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

摘要 阿肯色州西北部（本顿县和华盛顿县）的种族/民族差异如此明显， 疾病控制和预防中心（CDC）和国家卫生研究院派出了调查人员。 疾病控制和预防中心的报告记录了阿肯色州西北部45%的成年病例是西班牙裔/拉丁裔 19%为夏威夷原住民/太平洋岛民（NHPI）患者。1仅西班牙裔/拉丁裔和NHPI 分别占两县人口的17%和2.4%。阿肯色州西北部2019冠状病毒病死亡病例 在种族和民族上也是不同的。据估计，NHPI死亡人数超过每10万人200人- 远高于该县每10万人中5.10人的总体死亡率，以及白人的死亡率 1在少数种族/族裔中，阿肯色州西北部的NHPI人口突出， 死于COVID-19的几率要高得多。1即使COVID-19检测的可用性增加， 和疫苗接种方面，种族和少数民族人口仍然面临障碍。虽然COVID-19的可用性 测试已经改善，测试中的种族，民族和社会经济地位的差异继续阻碍 努力降低COVID-19的发病率和死亡率。西班牙裔/拉丁裔和NHPI也经历了 与COVID-19相关的歧视增加。我们的初步研究表明这些经历 歧视可能会降低西班牙裔/拉丁裔和NHPI接受测试的意愿。少数民族人口 更有可能不信任传统的医疗保健方法。除了信任问题， 歧视，西班牙裔/拉丁裔和NHPI社区成员面临的准入障碍，包括长期工作 轮班、无法请假去医疗保健和缺乏保险。COVID-19自我检测有希望 在克服信任、歧视和获得医疗保健方面的障碍。然而，还没有研究测试出最好的 西班牙裔/拉丁裔和NHPI之间自我测试的分配方法。这项研究填补了这一空白，并认为 承诺增加西班牙裔/拉丁裔和NHPI社区的可持续访问，并减少大量 COVID-19发病率、住院率和死亡率的差异。我们的具体目标是：目标1。充分利用和 参与我们长期以来以社区为基础的伙伴关系，以克服信任，歧视和 卫生保健的获取，以增加COVID-19自我检测的使用。目标二。实施和评估准入， 采用两种自我检测分发办法的战略（地方社区诊所和社区诊所） 非营利组织）了解对弱势群体的有效性和影响。目标3：充分 与RADx-UP协调和数据收集中心（CDCC）和其他RADx站点合作。

Abstract The racial/ethnic disparities in Northwest Arkansas (Benton and Washington Counties) were so stark that the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health sent investigators. The CDC's 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.1 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.1 Among racial/ethnic minorities, the Northwest Arkansas NHPI population stands out as having much higher odds of death from COVID-19.1 Even with the increased availability of COVID-19 testing and vaccination, barriers remain for racial and ethnic minority populations. While the availability of COVID-19 testing has improved, disparities in testing across race, ethnicity, and socioeconomic status continue to stymie efforts to reduce COVID-19 morbidity and mortality. Hispanic/Latinx and NHPIs have also experienced increased discrimination related to COVID-19. Our preliminary research documents that these experiences with discrimination may reduce Hispanic/Latinx and NHPI willingness to get tested. Minority populations are more likely to distrust traditional approaches to health care. In addition to concerns with trust and discrimination, Hispanic/Latinx and NHPI community members face access barriers including long-working shifts, inability to take off work for health care, and lack of insurance. Self-testing for COVID-19 holds promise in overcoming the barriers of trust, discrimination, and health care access. Yet no studies have tested the best distribution methods for self-testing among Hispanic/Latinx and NHPI. This study fills that gap and holds promise for increasing sustained access for Hispanic/Latinx and NHPI communities and reducing significant COVID-19 disparities in incidence, hospitalization, and death. Our specific aims are: Aim 1. Leverage and fully engage our long-standing community-based partnerships to overcome barriers of trust, discrimination, and health care access to increase the use of COVID-19 self-testing. Aim 2. Implement and evaluate access and uptake strategies of two self-testing distribution approaches (local community clinics and community-based non-profit organizations) to understand effectiveness and impact for vulnerable populations. Aim 3. Fully collaborate with the RADx-UP Coordination and Data Collection Center (CDCC) and other RADx sites.