Peer Support for Achieving Independence in Diabetes (Peer AID)

描述(申请人提供)：2型糖尿病是一个重要和常见的健康问题，对低收入和少数族裔人群的影响不成比例。获得糖尿病自我管理技能并在日常生活中应用这些技能是具有挑战性的，特别是对资源有限的个人来说。利用社区卫生工作者(CHW)的干预措施改善了糖尿病患者的知识和行为，在一些研究中改善了健康结果。从理论上讲，社区卫生服务是接触弱势人群的一种有吸引力的方式，然而，还需要更多的工作来了解社区卫生服务如何以及在什么情况下才能最有效地影响糖尿病护理和减少健康差距。还需要关于成本效益和投资回报的信息。目的：我们将验证以下假设：CHW为2型糖尿病的自我管理提供家庭支持、糖尿病资源，并协助与医疗提供者进行有效的联系和沟通，将：(1)改善HbA1c(主要结果)和次要结果，包括血压和血脂控制、医疗保健利用和与健康相关的生活质量；(2)改善糖尿病的自我管理，包括自我效能、体力活动、营养和用药依从性；以及(3)具有成本效益和可行性。方法：我们将实施一项为期5年的随机对照试验，将由家庭糖尿病自我管理支持、团体支持链接和电话支持组成的CHW模式与常规护理进行比较。社区卫生工作者将在一年中进行最多5次家访，在自我管理的关键部分提供量身定制的支持；转介到包括疾病自我管理课程在内的小组活动；通过与客户的关系产生社会支持；以及发展适应医疗保健系统的技能。在研究期结束时，常规护理参与者将接受CHW和糖尿病自我管理资源的家访。参与者将来自种族和文化多样化的低收入患者群体，年龄在30-70岁之间，他们说英语或西班牙语，患有2型糖尿病，血糖和/或血压控制不佳，居住在华盛顿州金县。参与者将从当地退伍军人事务部(VA)医院、县医院(Harborview)和社区卫生中心(Sea Mar)招募。我们的主要结果将是通过HbA1c来衡量血糖控制。次要结果是血压、血脂、卫生保健利用、健康相关生活质量、自我效能和糖尿病自我管理行为。 公共卫生相关性：这项研究将测试社区卫生工作者干预的有效性，该干预包括在多样化的低收入人群中进行以家庭为基础的糖尿病教育和与社区资源的联系。我们将开发一种可复制和可持续的模式，可供社区组织和当地公共卫生机构采用。鉴于2型糖尿病患者的患病率越来越高，需要具有成本效益的机制来管理这一慢性病的负担。

DESCRIPTION (provided by applicant): Type 2 diabetes is an important and common health problem and disproportionately affects low income and minority populations. Acquiring diabetes self- management skills and applying them on a daily basis is challenging, especially for individuals with limited resources. Interventions utilizing community health workers (CHWs) improve knowledge and behavior among persons with diabetes, and in some studies have improved health outcomes. CHWs are a theoretically appealing way to reach vulnerable populations, however, additional work is needed to understand how and in what settings CHWs could most effectively impact diabetes care and reduce health disparities. Information regarding cost- effectiveness and return on investment is also needed. OBJECTIVES: We will test the hypotheses that CHWs providing in-home support for self- management of type 2 diabetes, resources for diabetes, and assistance in effective linkage and communication with medical providers will: (1) improve HbA1c (primary outcome) and secondary outcomes including blood pressure and lipid control, health care utilization, and health-related quality of life; (2) improve diabetes self-management, including self-efficacy, physical activity, nutrition, and medication adherence; and (3) be cost-effective and feasible. METHODS: We will implement a 5-year randomized controlled trial that will compare a CHW model consisting of in home diabetes self-management support, links to group support, and telephone support compared to usual care. CHWs will make up to 5 home visits over the course of a year to provide tailored support in the key components of self-management; referral to group activities including disease self-management classes; generate social support through relationships with their clients; and develop skills to navigate the health care system. At the end of the study period, usual care participants will receive a home visit by a CHW and diabetes self-management resources. The participants will be drawn from an ethnically and culturally diverse group of low-income patients age 30-70 who speak English or Spanish with type 2 diabetes and poorly controlled blood sugar and/or blood pressure who reside in King County, Washington. Participants will be recruited from the local Veterans Affairs (VA) hospital, the county hospital (Harborview) and a community health center (Sea Mar). Our primary outcome will be glycemic control as measured by a HbA1c. Secondary outcomes are blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self- management behaviors. PUBLIC HEALTH RELEVANCE: This study will test the effectiveness of a community health worker intervention that includes home-based diabetes education and links to community resources in a diverse low-income population. We will develop a replicable and sustainable model that can be adopted by community-based organizations and local public health agencies. Given the increasing prevalence of individuals with type 2 diabetes, cost-effective mechanisms are needed to manage the burden of this chronic disease.