Mexican-American Trial of Community Health Workers-MATCH

描述（由申请人提供）：糖尿病是墨西哥裔美国人的主要问题，墨西哥裔美国人是美国人口中增长最快的部分。西班牙裔人糖尿病的患病率高于非西班牙裔白人，并且发病率和死亡率过高。西班牙裔死于糖尿病并发症的可能性是非西班牙裔白人的1.45倍。有证据表明，糖尿病并发症可以通过控制空腹血糖和血压来减少。试验表明，自我管理行为（自我监测血糖，按规定服药，定期安排门诊）可以在实现这些结果方面产生积极的影响。然而，在墨西哥裔美国人中，文化，后勤，语言和环境障碍导致自我管理行为的记录率较低。尽管改善自我管理的行为干预措施在改善自我护理和代谢结果方面显示出希望，但人们很少关注西班牙裔面临的独特文化障碍或克服这些障碍以实现成功自我管理的方法。MATCH研究（墨西哥裔美国人社区卫生工作者试验）将检验以下假设：使用从目标社区招募并经过培训以提供文化上适当的糖尿病教育的土著社区卫生工作者（CHW），可以促进居住在市中心的墨西哥裔美国人2型糖尿病患者的积极自我管理。该研究的目的是证明，与注意力控制相比，CHW将：1）导致短期生理结果（血红蛋白Alc水平和血压）的改善，以及2）导致三种自我管理行为（每日自我血糖监测，药物服用和临床随访）的频率增加。研究设计是一项部分盲法随机对照试验，纳入154例2型糖尿病患者，从大型开放式HMO健康计划的入组者中招募。参与者必须居住在两个目标内城社区之一，并且必须是墨西哥人或墨西哥裔美国人。参与者将被随机分配到实验组，接受CHW每月两次的糖尿病教育和自我管理技能培训的家访，或注意力控制。四种自我管理技能（自我监控、环境重构、社会环境参与和问题解决）将应用于3种自我护理行为结果。本研究的未来翻译将通过一个良好的标准化干预和严格的监测CHW遭遇，通过录音带和文件的干预措施来促进。

DESCRIPTION (provided by applicant): Diabetes is a major problem among Mexican-Americans, the most rapidly growing segment of the US population. Hispanics have higher prevalence rates of diabetes than non-Hispanic whites and experience excess morbidity and mortality. Hispanics are 1.45 times more likely to die of diabetes complications than non-Hispanic whites. Evidence suggests that diabetes complications can be reduced through control of fasting blood sugar and blood pressure. Trials show that self-management behaviors (self monitoring of blood glucose, taking medications as prescribed, and periodic scheduled clinic attendance) can make a positive difference in achieving these outcomes. Among Mexican-Americans, however, cultural, logistical, linguistic, and environmental barriers result in lower documented rates of self-management behaviors. Although behavioral interventions to improve self-management have shown promise in improving self care and metabolic outcomes, very little attention has been paid to the unique cultural barriers faced by Hispanics or to ways of overcoming these barriers to achieve successful self-management. The MATCH study (Mexican-American Trial of Community Health Workers) will test the hypothesis that the use of indigenous Community Health Workers (CHWs), recruited from the target community and trained to provide culturally appropriate diabetes education, can promote pro-active self-management among inner-city dwelling Mexican-Americans with Type2 diabetes mellitus. The study aims are to demonstrate that a CHW, compared to an attention control, will: 1) result in improvement in short term physiologic outcomes (Hemoglobin Alc levels and blood pressure), and 2) result in increased frequency of three self-management behaviors (daily self blood-glucose monitoring, medication taking, and clinic follow-up). Study design is a partially blinded, randomized controlled trial of 154 patients with Type 2 diabetes mellitus, recruited from among enrollees in a large open-panel HMO health plan. Participants must reside in one of two targeted inner city neighborhoods, and must be Mexican or Mexican- American. Participants will be randomized to an experimental group to receive twice-monthly home visits from a CHW for diabetes education and self-management skills training, or to an attention control. Four self-management skills (self-monitoring, environmental restructuring, involvement of the social environment, and problem-solving) will be applied to the 3 self-care behavioral outcomes. Future translation of this research will be facilitated by a well-standardized intervention and rigorous monitoring of CHW encounters through audiotapes and documentation of intervention worksheets.