Stories for Change (S4C): Digital Storytelling for Diabetes Self-Management among Hispanic Adults

项目摘要/摘要 西班牙裔成年人患2型糖尿病(T2D)的可能性是后者的两倍，死于 这种疾病比非西班牙裔白人要好。这些差异在一定程度上是由不太健康的 体力活动、饮食质量、服药依从性和血糖自我监测 白色的。考虑到影响这些行为的复杂的社会文化力量，以社区为基础的参与式 需要采用研究(CBPR)方法来解决这些问题。罗切斯特健康社区伙伴关系是一项 由社区组织、卫生服务组织和 在共同部署方案编制和成果评估方面经验丰富的学者 移民人口。在过去的三年里，来自西班牙裔社区的RHCP合作伙伴共同 创建了用于T2D自我管理的数字讲故事干预，已在初级保健中试行 跨多个机构的设置。数字讲故事干预是基于叙事的视频 通过CBPR方法，让与会者克服健康障碍的真实声音浮出水面 促进行为，在这种情况下，是与糖尿病自我管理相关的行为(体力活动，健康 饮食、服药依从性和血糖监测)。这些视频可以塑造儿童的健康行为 通过影响观众的态度和信仰。其目的是：1)评估一个社区的效能- 在T2D控制不良的西班牙裔成年人中衍生的数字讲故事干预，以及2)探索 干预对拟议的以理论为基础的变革调解人的影响。使用两组设计，450 T2D控制不佳的西班牙裔成年人将被随机分配观看12分钟的数字故事讲述 常规护理干预或仅接受常规临床护理。两组都将接受糖尿病教育 材料和资源指南，用于联系他们的糖尿病护理团队，符合现有的 关心。干预后6个月测量的主要结果是血糖控制为 以血红蛋白A1c表示。次要结果将包括糖尿病自我管理行为、血液 血压、低密度脂蛋白和体重指数。伴随协变量的影响，包括性别、年龄、 而社会经济状况对干预效果的敏感度也将进行探讨。这项工作测试了一个 在初级保健环境中实施针对弱势人群的可扩展、低成本干预措施 为快速翻译实践提供了机会。我们将为社区建立一个可传播的框架 参与慢性病管理的数字故事制作，提供了一种可能 适用于其他社区和卫生优先事项。

PROJECT SUMMARY/ABSTRACT Hispanic adults are twice as likely to have type 2 diabetes mellitus (T2D) and 1.5 times more likely to die from the disease than non-Hispanic whites. These disparities are mediated, in part, by less healthful levels of physical activity, dietary quality, medication adherence, and self-monitoring of blood glucose than non-Hispanic whites. Given the complex sociocultural forces that influence these behaviors, a community-based participatory research (CBPR) approach is called for to address them. The Rochester Healthy Community Partnership is a robust CBPR partnership consisting of community-based organizations, health service organizations, and academics who are experienced at collectively deploying programming and outcomes assessment among immigrant populations. Over the past three years, RHCP partners from the Hispanic community have co- created a digital storytelling intervention for T2D self-management that has been piloted in primary care settings across multiple institutions. Digital storytelling interventions are narrative-based videos elicited through a CBPR approach to surface the authentic voices of participants overcoming obstacles to health promoting behaviors, in this case, behaviors related to diabetes self-management (physical activity, healthful diet, medication adherence, and blood glucose monitoring). These videos can shape health behaviors of viewers through influences on attitudes and beliefs. The aims are: 1) To evaluate the efficacy of a community- derived digital storytelling intervention among Hispanic adults with poorly controlled T2D, and 2) to explore the effect of the intervention on proposed theory-based mediators of change. Using a two-group design, 450 Hispanic adults with poorly controlled T2D will be randomly assigned to view the 12-minute digital storytelling intervention with usual care or receive usual clinical care only. Both groups will receive diabetes education materials and a resource guide for contacting their diabetes care team, consistent with existing standards of care. The primary outcome, measured up to six months after intervention delivery, will be glycemic control as measured by hemoglobin A1c. Secondary outcomes will include diabetes self-management behaviors, blood pressure, LDL-cholesterol, and body mass index. The impact of concomitant covariates, including sex, age, and socio-economic status, on the sensitivity of the intervention effect will also be explored. This work tests a scalable, low cost intervention targeting vulnerable populations implemented in primary care settings with the opportunity for rapid translation to practice. We will establish a disseminable framework for community participation in digital storytelling production for chronic disease management, providing a model that may be applied to other communities and health priorities.