Integrating Education, Group Support, and Case Management for Diabetic Hispanics

描述（由申请人提供）：斯塔尔县是得克萨斯州和墨西哥边境的一个农村社区，98%是墨西哥裔美国人，在得克萨斯州与糖尿病相关的死亡率最高。自1988年以来，我们已经证明了通过文化上有能力的糖尿病自我管理教育可以降低HbA 1c，但随着时间的推移，效果会减弱。结果表明，社会文化和个人障碍仍然存在，阻碍个人实现最佳健康成果。拟议的规划研究将探索一种在农村社区相对未经测试的策略，该策略将协调个人糖尿病护理的各个方面，包括参与我们的自我管理干预。我们建议进行一项试点测试，我们以前测试的“压缩”自我管理干预加强了护士的情况下，经理，以：1）定义和完善的作用，护士的情况下，经理（NCM）为农村边境社区进行焦点小组与各种群体在斯塔尔县：a）参与者在我们以前的干预研究; B）在边境两侧执业的医生，为德克萨斯州边境居民提供糖尿病护理; c）当地社区卫生官员; d）提供糖尿病护理的其他卫生保健提供者（护士、营养师、当地医院和诊所雇用的社区卫生工作者）; e）社区的关键权威人物（如当地天主教神父、县官员）;以及f）有经验的国家医疗机构。2)通过比较两组来确定采用糖尿病NCM以增强自我管理干预的积极效果的可行性：a）涉及护士CM的联合策略加上先前测试的糖尿病自我管理干预的“压缩”版本;和B）单独的“压缩”糖尿病自我管理干预。我们将使用前测/后测对照组设计在斯塔尔县进行试点研究。将招募96名当前遗传学研究的参与者，并将其分配到其中一项干预措施中。我们将在基线以及3个月和6个月时收集我们之前测量的结果数据-HbA 1c、FBG、血脂、血压、知识、健康行为（体力活动、饮食摄入、血糖监测和药物使用）和BMI。我们计划增加2个新变量：1）医疗保健利用率和2）成本。在拟议的试点项目期间将进行最低限度的数据分析，因为目的是确定干预的可行性。将进行基本描述性分析（平均值、频率）和非参数比较; HLM将用于探索性目的。这项研究是确定墨西哥裔美国人糖尿病自我管理有效方法的关键一步。

DESCRIPTION (provided by applicant): Starr County is a rural Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. Since 1988 we have demonstrated reductions in HbA1c through culturally competent diabetes self-management education, but effects diminished overtime. Results indicated that socio-cultural and personal barriers remained, preventing individuals from achieving optimal health outcomes. The proposed planning study will explore a strategy relatively untested in rural communities that will provide coordination of all aspects of an individual's diabetes care, including participation in our self-management intervention. We propose to conduct a pilot test of our previously tested 'compressed" self-management intervention enhanced by a nurse case manager in order to: 1) Define and refine the role of the nurse case manager (NCM) for a rural border community by conducting focus groups with a variety of groups in Starr County: a) participants in our previous intervention studies; b) physicians practicing on either side of the border who provide diabetes care for Texas border residents; c) local community health officials; d) other health care providers who provide diabetes care (nurses, dietitians, community health workers employed by local hospitals and clinics); e) key authority figures in the community (such as local Catholic priests, County officials); and f) experienced NCMs. 2) Determine the feasibility of employing a diabetes NCM in order to enhance the positive effects of our self- management interventions by comparing 2 groups: a) a combined strategy involving the nurse CM PLUS the "compressed" version of our diabetes self-management intervention previously tested; and b) "compressed" diabetes self-management intervention ALONE. We will conduct a pilot study in Starr County using a pretest/posttest control group design. 96 participants of current genetic studies will be recruited and assigned to 1 of the interventions. We will collect data at baseline and at 3 and 6 months on outcomes we have measured previously-HbA1c, FBG, lipids, blood pressure, knowledge, health behaviors (physical activity, dietary intake, glucose monitoring, and medication usage), and BMI. We plan to add 2 new variables: 1) health care utilization and 2) cost. Minimal data analysis will be performed during the proposed pilot project, since the intent is to determine intervention feasibility. Basic descriptive analyses (means, frequencies) and non-parametric comparisons will be performed; HLM will be used for exploratory purposes. The proposed study is a critical step in determining effective ways of sustaining the effects of diabetes self-management in Mexican American populations.