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，是美国人口中增长最快的部分。拉美裔人的糖尿病患病率高于非拉美裔白人，发病率和死亡率也高于非拉美裔白人。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，通过控制空腹血糖和血压可以减少糖尿病并发症。试验表明，自我管理行为（自我监测血糖，按规定服药，定期安排就诊）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了较低的自我管理行为记录率。尽管改善自我管理的行为干预在改善自我护理和代谢结果方面显示出希望，但很少有人关注西班牙裔面临的独特文化障碍，也很少有人关注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）将检验一种假设，即从目标社区招募土著社区卫生工作者（chw）并接受培训，提供文化上适当的糖尿病教育，可以促进居住在市中心的2型糖尿病墨西哥裔美国人的主动自我管理。本研究旨在证明，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；2)导致三种自我管理行为（每日自我血糖监测、服药和临床随访）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，这些患者来自HMO大型开放式健康计划的参保者。参与者必须居住在两个目标内城区之一，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，接受每月两次的糖尿病教育和自我管理技能培训的CHW家访，或接受注意力控制。四种自我管理技能（自我监控、环境重组、社会环境参与和问题解决）将应用于3种自我照顾行为结果。通过录音带和干预工作表的文件，通过标准化的干预和对CHW遭遇的严格监测，将促进本研究的未来翻译。

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.