Improving Hmong Health through Community Based Participatory Research

描述（由申请人提供）：美国苗族人口的经验2型糖尿病（T2 DM）在不成比例的比率相比，非西班牙裔白人（24%对10.2%）。在越南战争后重新定居美国之前，苗族人没有糖尿病的概念。由于这种知识缺乏，苗族可能更有可能在T2 DM疾病晚期以及T2 DM表现出严重残疾后寻求护理。这种延迟的医疗保健模式反映在苗族T2 DM患者的HbAIC（糖化血红蛋白-糖尿病管理的测量）高于推荐水平（9.3%至11.6%，而不是推荐的<6.5%）。护理的延迟，沿着在遵循推荐的西方医学指南来管理糖尿病方面的挑战，导致疾病负担增加，例如在苗族中发现的心脏病、肾衰竭、视力丧失和周围神经病变的不成比例的比率。为了解决这一健康不平等的社区参与性研究（CBPR）伙伴关系项目的开发，以减少苗族社区之间的2型糖尿病的疾病负担。CBPR伙伴关系的工作由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血统，包括护士、执业护士、药剂师、自然疗法提供者、萨满、社区领袖和糖尿病患者及其家庭成员。CBPR伙伴关系对苗族T2 DM患者进行了社区需求评估，发现只有13%的人接受过足部检查，30%的人报告在去年进行了散瞳眼科检查，只有35%的人见过糖尿病教育者，38%的人不知道他们的HbAlC状况，也没有听说过这个术语。只有20%的人报告每天至少检查一次血糖，15%的人报告做任何类型的锻炼或体育活动。为了解决推荐的糖尿病护理的差距，社区咨询委员会提出了这项研究提案的四个目标：（1）创建一个有效的社区学术为基础的参与性伙伴关系和社区咨询委员会，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的有效性，他们作为服务协调员，健康教育工作者，苗族社区T2 DM成员的医疗保健导航员，（3）翻译和评估苗族社区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）进行准经验研究，以确定社区卫生工作者的服务和参与气功（调解和运动计划）将改善生活质量和苗族社区成员的生物标志物与T2 DM。苗族社区T2 DM并发症的持续负面后果需要进一步研究有效的社区机制，以改善生活质量和健康结局，并为未来的循证转化研究提供依据。 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型糖尿病会造成不必要的疾病负担和经济困难。本研究的目的是帮助苗族社区2型糖尿病患者实现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.