Community-Based Intervention to Improve Diabetes Outcomes in Older African American Women with Multi-Caregiving Burden

以社区为基础的干预措施，以改善承担多重护理负担的老年非洲裔美国妇女的糖尿病结局

• 批准号: 10409770
• 负责人: Joni Strom Williams
• 金额: $ 19.37万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-11 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409770
• 关键词: 18 year old; Address; Adult; Adult Children; African American; African American population; Age; Aging; Anger; Behavior; Blood Glucose; Caring; Cessation of life; Child; Communities; Complications of Diabetes Mellitus; Coping Skills; Data; Diabetes Mellitus; Diet; Diet Habits; Distress; Elderly; Elements; Emotional; End stage renal failure; Financial Hardship; Focus Groups; Frustration; Future; Generations; Glycosylated hemoglobin A; Goals; Health; High Prevalence; Household Heads; Intervention; Literature; Measures; Metabolic Control; Monitor; Morbidity - disease rate; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Ophthalmic examination and evaluation; Outcome; Parents; Participant; Persons; Physical activity; Population; Prevalence; Problem Solving; Quality of life; Randomized; Risk; SF-12; Self Care; Social isolation; Stress; Structure; Study Section; Symptoms; Telephone Interviews; Testing; Time; Training and Education; United States; Visual impairment; Woman; Work; base; behavior change; blood pressure control; blood pressure reduction; burden of illness; care giving burden; caregiving; design; diabetes education; effective intervention; experience; feasibility testing; foot; glucose monitor; glycemic control; grandparent; improved; improved outcome; inner city; intervention mapping; medication compliance; mortality; multi-component intervention; neglect; novel; peer support; recruit; skills training; stress reduction; stressor; treatment adherence; treatment as usual; uptake

PROJECT SUMMARY/ABSTRACT African Americans (AA) with type 2 diabetes (T2DM) have a higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to Whites. AA Women (AAW) have a higher rate of diabetes, higher prevalence of visual impairment, higher rate of end-stage renal disease, and higher age-adjusted mortality rate compared to White women. While the reasons for higher diabetes-related morbidity and mortality in AAW have not been clearly elucidated, multi-caregiving responsibilities, or the provision of care (emotional, physical/tangible, financial, spiritual) to parents/grandparents, children/grandchildren, significant others, and their larger community, is a significant barrier to effective diabetes care and contributes to the higher disease burden and increased mortality in AAW with T2DM. This is particularly true for AAW in the Sandwich Generation (adults in their 40s and 50s who are wedged between elderly parents and adult children/grandchildren), and the Club Sandwich Generation (adults in their 50s and 60s, who are wedged between aging parents/grandparents, adult children, and grandchildren), where multi- caregiving responsibilities have resulted in increased stress, poorer glycemic control, and suboptimal self-care behaviors. In addition, there is limited evidence on effective interventions that address multi-caregiving burden in inner city AAW with T2DM. Preliminary data from our group suggests that a community-based, nurse- facilitated, group-based, peer-support intervention that incorporates storytelling, problem solving and goal setting, coping strategies, and diabetes education and skills training may be effective in this population. Therefore, we propose a pilot randomized study to test the feasibility and preliminary efficacy of a novel, community-informed, multicomponent intervention on mitigating stressors associated with multi- caregiving responsibilities to improve diabetes outcomes compared to diabetes enhanced usual care. The long-term goal of the project is to identify effective strategies for improving metabolic control and reducing diabetes complications and mortality rates in AAW with T2DM.

项目总结/摘要 患有2型糖尿病（T2 DM）的非洲裔美国人（AA）的糖尿病患病率较高， 代谢控制，并发症和死亡的风险更大。AA妇女（AAW）有一个 糖尿病发病率较高，视力损害患病率较高，终末期肾病发病率较高， 与白色女性相比，年龄调整后的死亡率更高。虽然与糖尿病相关的高血糖的原因 AAW的发病率和死亡率尚未明确阐明，多重责任，或 向父母/祖父母提供照顾（情感、身体/有形、经济、精神）， 子女/孙辈、重要的其他人及其更大的社区，是有效实施的重大障碍。 糖尿病护理，并导致AAW伴T2 DM患者的疾病负担更高和死亡率增加。这是 尤其是三明治一代的AAW（40多岁和50多岁的成年人， 老年父母和成年子女/孙辈），以及俱乐部三明治一代（50多岁的成年人和 60岁的人，夹在年迈的父母/祖父母、成年子女和孙子孙女之间）， 过度的责任感会导致压力增加、血糖控制不佳和自我护理欠佳 行为。此外，关于解决多重生育负担的有效干预措施的证据有限。 患有2型糖尿病我们小组的初步数据表明，一个以社区为基础的护士- 促进，以小组为基础，同伴支持干预，包括讲故事，解决问题， 目标设定、应对策略、糖尿病教育和技能培训可能对此有效 人口因此，我们建议进行一项试点随机研究，以测试的可行性和初步疗效， 新的，社区知情的，多成分干预，以减轻与多因素相关的压力， 与糖尿病相比，改善糖尿病结局的责任增强了常规护理。的 该项目的长期目标是确定有效的策略，以改善代谢控制和减少 AAW合并T2 DM患者的糖尿病并发症和死亡率。

项目成果

Intersection of Structural Racism, Social Determinants of Health, and Implicit Bias With Emergency Physician Admission Tendencies.

• DOI: 10.1001/jamanetworkopen.2021.26375
• 发表时间: 2021-09-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Egede LE;Walker RJ;Williams JS
• 通讯作者: Williams JS

Nonmedical Interventions For Type 2 Diabetes: Evidence, Actionable Strategies, And Policy Opportunities.

• DOI: 10.1377/hlthaff.2022.00236
• 发表时间: 2022-07
• 期刊: HEALTH AFFAIRS
• 影响因子: 9.7
• 作者: Egede, Leonard E.;Walker, Rebekah J.;Linde, Sebastian;Campbell, Jennifer A.;Dawson, Aprill Z.;Williams, Joni S.;Ozieh, Mukoso N.
• 通讯作者: Ozieh, Mukoso N.

Gender invariance in the relationship between social support and glycemic control.

• DOI: 10.1371/journal.pone.0285373
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Williams, Joni S.;Walker, Rebekah J.;Egede, Leonard E.
• 通讯作者: Egede, Leonard E.

Integrating Medical and Social Care to Reduce Diabetes Inequities: Lessons from the Bridging the Gap Program.

整合医疗和社会护理以减少糖尿病不平等：弥合差距计划的经验教训。

• DOI: 10.1007/s11606-022-07977-5
• 发表时间: 2023
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Williams,JoniS;Walker,RebekahJ;Peek,MonicaE;Chin,MarshallH
• 通讯作者: Chin,MarshallH