AMERICAN INDIAN DIABETES BELIEFS & PRACTICES: MATERNAL CARE, INFANT MORTALITY....

美洲印第安人对糖尿病的看法

• 批准号: 7628684
• 负责人: Joseph Neil Henderson
• 金额: $ 23.44万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7628684
• 关键词: Abate; Adherence; American; American Indians; Area; Behavior; Behavioral; Belief; Caring; Categories; Choctaw Nation of Oklahoma; Clinical Research; Collaborations; Communication; Communication Barriers; Community Health; Community Health Education; Diabetes Mellitus; Discipline; Disease; Education; Etiology; Gestational Diabetes; Goals; Healed; Health; Health Personnel; Health Promotion; Health Sciences; Health behavior; Health education; Healthcare; Home visitation; House Call; Infant Mortality; Institution; Interview; Knowledge; Licensing; Mainstreaming; Measures; Medical; Modeling; Nurses; Oklahoma; Outcome; Participant; Patient currently pregnant; Patients; Perception; Pharmaceutical Preparations; Phase; Physicians; Pregnancy; Pregnant Women; Prevalence; Prevention; Preventive; Process; Provider; Questionnaires; Rate; Recommendation; Recruitment Activity; Research; Resources; Screening procedure; Site; Source; Today; Training; Transportation; Tribes; Universities; Woman; base; care delivery; care seeking; concept; coping; diabetes education; diabetes educator; diabetes management; diabetic; experience; healing; health belief; health care delivery; health disparity; help-seeking behavior; implementation research; improved; infant outcome; non-diabetic; satisfaction; social; tool; treatment planning; tribal community

Specific Aims This research on American Indian (AI) diabetes beliefs and practices as they relate to maternal care, infant mortality, and adherence seeks to elicit practitioner and patient Explanatory Models of pregestational and gestational diabetes mellitus, and will be conducted in collaboration with the Chickasaw and Choctaw Nations of Oklahoma, under the auspices of the Oklahoma Center for American Indian Diabetes Health Disparities Research (OCAIDHD) at the University of Oklahoma Health Sciences Center (OUHSC) and the General Clinical Research Center (GCRC). The schema for this research is based on Kleinman (1978) concept of health behaviors being located in three sectors: professional (licensed, educated in cosmopolitan institutions), popular (lay), and folk (lay but with social recognition of healing capacity). The research is directed at all three sectors, but telescoped into "professional" and "popular and folk." The professional sector is comprised of health providers that are (AI and non-AI) licensed practitioners whose education is steeped in biomedicine. The popular/folk sector is comprised of pregnant AI women: gestational, pre-gestational, or "never had" diabetes. The popular and folk sector is combined because participants characterized as "folk practitioners" are not sought as direct subjects. However, subjects from the popular sector may make references to "folk" sector participants. If this occurs, that information will be collected as part of the popular sector subjects' experience with diabetes coping. The result is that, if present, the folk sector influence will still be captured but viewed as a part of popular sector subjects' way of managing diabetes. This research will provide practitioners of multiple disciplines new information that delineates patients' ways of help-seeking and adherence/non-adherence with treatment recommendations for pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). Findings will inform practitioners about 1) differing Explanatory Models of diabetes held by their patients, 2) how practitioners' biomedical Explanatory Models of diabetes during pregnancy differ from patient culturallybased models, and 3) areas of concordance and discordance across models. Knowledge gained from this research will facilitate health care delivery in that biomedical diabetes education before and during pregnancy can be more appropriately integrated with pre-existing patient models, thus providing the pregnant woman with access to culturally-relevant diabetes education. Moreover, this research will contribute to a more complete understanding of health beliefs and behavioral dynamics in terms of how disease is culturally constructed, with particular relevance to potential impacts on maternal care and infant mortality in the context of diabetes. Paradoxically, in spite of today's most advanced medical treatment, prevention campaigns, and health promotion strategies, prevalence rates for diabetes mellitus, as well as GDM, are persistent and rising. In the presence of potent drugs and wide-spread health education information, diabetes prevalence should be abating. Since it is not, other factors promoting diabetes must be operating. Preliminary research suggests that one possible source for persistent and increasing diabetes prevalence is that nonobvious sociocultural factors are present that impede the productive application of pharmacologic and health education tools. In addition to poor management of the diabetes, mutual respect between practitioners and patients suffers from communication discordance with the result that both are very dissatisfied with the encounter. The non-obvious sociocultural factors operating to impede effective health care are found in the divergent models of diabetes held by practitioners and patients. Specifically, professional and lay explanations for disease, treatment, and prevention can vary radically. Explanations for the etiology, treatment, course, and preventive measures for sickness are known as "explanatory models." Explanatory Models (EMs) held by providers and patients may be similar. Similar EMs facilitate communication and are associated with increased adherence to treatment recommendations and patient/provider satisfaction. However, EMs that are discordant between practitioners and patients are prone to reduce effective communications, adherence to treatment recommendations, and negatively impact health outcomes. This research will elicit Explanatory Models of diabetes during pregnancy from pregnant diabetics (n=40), 60 pregnant non-diabetics (n=60), and their health care providers (n=60 ) regarding etiology, course, and treatment in order to reduce barriers to adherence and improve diabetes outcomes. All pregnant subjects are AI's. "Health Care Providers" are defined as physicians, licensed nurses, Certified Diabetes Educators (CDE's), and tribal Community Health Representatives (CHR's: paraprofessionals trained for home visits, screenings, health education, community resource identification, and transportation to health care sites). Collaboration with the Choctaw and Chicksaw Nations of Oklahoma will be continuous to strengthen all phases of the research process and assure that appropriate research goals will be met. Specific Aim # 1: Collaboration with Choctaw and Chickasaw Nations on decisions regarding questionnaire refinement, research implementation, and application of the research findings. Specific Aim # 2: Recruit 60 health care providers and 100 pregnant patients to serve as subjects for interviews. Specific Aim #3: Delineate the Explanatory Models held by 100 pregnant women of which 10 will have pre-gestational diabetes, 30 will have gestational diabetes, and 60 will not have diabetes. Hypothesis: Explanatory Models will vary by category of disease experience. Specific Aim # 4: Delineate the Explanatory Models held by patients about maternal and infant outcomes relevant to diabetes during pregnancy. Hypothesis: Patient's Explanatory Models of maternal and infant outcomes may predict help-seeking and adherence behaviors. Specific Aim # 5: Delineate the Explanatory Models of diabetes held by providers regarding their patients' diabetes education, care-seeking behaviors, and adherence/non-adherence to treatment plans. Hypothesis: Provider Explanatory Models of diabetes may be discordant with patient models of diabetes, contributing to communication barriers. Perceptions of patient help-seeking and adherence may either facilitate or be a barrier to optimal care. Specific Aim #6: Delineate provider models of care delivery. Hypothesis: Provider models of care delivery may either facilitate or impede patients' help-seeking and adherence behaviors.. Specific Aim #7: Delineate subjects' degree of identification with traditional AI culture or mainstream culture. Hypothesis: Subjects' cultural identification may predict their Explanatory Model of diabetes. Specific Aim # 8: In collaboration with Choctaw and Chickasaw Nations, disseminate the findings of the research to health care providers in both tribes.

