Improving Hmong Health through Community Based Participatory Research

描述(由申请人提供)：与非西班牙裔白人相比，美国苗族人口经历2型糖尿病(T2 DM)的比例不成比例(24%对10.2%)。在越美战争后移居美国之前，苗族人没有糖尿病的概念。由于这种知识缺失，苗族人可能更有可能在晚期T2 DM疾病中寻求治疗，以及在T2 DM表现为严重残疾后寻求治疗。这种延迟医疗的模式反映在苗族T2 DM患者中发现的HbAIC(糖化血红蛋白-糖尿病管理的衡量标准)高于推荐水平(9.3%至11.6%，而不是推荐值6.5%)。护理的延误，加上遵循推荐的西方医学指南管理糖尿病的挑战，导致疾病负担增加，如在苗族人中发现的心脏病、肾衰竭、视力丧失和周围神经病变的比例不成比例。为了解决这一健康不平等问题，开发了一个基于社区的参与性研究(CBPR)伙伴关系项目，以减少苗族社区中T2 DM的疾病负担。CBPR伙伴关系的工作由一个社区咨询委员会提供信息。社区咨询委员会的所有成员都是苗族人，包括护士、护士从业者、药剂师、自然疗法提供者、萨满、社区领袖和患有糖尿病的个人及其家人。CBPR合作伙伴进行了一项苗族T2 DM患者的社区需求评估，发现只有13%的人接受过脚部检查，30%的人报告在去年做过扩眼检查，只有35%的人见过糖尿病教育者，38%的人不知道他们的HbAlC状态，也没有听说过这个词。只有20%的人报告说他们每天至少检查一次血糖，15%的人报告说他们做过任何类型的锻炼或体力活动。为了解决推荐的糖尿病护理方面的差距，社区咨询委员会为这项研究提案提出了四个目标：(1)创建一个有效的以社区和学术为基础的参与性伙伴关系和社区咨询委员会，其中包括苗族西部和补充和替代医疗保健提供者，(2)确定社区卫生保健工作者作为服务协调员、健康教育者和患有T2 DM的苗族社区成员的保健导航员的有效性，(3)翻译和评估世界卫生组织T2 DM护理管理和生物医学研究的世界卫生组织生活质量-BREF工具，(4)进行准体验式研究，以确定社区卫生工作者的服务和参与气功(一种调解和锻炼计划)是否会改善苗族社区T2 DM患者的生活质量和生物标志物。苗族社区T2 DM并发症的持续负面后果需要进一步研究以社区为基础的有效机制，以改善生活质量和健康结果，并进行未来基于证据的翻译研究。 相关性(见说明)：2型糖尿病是苗族社区发病率和死亡率的主要原因。治疗不足的2型糖尿病造成了不必要的疾病负担和经济困难。这项研究的目标是帮助苗族社区2型糖尿病患者达到2020年健康人目标(D2-14)，并改善健康状况。

DESCRIPTION (provided by applicant): The U.S. Hmong population experiences Type 2 diabetes mellitus (T2DM) at disproportionate rates when compared to Non-Hispanic whites (24 percent vs. 10.2 percent). Prior to resettling in the United States after the Vietnam-American War, the Hmong had no concept of diabetes. As a result of this knowledge deficit, the Hmong may be more likely to seek care in an advanced state T2DM disease and after the T2DM has manifested itself in significant disability. This pattern of delayed health care is reflected in hiher than recommended levels of HbAIC (glycosylated hemoglobin-a measurement of diabetes management) found in Hmong patients with T2DM (9.3 to 11.6 percent instead of the recommended <6.5 percent). The delay in care, along with challenges in following recommended Western medical guidelines to manage diabetes, leads to increased burden of disease such as the disproportionate rates of heart disease, kidney failure, loss of vision, and peripheral neuropathy found among the Hmong. To address this health inequity a community based participatory research (CBPR) partnership project was developed to reduce the disease burden of T2DM among the Hmong community. The CBPR partnership's work is informed by a community advisory board. All members of the community advisory board are Hmong in origin and include nurses, nurse practitioners, pharmacists, naturopathic providers, shaman, community leaders and individuals and their family members with diabetes. The CBPR partnership conducted a community needs assessment persons of Hmong origin with T2DM and found that only 13 percent had ever received a foot check, 30 percent reported having a dilated eye exam in the last year, as few as 35 percent had seen a diabetic educator and 38 percent are not aware of their HbAlC status and had not heard the term. Only 20 percent reported checking their blood glucose at least once a day, and 15 percent reported doing any type of exercise or physical activity. In order to address the gaps in recommended diabetes care, the community advisory board proposed four aims for this research proposal: (1) create an effective community-academic based participatory partnership and community advisory board that is inclusive of both Hmong Western and complementary and alternative healthcare providers, (2) determine the effectiveness of Community Healthcare Workers who function as service coordinators, health educators, and healthcare navigators for Hmong community members with T2DM, (3) translate and evaluate the World Health Organization Quality of Life-BREF instrument for care management and biomedical research of T2DM among the Hmong community, (4) conduct a quasi-experiential study to determine if Community Health Workers' services and participation in Qigong (a mediation and exercise program) will improve the quality of life and biomarkers for Hmong community members with T2DM. The continued negative consequence of complications from T2DM in the Hmong community warrants further research into effective community based mechanisms to improve quality of life and health outcomes and for future evidence based translational research. RELEVANCE (See instructions): Type 2 diabetes mellitus is a leading cause of morbidity and mortality among the Hmong community. Undertreated Type 2 diabetes mellitus creates undue burden of disease and financial hardship. The goal of this study is to assist in meeting the Healthy People 2020 objectives (D 2-14) for Hmong community members with Type 2 diabetes mellitus and improve health outcomes.