A Mobile Health Intervention to Reduce Diabetes Disparities in Chinese Americans

项目摘要/摘要 华裔美国人是美国增长最快的移民群体之一，他们遭受的影响不成比例 2型糖尿病(T2D)负担高，T2D控制差。尽管有很好的T2D记录 尽管这一少数群体存在差异，但在改善中国人的健康状况方面开展的工作有限 美国人。这个独立之路奖(K99/R00)的目标是加快候选人的 过渡到一名独立调查员，他在发展和评估方面拥有专注的专业知识 在文化和语言上量身定做的可持续干预措施，以减少中国人的T2D差异 美国人。在该奖项的K99阶段，候选人将获得完成此任务所需的关键培训 Goal，并将开发短消息服务(SMS)干预，以改善中文的T2D管理 美国人。在R00阶段，候选人将利用掌握的技能进行随机对照试验 试验以检查短信干预的潜在疗效。在K99阶段，候选人还将 开展试点工作，开发语言和文化上量身定制的短信干预内容，并完善 在R00阶段测试干预措施。更具体地说，目标是1)描述障碍和 T2D华裔美国人的血糖控制促进剂(目标1a)；2)在文化和语言方面的发展 定制短信干预内容(目标1b)；以及3)评估短信的可行性和可接受性 干预试验前、后研究(目标1c)。在R00阶段，应聘者将完善短信干预 基于K99飞行员的数据，并评估其在飞行员随机试验中的有效性的概念验证 66例华裔美国人的T2D对照试验(AIM 2)。参赛者将被随机分成两组 ARM(n=33)：1)等待名单控制；2)短信干预。这两组人将继续获得标准的 他们的T2D的护理治疗。短信小组将通过短信链接收到简短的生活方式咨询视频。在 研究结束后，将为轮候名单控制组提供接收基于短信的机会 咨询视频。测量将在基线、3个月和6个月获得。主要结果是 糖化血红蛋白和次要结果包括自我效能、糖尿病自我管理行为、饮食摄入量和 体力活动行为。将使用线性混合建模来检查分组和按时间分组 短信干预与轮候名单对照组的交互作用效果。这项R00研究的发现将 通知短信干预的更大规模的R01疗效试验，并最终建立候选人的 研究计划的重点是开发和测试可持续的干预措施，以减少 华裔美国人的慢性病结局。该项目可作为其他慢性病的规划模式 需要改变生活方式的华裔美国人的疾病干预措施(例如，糖尿病前期、高血压)， 或者用于其他高危移民群体(例如南亚人、拉美裔美国人)的差异研究。

PROJECT SUMMARY/ABSTRACT Chinese Americans are one of the fastest growing immigrant groups in the US, who suffer disproportionately high type 2 diabetes (T2D) burden and have poorly controlled T2D. Despite the well-documented T2D disparities in this minority group, limited work has been conducted to improve health outcomes in Chinese Americans. The goal of this Pathway to Independence Award (K99/R00) is to expedite the candidate's transition to an independent investigator who possesses focused expertise in development and evaluation of culturally and linguistically tailored and sustainable interventions to reduce T2D disparities in Chinese Americans. In the K99 phase of this award, the candidate will obtain critical training needed to accomplish this goal and will develop a short message service (SMS) intervention to improve T2D management in Chinese Americans. In the R00 phase, the candidate will utilize acquired skills to conduct a pilot randomized controlled trial to examine the potential efficacy of the SMS intervention. In the K99 phase, the candidate will also conduct pilot work to develop linguistically and culturally tailored SMS intervention content and to refine the intervention to be tested in the R00 phase. More specifically, the aims are to 1) characterize barriers and facilitators of glycemic control in Chinese Americans with T2D (Aim 1a); 2) develop culturally and linguistically tailored SMS intervention content (Aim 1b); and 3) assess the feasibility and acceptability of the SMS intervention in a pre-, post-test study (Aim 1c). In the R00 phase, the candidate will refine the SMS intervention based on the K99 pilot data and evaluate the proof-of-concept regarding its efficacy in a pilot randomized controlled trial among 66 Chinese Americans with T2D (Aim 2). Participants will be randomized to one of 2 arms (n=33 each): 1) wait-list control and 2) SMS intervention. Both groups will continue to receive standard of care treatment for their T2D. The SMS group will receive brief lifestyle counseling videos via SMS links. At the end of the study, the wait-list control group will be provided the opportunity to receive the SMS-based counseling videos. Measurements will be obtained at baseline, 3, and 6 months. The primary outcome is HbA1c and secondary outcomes include self-efficacy, diabetes self-management behaviors, dietary intake and physical activity behaviors. Linear mixed modeling will be used to examine the group and group by time interaction effects between the SMS intervention and wait-list control group. Findings from this R00 study will inform a larger full-scale R01 efficacy trial of the SMS intervention, and ultimately, establish the candidate's program of research focused on developing and testing sustainable interventions to reduce disparities in chronic disease outcomes in Chinese Americans. This project can serve as a program model for other chronic disease interventions in Chinese Americans that require lifestyle modification (e.g., prediabetes, hypertension), or for disparities research in other high-risk immigrant populations (e.g., South Asians, Hispanic Americans).