Integrated Second Language Learning for Chronic Care: A model to improve primary care for Hispanics with diabetes

描述（由申请人提供）：慢性病护理综合第二语言学习：改善西班牙裔糖尿病护理的干预措施 摘要 医疗保健中的语言障碍被认为是美国西班牙裔健康差异的主要决定因素。1 有限的英语水平 (LEP) 也与西班牙裔糖尿病流行率飙升有关。对于西班牙裔人来说，2 型糖尿病 (DM2) 的患病率是非西班牙裔白人的 1.5 倍。3 在家中不会说英语的西班牙裔患者放弃糖尿病护理的风险更大，而且他们比非西班牙裔人采用特殊饮食来控制糖尿病、定期锻炼、 6, 3 最近的研究表明，患者和初级保健提供者之间的语言一致性 (LC) 是改善 LEP 糖尿病患者治疗结果的有效先决条件。增加 LC 执业护士数量的干预措施包括培养医疗保健专业人员第二语言 (L2) 能力的教育计划。现有二语训练文献综述 卫生专业人员透露，大部分课程和材料都是针对基本熟练程度，并且仅限于有限类型的临床互动。目前的研究团队认为，这些计划和材料主要面向急性护理，反映了患有慢性疾病的 LEP 患者群体与接受过二级急性护理职能培训的卫生专业人员之间的不匹配。我们认为，这种不匹配加剧了患有糖尿病的 LEP 患者在实现成功的自我管理以及随之而来的身心健康方面所面临的困难。该提案描述了针对执业护士学生的创新教育干预措施的设计和评估，该教育干预措施称为慢性护理综合语言学习（IL2L）。它追求第二语言和沟通技能的综合发展，以促进讲西班牙语的执业护士和 LEP 西班牙裔糖尿病患者之间富有成效的互动。将采用混合方法研究设计来检查干预措施的初步功效和可接受性。在患者层面，我们将采用随机对照试验来确定 IL2L 对未受控制的糖尿病患者的身体健康、心理健康和自我效能的影响。在学生层面，我们将采用 Roter 互动分析系统来衡量干预前后西班牙语互动技能的进步。在项目层面，我们将使用语言项目评估方法来评估领先护理学院的护士执业培训项目中干预措施的可接受性。

DESCRIPTION (provided by applicant): Integrated Second Language Learning for Chronic Care: An Intervention to Improve Nursing Care for Hispanics with Diabetes ABSTRACT Language barriers in healthcare are recognized as a leading determinant of health disparities among Hispanics in the United States.1 Limited English proficiency (LEP) has also been linked to the soaring diabetes epidemic among Hispanics. For Hispanics, the prevalence of type 2 diabetes mellitus (DM2) is 1.5 times that of non- Hispanic whites.3 Hispanic patients who do not speak English at home are at greater risk of foregoing diabetes care and they are significantly less likely than non-Hispanics to adopt a special diet for diabetes control, to exercise regularly, and to receive a yearly eye examination.6, 3 Recent research suggests that language concordance (LC) between patients and primary care providers is an effective precondition that improves outcomes in the treatment of LEP patients with diabetes. Interventions to increase the number of LC nurse practitioners consist of educational programs that develop second language (L2) abilities for health care professionals. A review of extant literature on L2 training for health professionals revealed that the preponderance of programs and materials are directed at basic levels of proficiency and confined to limited types of clinical interactions. The view of he present research team is that these programs and materials are substantially geared towards acute care and reflect a mismatch between an LEP patient population with chronic illnesses and a health professional workforce trained in L2 for acute care functions. This mismatch, we contend, exacerbates the difficulties faced by LEP patients with diabetes in achieving successful self- management and the physical and emotional wellness that goes along with it. This proposal describes the design and evaluation of an innovative educational intervention for nurse practitioner students called Integrated Language Learning for Chronic Care (IL2L). It pursues an integrated development of L2 and communication skills that will facilitate productive interactions between Spanish-speaking nurse practitioners and LEP Hispanic patients with diabetes. A mixed-method study design will be used to examine the preliminary efficacy and acceptability of the intervention. At the patient level, we will employ an RCT to determine the impact IL2L on the physical health, mental health, and self-efficacy of patients with uncontrolled diabetes. At the student level, we will employ the Roter Interaction Analysis System to measure gains in Spanish language interaction skills pre and post intervention. At the program level, we will use language program evaluation methodologies to assess the acceptability of the intervention within a nurse practitioner training program in a leading College of Nursing.