MAKING A DIFFERENCE--THE ROLE OF FAMILY IN NAVAJO DIABETICS

该项目调查了家庭在促进2型糖尿病纳瓦霍人疾病管理中的作用，具体包括：1）家人对糖尿病患者的支持; 2）家庭支持和纳瓦霍哲学概念如何与印度卫生服务局进行的两项糖尿病干预措施相互作用。在之前的MBRS研究项目中，家庭支持成为决定纳瓦霍糖尿病患者坚持规定的自我护理行为（如饮食改变，体重控制和锻炼）程度的关键因素。某些传统的纳瓦霍哲学概念也与自我管理技术的使用有关。该项目将涉及两组不同的答卷人。“家庭研究”将包括民族志访问和焦点小组，访问12个家庭（包括糖尿病患者和非糖尿病患者）的成员，他们有一个或多个糖尿病亲属，以深入了解家庭支持的动态，并使用传统的哲学概念来帮助糖尿病家庭成员。“干预”将跟踪三组门诊患者在参与两种正在进行的糖尿病干预措施之一后或在类似的非干预时间段后的健康状况变化。这些干预措施在家庭参与和纳瓦霍哲学原则的纳入程度上各不相同。在研究的两个部分中，考虑的结果将包括从病历中获得的糖尿病管理的客观措施，以及纳瓦霍糖尿病患者报告的自我管理行为。假设是：1）家庭提供一致的，积极的和多样的支持的个人将比那些缺乏这种家庭支持的人更好地管理他们的糖尿病; 2）表达传统纳瓦霍哲学概念的家庭，如上文所述，将更有可能为他们的糖尿病亲属提供支持;和3）针对整个家庭的变化，与针对个体变化和压力的干预相比，说教式的展示这些研究领域的发现将对改善纳瓦霍糖尿病患者的疾病管理和卫生保健干预产生重大影响。

This project investigates the roles of the family in facilitating disease management among Navajo individuals with type 2 diabetes, specifically: 1) the support given to diabetics by their families; and 2) how family support and Navajo philosophical concepts interact with two current diabetes interventions conducted by the Indian Health Service. In the previous MBRS research project, family support emerged as a critical factor in determining the extent to which Navajos with diabetes adhere to prescribed self-care behaviors such as diet change, weight control, and exercise. Certain traditional Navajo philosophical concepts also were associated with use of self-management techniques. The project will involve two distinct groups of respondents. The "Family Study" will involve ethnographic interviews and focus groups with members of 12 families (both diabetics and non-diabetics) who have one or more diabetic relatives to provide a depth of understanding of the dynamics of family support and use of traditional philosophical concepts in assisting diabetic family members. The "Intervention" will follow three groups of clinic patients with regard to change in their health status either following participation in one of two ongoing diabetes interventions, or after a similar period of time with non intervention. The interventions vary in the degree to which family involvement and tenets of Navajo philosophy are incorporated. In both parts of the study, the outcomes considered will include objective measures of diabetes management taken from the medical record, as well as self-management behaviors as reported by the Navajo diabetics. Hypotheses are: 1) that individuals whose families offer consistent, active and varied support will manage their diabetes better than those lacking such family support; 2) that families expressing traditional Navajo philosophical concepts such as those described above will be more likely to provide support for their diabetic relative; and 3) that interventions which target family-wide change, and involve active learning will have a greater impact on management behaviors and ultimately blood glucose than interventions which target individual change and stress didactic presentation. The findings in each of these areas of study will have significant ramifications for improving disease management and health care interventions for Navajos with diabetes.