosed with diabetes who share a household). Adolescents will receive either the six-month diabetes intervention or a leadership and life skills- focused control curriculum in groups (n=10 participants in each group). Aside from planned research assessments we will have no contact with the adults in the dyad, who will proceed with their usual diabetes care. To test our hypothesis that adolescents receiving the intervention will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe that exposure to the intervention may encourage positive behavior change in the adolescent themselves we will measure similar outcomes in the adolescents. Outcomes will be measured at baseline, at the end of the active intervention phase (six months post- randomization) and at 12-months post-randomization, to examine maintenance of intervention effects in the absence of contact. To determine potential for long-term sustainability and scale up, we will examine program acceptability, feasibility, fidelity, reach, and cost. Successful completion of our aims and proof of efficacy would produce an innovative, scalable program with high potential for replication in other similar, low-resource, family-centered, ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

项目概要 美国 (US) 被诊断患有 2 型糖尿病的人数增加了一倍多 自 2000 年以来，这一数字已超过 3000 万，另有 8410 万患有糖尿病前期。一个少数群体在 太平洋岛民 (PI) 面临的风险尤其大，他们面临着不成比例的风险，并面临许多障碍（结构性和 文化）进行预防或自我保健。满足糖尿病预防和治疗的迫切需求 针对 PI 的治疗计划，并以家庭为中心的文化为基础，我们的目标是进行试点测试并 评估一项由青少年介导的干预措施的随机对照试验，旨在改善 一对患有糖尿病的成年家庭成员的血糖控制和自我护理实践。建立在 我们自己之前的工作已经采用了有效的、基于初级保健的糖尿病自我管理计划 用于交付给青少年。具体来说，我们细化了干预内容，重点关注有助于 在该计划的先前迭代中，为了控制血糖，调整了内容以青少年为目标 通过增加沟通和领导技能并纳入体验式学习活动来改变。我们 将通过试点随机对照试验来检查干预措施的有效性。我们将随机化 n=160 双人组（青少年（没有糖尿病）和被诊断患有糖尿病的父母/祖父母，他们共享一个 家庭）。青少年将接受为期六个月的糖尿病干预或领导力和生活技能- 小组集中控制课程（每组 10 名参与者）。除了计划中的研究之外 我们不会与二人组中的成年人进行评估，他们将继续患有通常的糖尿病 关心。检验我们的假设，即接受干预的青少年将是糖尿病的有效传播者 知识并会支持他们的配对成年人采用自我护理策略，这是我们的主要功效 结果将是成人血糖控制和心血管危险因素（体重指数、血压、腰围） 圆周）。其次，因为我们相信接受干预可能会鼓励积极的 青少年本身的行为变化，我们将测量青少年的类似结果。 结果将在主动干预阶段结束时（干预后六个月）在基线进行衡量 随机化）和随机化后 12 个月，以检查干预效果的维持情况 没有联系。为了确定长期可持续性和扩大规模的潜力，我们将检查计划 可接受性、可行性、保真度、影响范围和成本。成功完成我们的目标并证明功效将 产生一个创新的、可扩展的项目，在其他类似的、资源匮乏的、 美国各地以家庭为中心的少数族裔群体是创新的理想受益者，以减少 慢性病风险并消除健康差距。