Reversing Non-adherence in American Indians with Diabetes Mellitus Type Two

扭转患有二型糖尿病的美洲印第安人的不依从性

• 批准号: 8261678
• 负责人: Marlene K. Wilken
• 金额: $ 20.97万
• 依托单位: CREIGHTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8261678
• 关键词: Address; Adherence; Adult; American Indians; Behavior; Blood Pressure; Body mass index; Caring; Cessation of life; Communities; Consent; Control Groups; Creatinine; Data; Death Rate; Decision Making; Depression screen; Diabetes Mellitus; Documentation; Education; Educational process of instructing; Effectiveness; Elements; Enzymes; Ethnic group; Exhibits; Future; Genetic Transcription; Glycosylated hemoglobin A; Goals; Health; Health Services Research; Healthy People 2010; Individual; Insulin; Intervention; Lead; Lipids; Liver; Longevity; Measures; Methods; Modeling; Monitor; Nebraska; Non-Insulin-Dependent Diabetes Mellitus; Ophthalmic examination and evaluation; Oral; Outcome; Pilot Projects; Population; Population Study; Process; Psyche structure; Public Health; Quality of life; Reading; Recruitment Activity; Reporting; Self Care; Self Management; Sioux Indians; Site; Societies; South Dakota; Testing; Tribes; United States; United States Dept. of Health and Human Services; United States Indian Health Service; Vulnerable Populations; Weight; base; burden of illness; design; diabetes education; diabetic; foot; health care quality; improved; inclusion criteria; innovation; meetings; member; spiritual healing

DESCRIPTION (provided by applicant): This pilot study is designed to compare diabetes self-management outcomes and effectiveness between two groups of adult American Indians (AIs) who have been identified as having uncontrolled diabetes mellitus type two (DM2) and have been prescribed insulin but do not take insulin as directed. The experimental group will receive diabetes self-management education (DSME) using the culturally appropriate Talking Circles (TCs) format and the control group will receive DSME using the traditional didactic-classroom format. Talking Circles (TCs) are a cultural means to facilitate teaching and decision-making in AIs and have been identified as an Indian Health Service (IHS) best practice but have not been tested as a means of improving diabetes self-management outcomes. The hypothesis is that the experimental group will have better diabetes self-management adherence and outcomes than will the control group. Goal 1: Test two approaches to DSME in a population of AIs who have uncontrolled DM2. Implement DSME in an experimental group (N=40) using TCs and in a control group (N =40) using traditional DSME. Goal 2: Describe and analyze the TC process and key elements. Audio record, transcribe and analyze the discussion in the TC meetings using content analysis for documentation and future replication. Goal 3: Monitor, compare, and report outcomes of the experimental and control groups at recommended intervals for the duration of the study. Outcomes to be monitored and compared include changes in self-care behavior and quality of life (QOL), and the IHS Standards of Care for Diabetes which include HbA1c, blood pressure, weight, body mass index, foot inspection, depression screen, lipid profile, creatinine, liver enzymes, and eye exam. The study is relevant to public health because it addresses what society can do to improve conditions in which a vulnerable population can be healthy. The diabetes-related death rate for AIs in the United States is 136 per 100,000 and the Healthy People 2010 objective is 25.0 per 100,000 population. AI communities use traditional and cultural approaches to improve health. TCs have been identified as a best practice for AIs but there are no data to indicate its potential to improve diabetes self-management. The desired outcome is that AIs with DM2 who receive culturally appropriate DSME will have improved self- care adherence outcomes and quality of life. In addition, improved outcomes could reduce the burden of disease, decrease diabetes-related death rates and increase the life span for AIs. Results are intended to lead to future multi-site studies to determine whether TCs fulfill their promise in DSME and can be replicated and generalized to improve DM2 outcomes in AIs. PUBLIC HEALTH RELEVANCE: The study is relevant to public health because it addresses what society can do to improve conditions in which a vulnerable population can be healthy. The diabetes-related death rate for AIs in the United States is 136 per 100,000 and the Healthy People 2010 objective is 25.0 per 100,000 population. American Indian communities use traditional and cultural approaches to improve health. The Talking Circle has been identified as a best practice for AIs but there is no data to indicate its potential to improve diabetes self-management. The desired outcome is that AIs with DM2 who receive culturally appropriate diabetes self-management education will have improved self-care adherence, outcomes and quality of life.

描述（由申请人提供）：这项试验研究旨在比较两组成年美国印第安人（AIS）之间的糖尿病自我管理结果和有效性，他们被确定为未经控制的糖尿病二型糖尿病（DM2）（DM2），但已被处方胰岛素，但不接受胰岛素。实验组将使用适当的文化讲座圈（TCS）格式接受糖尿病自我管理教育（DSME），并且对照组将使用传统的Didactic-clostroom格式接收DSME。会说话圈子（TCS）是一种文化手段，旨在促进AIS的教学和决策，并被确定为印度卫生服务（IHS）最佳实践，但未被视为改善糖尿病自我管理结果的一种手段。假设是，与对照组相比，实验组将具有更好的糖尿病自我管理依从性和结果。目标1：在不受控制的DM2的AIS中测试两种DSME的方法。使用传统DSME在实验组（n = 40）和对照组（n = 40）中实现DSME。目标2：描述和分析TC过程和关键要素。音频记录，转录和分析TC会议中的讨论，使用内容分析进行文档和未来复制。目标3：在研究期间，以建议的间隔进行监测，比较和报告实验组和对照组的结果。要监控和比较的结果包括自我保健行为和生活质量的变化（QOL），以及包括HBA1C，血压，体重，体重，体重指数，脚部检查，抑郁症状，脂质筛查，脂质特征，肌酐，肌氨酸，肝酶和眼科检查的糖尿病的IHS护理标准。该研究与公共卫生有关，因为它解决了社会可以采取的措施来改善脆弱人群可以健康的状况。美国AIS与糖尿病相关的死亡率为每100,000人136，而2010年健康人的目标为每100,000人口25.0。 AI社区使用传统和文化方法来改善健康。 TC已被确定为AIS的最佳实践，但没有数据表明其可能改善糖尿病自我管理的潜力。理想的结果是，与DM2获得适当文化的DSME的AI将改善自我护理的依从性结果和生活质量。此外，改善的结局可以减轻疾病的负担，降低与糖尿病相关的死亡率并增加AIS的寿命。结果旨在导致未来的多站点研究，以确定TCS是否符合其在DSME中的诺言，并且可以复制和概括以改善AIS中的DM2结果。 公共卫生相关性：该研究与公共卫生有关，因为它解决了社会可以采取的措施来改善脆弱人群可以健康的状况。美国AIS与糖尿病相关的死亡率为每100,000人136，而2010年健康人的目标为每100,000人口25.0。美洲印第安人社区使用传统和文化方法来改善健康。谈话圈已被确定为AIS的最佳实践，但没有数据表明其可能改善糖尿病自我管理的潜力。理想的结果是，接受文化上适当的糖尿病教育的DM2的AI将改善自我保健的依从性，成果和生活质量。