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

通过家庭 DSMES 解决马绍尔移民糖尿病自我管理的障碍

• 批准号: 10469701
• 负责人: Pearl Mcelfish
• 金额: $ 57万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-29 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469701
• 关键词: Acculturation; Address; Adherence; Arkansas; Behavior; Biometry; Blood Pressure; Body mass index; Communities; Community Health Aides; Complications of Diabetes Mellitus; Cost Effectiveness Analysis; Data; Diabetes Mellitus; Distress; Education; Evaluation; Family; Family member; Fasting; Glycosylated hemoglobin A; Goals; Health; Heterogeneity; Home; Immigrant; Immigrant community; Intervention; Lipids; Literature; Measures; Mediation; Medical Records; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Participant; Patient-Focused Outcomes; Patients; Persons; Population; Prediabetes syndrome; Quality of life; Quality-Adjusted Life Years; Research; Risk Factors; Self Efficacy; Self Management; Testing; Time; United States; Waiting Lists; Work; arm; base; behavioral adherence; cardiometabolic risk; community partnership; comparison group; cost; cost effective; diabetes self-management; effectiveness evaluation; effectiveness testing; experience; family influence; family support; fasting glucose; glycemic control; health disparity; improved; intervention cost; intervention effect; medication compliance; minority communities; post intervention; public health relevance; sex; social; treatment effect; waist circumference

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.

摘要 阿肯色州西北部(本顿县和华盛顿县)的种族/民族差距如此明显，以至于 疾病控制和预防中心(CDC)和美国国立卫生研究院派出了调查人员。 疾控中心的报告记录了阿肯色州西北部45%的成人病例是西班牙裔/拉丁裔 患者和19%为夏威夷土著/太平洋岛民(NHPI)患者。1仅限西班牙裔/拉丁裔和NHPI 分别占两县人口的17%和2.4%。阿肯色州西北部新冠肺炎死亡人数 在种族和民族方面也是不同的。据估计，每10万人中有200多人死于NHPI- 远高于该县5.10/10万的整体死亡率，以及白人的死亡率 在种族/少数民族中，阿肯色州西北部的NHPI人口为每100K.1 4.03人 即使新冠肺炎检测的可用性增加，死于COVID-19.1的几率也要高得多 在疫苗接种方面，种族和少数民族人口面临的障碍依然存在。虽然新冠肺炎的可用性 测试有所改善，种族、民族和社会经济地位之间的测试差异继续阻碍着测试 努力降低新冠肺炎发病率和死亡率。西班牙裔/拉丁裔和NHPI也经历了 与新冠肺炎相关的歧视增加。我们的初步研究证明，这些经历 有歧视可能会降低西班牙裔/拉丁裔和NHPI接受测试的意愿。少数族裔人口是 更有可能不信任传统的医疗保健方法。除了对信任和 歧视、西班牙裔/拉丁裔和NHPI社区成员面临包括长时间工作在内的准入障碍 轮班、不能因医疗保健而休假以及缺乏保险。新冠肺炎自测前景看好 在克服信任、歧视和获得医疗保健方面的障碍方面。然而，还没有研究证明这是最好的 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，并保持了 承诺增加西班牙裔/拉丁裔和NHPI社区的持续准入，并显著减少 新冠肺炎在发病率、住院率和死亡率方面的差异。我们的具体目标是：目标1.充分发挥杠杆作用 利用我们长期以社区为基础的伙伴关系，克服信任、歧视和 医疗卫生准入方面，增加使用新冠肺炎自检。目标2.实施和评估接入和 两种自测分发方法(当地社区诊所和社区为基础)的采用策略 非营利组织)，以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站点协作。