Developing and Pilot Testing Community and Family-Based Strategies to improve Type 1 Diabetes Management in African American and Latino School-Aged Children

项目总结和摘要 越来越多的研究表明，患有1型糖尿病（T1 D）的非洲裔美国人和拉丁裔儿童 健康状况比非西班牙裔白色儿童差。父母之间的强烈参与， 儿童糖尿病管理行为对优化青年血糖控制至关重要， 防止青少年期血糖控制迅速恶化和青年期不良结局。 非裔美国人和拉丁裔家庭不太可能共同参与糖尿病管理， 但没有研究确定少数民族家庭面临的障碍。文献中的这一空白严重限制了 制定针对共同参与的干预措施，以改善血糖控制， 防止少数民族家庭在青春期血糖控制恶化。另一个主要限制 防止这种恶化的文献是缺乏已发表的适应性干预试验， 在家庭健康常规之前，在学龄期（5-9岁）采取干预措施，改善糖尿病结局 都是固化的，很难修改。儿童哮喘研究表明， 由受过训练的父母同伴提供的干预措施也可能是改善健康的有效方法 T1 D学龄儿童的结局。这个项目的目的是创建和测试一个父对等体- 提供，基于家庭团队合作的社区家庭干预，一个有效的诊所为基础的脸， 对患有T1 D的青春期前和青春期早期青年及其父母进行面部干预，重点关注 非裔美国人或拉丁美洲人的学龄青年（5-9岁）。干预，我们命名为 家庭团队-同伴传递（FT-P），有可能防止血糖的快速恶化， 通过在家庭保健常规牢固确立之前将其作为目标，在青春期进行控制。我们将整合 改编的家庭团队合作课程材料最初是为青少年开发的， 我们的团队实施了由家长同行提供的干预计划，重点是提高质量 在资源有限和长期生活压力大的少数民族家庭中开展育儿工作。我们会申请，因为 每一种族/族裔群体分别采取参与性办法，让社区利益攸关方参与， 以证据为基础的家庭团队工作组成部分，并将其与父母同行交付格式相结合。的 这项研究将在多样化的休斯顿市进行，那里大约有30%的T1 D糖尿病儿童 非裔美国人或拉丁美洲人。我们将测试的可行性，利益相关者的满意度，和初步成果， 对非裔美国人和拉丁裔家庭进行的改进、调整和综合的FT-P干预， 关于家庭对干预措施的接受程度和有用性的定性数据，并进一步完善干预措施 为更大规模的随机对照试验做准备。

PROJECT SUMMARY AND ABSTRACT Studies have increasingly showed that African American and Latino children with type 1 diabetes (T1D) have poorer health outcomes than Non-Hispanic white children. Strong shared involvement between parents and children in diabetes management behaviors is essential to optimize glycemic control in youth, and protect against rapid deterioration of glycemic control during adolescence and poor outcomes in young adulthood. African American and Latino families are less likely to engage in shared involvement in diabetes management, but no studies have identified the obstacles faced by minority families. This gap in the literature severely limits the development of interventions that target shared involvement in order to improve glycemic control and prevent glycemic control deterioration during adolescence among minority families. Another major limitation of the literature for preventing this deterioration is that lack of published intervention trials of adapted interventions that improve diabetes outcomes during school-age years (5-9 years) before family health routines are solidified and challenging to modify. Studies in pediatric asthma suggest that community-based interventions delivered by trained parent peers may also be an effective approach for improving health outcomes in school-age children with T1D. The purpose of this project is to create and test a parent peer- delivered, community-based family intervention based on Family Teamwork, an effective clinic-based face to face intervention for pre- and early- adolescent youth with T1D and their parents, focusing on families of school-age youth (ages 5-9 years) who are African American or Latino. The intervention, which we have named Family Teamwork-Peer Delivery (FT-P), has the potential to prevent the rapid deterioration of glycemic control in adolescence by targeting family health routines before they are firmly established. We will integrate adapted Family Teamwork curriculum materials originally developed for adolescents with a successful intervention program delivered by parent peers our team has implemented focused on improving quality parenting among minority families with limited resources and high chronic life stressors. We will apply, for each racial/ethnic group separately, participatory approaches involving community stakeholders to adapt the evidence-based Family Teamwork components and integrate them with the parent peer delivery format. The study will occur in the diverse city of Houston, where approximately 30% of children with T1D diabetes are African American or Latino. We will test the feasibility, stakeholder satisfaction, and preliminary outcomes of the refined, adapted, and integrated FT-P intervention with African American and Latino families, obtain qualitative data on family acceptability and usefulness of the intervention, and further refine the intervention for each racial/ethnic group separately to prepare for a larger randomized controlled trial.