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

项目总结/摘要 美国无家可归的人面临着不成比例的过早死亡风险，部分原因是由于控制不良的慢性疾病。 包括糖尿病在内的疾病。1.5每年有100万美国成年人进入无家可归者收容所。人 患有糖尿病和无家可归的人10年前出现并发症并过早死亡 相比之下，他们的对手。该项目致力于实现这些人的健康公平。 大量证据表明，药物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群的糖尿病结局。改善药物治疗的行为支持 糖尿病患者和无家可归者的依从性是我们团队正在进行的工作的重点 （K23DK118117）。我们使用定性数据和社区参与的方法来制定一个量身定制的 行为干预（糖尿病无家可归者药物支持计划[D-Homes]）;试点测试 正在进行新的干预。D-Homes在12周内提供10次针对血糖控制的辅导课程 通过改善药物依从性。指导包括糖尿病教育和结构化目标设定 针对药物依从性和心理健康。到目前为止，英语流利一直是一个注册 由于现有的K23裁决资源有限，因此没有达到标准。然而，西班牙裔社区不成比例地 无家可归和糖尿病的比例更高。这项R-03奖将扩大D-家园干预， 包括讲西班牙语的人，目的有两个：（1）调整D-Homes方案和翻译的治疗材料， 来自讲西班牙语和西班牙裔的糖尿病和无家可归者的反馈（DH-SH）。我们 我将进行8-10次面试，以审查材料，计划招聘和保留战略，并研究 物流(2)评估适用于DH-SH的D-Homes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）招募和保留;（ii）辅导内容的可接受性和可行性 治疗材料;（三）结果评估。数据将包括系统跟踪征聘情况， 保留努力，工作人员的反馈，方案满意度和治疗后的定性访谈。我们 假设独特的招募/保留需求和独特的药物依从性促进因素/障碍 与讲英语的参与者相比。数据将确定解决方案，供今后工作使用。 这项研究是重要的，因为研究结果将使未来的，完全有力的临床试验的D-家庭， 招收讲英语和西班牙语的学生。我们团队的经验为这项工作奠定了坚实的基础： (1)我们的双语/双文化研究人员支持我们正在进行的NIDDK资助的西班牙裔参与者试验 2型糖尿病（R 01 DK 113999）;（2）PI的墨西哥血统、西班牙语技能和领导力 在当地无家可归者医疗保健计划中的作用;（3）我们的团队成功招募和保留了 不同的参与者在几个行为试验与难以达到的人群。这项研究是创新的，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--来定义必要的定制。

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.