Expanding the Diabetes Homelessness Medication Support (D-Homes) program to Spanish speaking Hispanics

项目摘要/摘要 美国无家可归者面临不成比例的过早死亡风险，部分原因是长期控制不善 包括糖尿病在内的疾病。每年有150万独立的美国成年人进入无家可归者收容所。人民 患糖尿病和无家可归的人会提前10年出现并发症并过早死亡。 与它们的居所同行相比。该项目致力于实现这些人的健康公平。 大量证据表明，服药依从性是导致贫困的主要可改变的健康行为 低收入和无家可归人口中的糖尿病后果。改善药物治疗的行为支持 糖尿病和无家可归患者的坚持是我们团队正在进行的工作的重点 (K23DK118117)。我们使用了定性数据和社区参与的方法来制定一个量身定做的 行为干预(糖尿病无家可归者药物支持计划[D-HOME])；对此进行试点测试 新的干预正在进行中。D-Home在12周内提供10次旨在控制血糖的辅导课程 通过改善服药依从性。辅导包括糖尿病教育和有组织的目标设定 瞄准服药依从性和心理健康。到目前为止，流利的英语一直是一项注册 由于现有K23奖项的资源有限，这一标准受到了限制。然而，西班牙裔社区却不成比例地 无家可归和糖尿病的比率都更高。这项R-03奖将把D-HOME干预扩展到 将讲西班牙语的人纳入两个目标：(1)改编D-Home方案和翻译的治疗材料 根据说西班牙语的西班牙裔糖尿病患者和无家可归者的反馈(DH-SH)。我们 将进行8-10次面试，以审查材料、计划的招聘和保留战略，并研究 物流。(2)评估改编后的D-HOME用于DH-SH的可行性和可接受性。我们将招募12名DH-SH 纳入单臂试验，以评估(I)招聘和保留；(Ii)指导内容的可接受性和可行性 和治疗材料；(3)结果评估。数据将包括系统地跟踪招聘和 留任努力、员工反馈、计划满意度和治疗后定性访谈。我们 假设独特的招聘/保留需求和独特的促进者/药物依从性障碍 与说英语的参与者进行比较。数据将确定今后工作中使用的解决方案。 这项研究具有重要意义，因为研究结果将使未来D-Home的全功率临床试验成为可能 同时招收说英语和西班牙语的学生。我们团队的经验为这项工作提供了坚实的基础： (1)我们的双语/双文化研究人员支持我们正在进行的由NIDDK资助的西班牙裔参与者试验 患有2型糖尿病(R01 DK113999)；(2)PI的墨西哥血统、西班牙语技能和领导力 在当地无家可归者保健计划中扮演的角色；(3)我们团队的成功招募和保留 不同的参与者参加了几个难以接触到的人群的行为试验。这项研究具有创新性，因为它 将根据语言和糖尿病护理的一个关键社会风险因素-无家可归-定义必要的定制。

PROJECT SUMMARY/ABSTRACT Homeless people in the US face disproportionate risk for early death in part due to poorly controlled chronic diseases including diabetes. 1.5 million unique US adults access homeless shelters annually. People experiencing diabetes and homelessness develop complications 10 years earlier and die prematurely compared to their housed counterparts. This project works to achieve health equity for these people. Substantial evidence links medication adherence as a leading modifiable health behavior driving poor diabetes outcomes in low-income and homeless populations. Behavioral support for improved medication adherence among people experiencing diabetes and homelessness is the focus of our team’s ongoing work (K23DK118117). We’ve used qualitative data and community engaged approaches to develop a tailored behavioral intervention (the Diabetes Homeless Medication Support program [D-Homes]); pilot testing of this new intervention is ongoing. D-Homes offers 10 coaching sessions over 12 weeks targeting glycemic control via improved medication adherence. Coaching includes diabetes education and structured goal setting targeting medication adherence and psychological wellness. To date English fluency has been an enrollment criterion due to limited resources in the existing K23 award. Yet the Hispanic community has disproportionately higher rates of both homelessness and diabetes. This R-03 award will expand the D-Homes intervention to include Spanish speakers in two aims: (1) Adapt D-Homes protocols and translated treatment materials based on feedback from people with diabetes and homelessness who speak Spanish and are Hispanic (DH-SH). We will conduct 8-10 interviews to review materials, planned recruitment and retention strategies, and study logistics. (2) Assess feasibility and acceptability of the adapted D-Homes for DH-SH. We will recruit 12 DH-SH into a single-arm trial to assess acceptability and feasibility of (i) recruitment and retention; (ii) coaching content and treatment materials; (iii) outcome assessments. Data will include systematic tracking of recruitment and retention efforts, staff feedback, program satisfaction and post-treatment qualitative interviews. We hypothesize unique recruitment/retention needs and unique facilitators/barriers to medication adherence among DH-SH compared to English-speaking participants. Data will define solutions for use in future work. This study is significant because findings will enable a future, fully powered clinical trial of D-Homes that will enroll both English and Spanish speakers. Our team’s experience provides a robust foundation for this work: (1) Our bilingual/bicultural research staff supports our ongoing NIDDK-funded trial with Hispanic participants with type 2 diabetes (R01 DK113999); (2) The PI’s Mexican heritage, Spanish language skills, and leadership role at the local Health Care for the Homeless program; (3) Our team’s successful recruitment and retention of diverse participants in several behavioral trials with difficult-to-reach populations. This study is innovative as it will define necessary tailoring based on language and a key social risk factor to diabetes care, homelessness.