A Mobile Health Intervention to Reduce Diabetes Disparities in Chinese Americans

项目总结/摘要 华裔美国人是美国增长最快的移民群体之一，他们遭受的痛苦不成比例 高2型糖尿病（T2 D）负担和T2 D控制不良。尽管有充分的证据表明T2 D 在这一少数群体中存在差异，为改善中国人的健康结果所做的工作有限。 美国人这个独立之路奖（K99/R 00）的目标是加快候选人的 过渡到一个独立的研究者，他在开发和评价方面拥有集中的专业知识， 在文化和语言上量身定制和可持续的干预措施，以减少中国T2 D的差异 美国人在此奖项的K99阶段，候选人将获得完成此任务所需的关键培训 目标，并将开发一种短消息服务（SMS）干预，以改善中国的T2 D管理 美国人在R 00阶段，候选人将利用获得的技能进行试点随机对照 试验，以检查SMS干预的潜在功效。在K99阶段，候选人还将 开展试点工作，开发适合语言和文化的短信干预内容，并完善 在R 00阶段测试干预措施。更具体地说，目标是：1）确定障碍的特征， 2）促进美籍华裔T2 D患者的血糖控制（目标1a）; 2）在文化和语言方面发展 定制SMS干预内容（目标1b）;以及3）评估SMS的可行性和可接受性 干预前，后测试研究（目标1c）。在R 00阶段，候选人将细化短信干预 基于K99试点数据，并评估其在试点随机 在66名华裔美国T2 D患者中进行的对照试验（Aim 2）。受试者将被随机分配至2组之一 组（每组n=33）：1）等待名单控制和2）短信干预。两组将继续接受标准的 治疗T2 D。短信组将通过短信链接收到简短的生活方式咨询视频。在 研究结束后，等待名单对照组将有机会收到基于SMS的 咨询视频将在基线、3个月和6个月时进行测量。主要结局是 HbA 1c和次要结局包括自我效能、糖尿病自我管理行为、饮食摄入和 身体活动行为。线性混合模型将用于按时间检查组和组 SMS干预与等待列表对照组之间的交互作用。这项R 00研究的结果将 通知一个更大的全面R 01疗效试验的SMS干预，并最终，建立候选人的 一项研究计划，重点是开发和测试可持续的干预措施，以减少 美国华人慢性病的预后该项目可以作为其他慢性病的项目模式。 需要改变生活方式的华裔美国人的疾病干预（例如，糖尿病前期、高血压）， 或用于其他高风险移民群体中的差异研究（例如，南亚人，西班牙裔美国人）。

PROJECT SUMMARY/ABSTRACT Chinese Americans are one of the fastest growing immigrant groups in the US, who suffer disproportionately high type 2 diabetes (T2D) burden and have poorly controlled T2D. Despite the well-documented T2D disparities in this minority group, limited work has been conducted to improve health outcomes in Chinese Americans. The goal of this Pathway to Independence Award (K99/R00) is to expedite the candidate's transition to an independent investigator who possesses focused expertise in development and evaluation of culturally and linguistically tailored and sustainable interventions to reduce T2D disparities in Chinese Americans. In the K99 phase of this award, the candidate will obtain critical training needed to accomplish this goal and will develop a short message service (SMS) intervention to improve T2D management in Chinese Americans. In the R00 phase, the candidate will utilize acquired skills to conduct a pilot randomized controlled trial to examine the potential efficacy of the SMS intervention. In the K99 phase, the candidate will also conduct pilot work to develop linguistically and culturally tailored SMS intervention content and to refine the intervention to be tested in the R00 phase. More specifically, the aims are to 1) characterize barriers and facilitators of glycemic control in Chinese Americans with T2D (Aim 1a); 2) develop culturally and linguistically tailored SMS intervention content (Aim 1b); and 3) assess the feasibility and acceptability of the SMS intervention in a pre-, post-test study (Aim 1c). In the R00 phase, the candidate will refine the SMS intervention based on the K99 pilot data and evaluate the proof-of-concept regarding its efficacy in a pilot randomized controlled trial among 66 Chinese Americans with T2D (Aim 2). Participants will be randomized to one of 2 arms (n=33 each): 1) wait-list control and 2) SMS intervention. Both groups will continue to receive standard of care treatment for their T2D. The SMS group will receive brief lifestyle counseling videos via SMS links. At the end of the study, the wait-list control group will be provided the opportunity to receive the SMS-based counseling videos. Measurements will be obtained at baseline, 3, and 6 months. The primary outcome is HbA1c and secondary outcomes include self-efficacy, diabetes self-management behaviors, dietary intake and physical activity behaviors. Linear mixed modeling will be used to examine the group and group by time interaction effects between the SMS intervention and wait-list control group. Findings from this R00 study will inform a larger full-scale R01 efficacy trial of the SMS intervention, and ultimately, establish the candidate's program of research focused on developing and testing sustainable interventions to reduce disparities in chronic disease outcomes in Chinese Americans. This project can serve as a program model for other chronic disease interventions in Chinese Americans that require lifestyle modification (e.g., prediabetes, hypertension), or for disparities research in other high-risk immigrant populations (e.g., South Asians, Hispanic Americans).