Community-Based Diabetes Care for Korean American Immigrants

为韩裔美国移民提供社区糖尿病护理

• 批准号: 7918282
• 负责人: Miyong T Kim
• 金额: $ 66.16万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-20 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918282
• 关键词: Address; Adult; Am 80; American; Asian Americans; Asians; Attitude; Behavior; Behavior Therapy; Behavioral; Caring; Case Management; Chronic Disease; Clinical Trials; Communication; Communities; Community Health; Control Groups; Counseling; Data; Diabetes Mellitus; Diet; Education; Educational Materials; Effectiveness; Experimental Designs; Family; Fostering; Generations; Glucose; Glycosylated hemoglobin A; Goals; Grant; Health; Health Insurance; Health Personnel; Health Services Accessibility; Healthcare; Hemoglobin; Home environment; Immigrant; Immigration; Intervention; Intervention Studies; Knowledge; Korean American; Koreans; Language; Lead; Medical; Mental Depression; Methodology; Minority; Minority Groups; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Online Systems; Outcome; Participant; Patients; Phase; Pilot Projects; Population; Prevalence Study; Problem Solving; Process; Protocols documentation; Psychosocial Factor; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Sampling; Self Care; Self Efficacy; Social isolation; Source; Structure; System; Technology; Telephone; Terminology; Testing; Translating; Translational Research; Visual; Vulnerable Populations; Weight Gain; Work; base; blood glucose regulation; blood pressure regulation; checkup examination; clinically significant; community based participatory research; community organizations; cost; cost effectiveness; design; diabetes management; diabetic; effective intervention; effectiveness trial; empowered; ethnic minority population; experience; fasting glucose; follow-up; glycemic control; group intervention; health literacy; health related quality of life; high risk; improved; innovation; insight; intervention program; mortality; news; post intervention; programs; public health relevance; self help; skills; stem; translational study; transmission process; treatment as usual

DESCRIPTION (provided by applicant): The primary objective of this translational study is to conduct an effectiveness trial of a community-based glucose control intervention program for Korean American immigrants (KAI) with type-2 diabetes mellitus (DM). The self-help intervention program for Korean Americans ( SHIP-DM) focuses on the self-help aspect of DM control by empowering patients through enhanced knowledge of DM and diet, utilizing available technology to develop their ability for self -monitoring their glucose control status, facilitating better communication with their health care providers, and enhancing their health literacy and general problem-solving skills. The SHIP-DM has been developed and pilot tested through a "planning grant" mechanism via NIDDK (R34). Using a randomized experimental design (N=80) in our pilot study, we were able to demonstrate the efficacy and feasibility of the SHIP-DM with KAIs up to 6 months post-intervention. The final analysis suggested that the SHIP-DM was effective in both significantly lowering HbA1c and fasting glucose as well as in improving psychosocial variables in the sample: The reduction of HbA1c levels among intervention group participants (1.19% at 18 weeks and 1.31% at 30 weeks) were not only statistically significant but clinically meaningful, with 10%and 15% of the intervention group achieving the suggested goal of HbA1c < 7%. In comparison to the control group, the intervention group showed significant improvement in DM knowledge, self-care activities, DM-related self-efficacy, and their attitudes toward diabetes, depression, and quality of life. In addition, we became aware of the urgent need for disseminating effective interventions which are both linguistically and culturally tailored to KAI. As news of our study spread through media sources in the Korean ethnic community, we became inundated by requests from KAI families and community organizations (including the American Diabetes Association) for type-2 DM educational materials and culturally relevant interventions targeted toward KAI audiences. Because of the resource limitations of the pilot project, we were forced to turn away substantial numbers of KAI with type 2 DM who wanted to participate in our study. To address this critical need within the KAI community, we now propose to build upon our pilot work by conducting a two-phase clinical trial to test the effectiveness of the SHIP-DM in a larger sample of KAI and a longer follow-up (12months) while building important infrastructures for disseminating an array of intervention materials designed to address the health literacy and resources necessities for this vulnerable population. PUBLIC HEALTH RELEVANCE: This application proposes a randomized controlled trial of a community-based behavioral intervention in linguistically isolated Korean immigrants with type-2 DM with endpoint focus on the improvement of (1) glycemic control and BP control, (2) self-efficacy and self-help skills including health literacy skills, and (3) health related quality of life.

描述（由申请人提供）：这项转化研究的主要目的是对患有 2 型糖尿病 (DM) 的韩裔美国移民 (KAI) 进行基于社区的血糖控制干预计划的有效性试验。韩裔美国人自助干预计划 (SHIP-DM) 侧重于糖尿病控制的自助方面，通过增强患者对糖尿病和饮食的了解，利用现有技术培养患者自我监测血糖控制状态的能力，促进与医疗保健提供者更好的沟通，并提高他们的健康素养和一般问题解决技能。 SHIP-DM 已通过 NIDDK (R34) 通过“规划拨款”机制进行开发和试点测试。在我们的试点研究中使用随机实验设计 (N=80)，我们能够证明 SHIP-DM 与 KAI 在干预后长达 6 个月的有效性和可行性。最终分析表明，SHIP-DM 在显着降低 HbA1c 和空腹血糖以及改善样本中的心理社会变量方面均有效： 干预组参与者的 HbA1c 水平降低（18 周时为 1.19%，30 周时为 1.31%）不仅具有统计学意义，而且具有临床意义，干预组中 10% 和 15% 的参与者实现了 HbA1c < 7% 的建议目标。与对照组相比，干预组在糖尿病知识、自我护理活动、糖尿病相关自我效能以及对糖尿病、抑郁症和生活质量的态度方面表现出显着改善。此外，我们意识到迫切需要传播在语言和文化上针对 KAI 量身定制的有效干预措施。随着我们研究的消息通过韩裔社区的媒体传播开来，KAI 家庭和社区组织（包括美国糖尿病协会）向我们提出了大量要求，要求我们提供针对 KAI 受众的 2 型糖尿病教育材料和文化相关干预措施。由于试点项目的资源限制，我们被迫拒绝了大量想要参与我们研究的患有 2 型糖尿病的 KAI。 为了满足 KAI 社区的这一迫切需求，我们现在建议在试点工作的基础上进行两阶段临床试验，以测试 SHIP-DM 在更大的 KAI 样本中的有效性和更长的随访时间（12 个月），同时建立重要的基础设施，传播一系列旨在解决这一弱势群体的健康素养和资源需求的干预材料。 公共健康相关性：本申请提出了一项随机对照试验，对语言孤立的患有 2 型糖尿病的韩国移民进行基于社区的行为干预，终点重点是改善 (1) 血糖控制和血压控制，(2) 自我效能和自助技能，包括健康素养技能，以及 (3) 健康相关的生活质量。