Culturally-adapted DPP intervention for Mexican Americans in primary care: An RCT

在初级保健中对墨西哥裔美国人进行文化适应的 DPP 干预：一项随机对照试验

• 批准号: 8916067
• 负责人: Jun Ma
• 金额: $ 24.81万
• 依托单位: PALO ALTO MEDICAL FOUNDATION RES INST
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8916067
• 关键词: Culturally; adapted; DPP; intervention; Mexican

DESCRIPTION (provided by applicant): Background: Latinos are the largest and fastest growing minority group (16% of the US population) and provide a potent example of existing health disparities among U.S. racial/ethnic groups. In particular, Mexican Americans-the largest US Latino subpopulation-have a notably higher prevalence of overweight and obesity (80%) than non-Hispanic whites (NHWs, 68%), and they are disproportionately affected by obesity-related risk factors (e.g., metabolic syndrome, pre-diabetes) and diseases (e.g., diabetes). Until efficacious lifestyle interventions for weight management are translated into practice, obesity and its comorbidities will continue to exact enormous and disproportionate burdens. Population-specific interventions are needed because undifferentiated interventions (often developed in white-dominant populations) may be inefficient-or even unintentionally increase health disparities. The Diabetes Prevention Program (DPP) trial demonstrated that an intensive lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults and that weight loss was the dominant predictor. Numerous DPP translation studies have been undertaken, including a pragmatic randomized trial our team recently completed ("E-LITE") with 241 participants (78% NHW) that showed success in integrating group counseling with health information technology (HIT) to operationalize the DPP intervention in primary care. To date, very few DPP translation studies have targeted Latinos. Design: We propose to culturally adapt the IT-enhanced group DPP intervention from E-LITE and test it among Spanish-speaking or bilingual Mexican Americans who are overweight or obese and have metabolic syndrome, pre-diabetes, or both. Participants (n=186) from 6 primary care practices in Santa Cruz, California (35% Latino residents; 91% of Mexican origin) will be randomly assigned to receive the culturally adapted intervention (CAI) or usual care. The primary aim is to determine the effectiveness of the CAI ("E" in the RE-AIM model). We hypothesize that the CAI will lead to a greater mean reduction in body mass index at 24 months (primary outcome) vs. usual care. Secondary outcomes will include cost-effectiveness, clinical (e.g., fasting glucose), psychosocial (e.g., quality of life), behavior change (e.g., diet, physical activity) measures. The secondary ai is to conduct process evaluation with mixed methods for the other RE-AIM attributes: Reach (e.g., participation rate of the target population), Adoption (e.g., participating clinic & provide characteristics), Implementation (e.g., intervention fidelity), and Maintenance (e.g., sustainabiliy in the practice setting). Implications: This health services research project (PA-13-045) falls within the AHRQ Research Portfolio areas of comparative effectiveness, HIT, and prevention and care management; it also targets a priority population. The findings will be of value to clinicians, patients, and other decision makers considering effective obesity and diabetes prevention programs for the millions of MAs who carry a disproportionate burden of these, with high potential for real-world applicability and impact on MA minority health and policies aimed to eliminate health disparities.

背景：拉丁美洲人是美国人口最多、增长最快的少数群体（占美国人口的16%），是美国种族/族裔群体之间存在健康差异的有力例证。特别是，墨西哥裔美国人——美国最大的拉丁裔亚群——超重和肥胖的患病率（80%）明显高于非西班牙裔白人（nhw, 68%），他们不成比例地受到与肥胖相关的危险因素（如代谢综合征、糖尿病前期）和疾病（如糖尿病）的影响。在有效的生活方式干预体重管理转化为实践之前，肥胖及其合并症将继续造成巨大和不成比例的负担。针对特定人群的干预措施是必要的，因为无差别的干预措施（通常在白人占主导地位的人群中开发）可能效率低下，甚至无意中增加了健康差距。糖尿病预防计划（DPP）试验表明，在高危成人中，强化生活方式干预使2型糖尿病发病率降低了58%，体重减轻是主要的预测因素。我们进行了大量的DPP翻译研究，包括我们团队最近完成的一项实用的随机试验（“E-LITE”），共有241名参与者（78% NHW），该试验成功地将团体咨询与健康信息技术（HIT）结合起来，在初级保健中实施DPP干预。迄今为止，很少有针对拉丁美洲人的DPP翻译研究。设计：我们建议对E-LITE的it增强组DPP干预进行文化调整，并在超重或肥胖且患有代谢综合征、糖尿病前期或两者兼而有之的西班牙语或双语墨西哥裔美国人中进行测试。来自加州圣克鲁斯6个初级保健诊所的参与者（n=186）（35%为拉丁裔居民，91%为墨西哥裔居民）将被随机分配接受文化适应干预（CAI）或常规护理。主要目标是确定CAI （RE-AIM模型中的“E”）的有效性。我们假设CAI将导致24个月时体重指数（主要结局）比常规护理更大的平均下降。次要结局将包括成本效益、临床（如空腹血糖）、社会心理（如生活质量）、行为改变（如饮食、身体活动）措施。二级人工智能是用混合方法对其他RE-AIM属性进行过程评估：Reach（例如，目标人群的参与率），Adoption（例如，参与诊所和提供特征），Implementation（例如，干预保真度）和Maintenance（例如，在实践环境中的可持续性）。含义：该卫生服务研究项目（PA-13-045）属于AHRQ研究组合领域的比较有效性，HIT和预防和护理管理；它还针对优先人群。该研究结果将对临床医生、患者和其他决策者有价值，他们正在考虑为数百万肥胖和糖尿病患者制定有效的预防方案，这些患者承担着不成比例的负担，具有很高的现实应用潜力，并对肥胖少数群体的健康和旨在消除健康差距的政策产生影响。