具体目标 这项关于美洲印第安人 (AI) 糖尿病信念和实践的研究，因为它们与母亲有关 护理、婴儿死亡率和依从性旨在引出医生和患者的孕前解释模型 和妊娠糖尿病，并将与 Chickasaw 合作进行 和俄克拉荷马州乔克托民族，在俄克拉荷马州美洲印第安人中心的赞助下 俄克拉荷马大学健康科学中心的糖尿病健康差异研究 (OCAIDHD) （OUHSC）和普通临床研究中心（GCRC）。 这项研究的模式基于 Kleinman (1978) 的健康行为概念 位于三个部门：专业（获得许可，在国际化机构接受教育）、大众（非专业）和 民间（外行但具有治愈能力的社会认可）。该研究针对所有三个部门，但是 概括为“专业”和“流行和民间”。专业部门包括健康 提供者是（人工智能和非人工智能）许可从业者，其教育背景是生物医学。这 流行/民间部门由怀孕的 AI 妇女组成：妊娠期、妊娠前或“从未有过” 糖尿病。流行和民间部分结合在一起，因为参与者的特征是“民间 从业者”不被视为直接主题。然而，来自大众部门的主题可能会使 提及“民间”部门参与者。如果发生这种情况，该信息将作为 热门部门受试者应对糖尿病的经验。结果是，如果存在的话，民间部门 影响力仍将被捕获，但被视为流行部门主题管理糖尿病方式的一部分。 这项研究将为多学科的从业者提供新的信息来描述 患者寻求帮助的方式以及遵守/不遵守孕前治疗建议的情况 糖尿病（PGDM）和妊娠期糖尿病（GDM）。调查结果将告知 从业者关于 1) 患者持有的不同糖尿病解释模型，2) 如何 从业者的妊娠期糖尿病生物医学解释模型与患者基于文化的不同 模型，以及 3) 模型之间的一致性和不一致的领域。由此获得的知识 研究将促进生物医学糖尿病教育之前和期间的医疗保健服务 怀孕可以更适当地与预先存在的患者模型相结合，从而提供 孕妇能够接受文化相关的糖尿病教育。此外，这项研究将 有助于更全面地了解健康信念和行为动态 疾病是由文化构成的，尤其与对孕产妇护理和婴儿的潜在影响有关 糖尿病背景下的死亡率。 矛盾的是，尽管当今有最先进的医疗、预防运动和 健康促进战略、糖尿病和 GDM 的患病率持续存在且 上升。在有效药物和广泛传播的健康教育信息的存在下，糖尿病患病率 应该会减弱。既然事实并非如此，那么肯定还有其他促进糖尿病的因素在起作用。初步的 研究表明，糖尿病患病率持续上升的一个可能原因是非明显的 社会文化因素的存在阻碍了药理和药物的有效应用 健康教育工具。除了糖尿病管理不善之外，相互尊重 医生和患者之间存在沟通不协调的问题，导致双方都非常不愉快。 对这次相遇不满意。 阻碍有效医疗保健的非明显社会文化因素存在于 从业者和患者持有不同的糖尿病模型。具体来说，专业和外行 对疾病、治疗和预防的解释可能截然不同。病因学的解释， 疾病的治疗、病程和预防措施被称为“解释模型”。解释性的 提供者和患者持有的模型 (EM) 可能相似。类似的 EM 有助于沟通和 与增加对治疗建议的依从性和患者/提供者的满意度相关。 然而，医生和患者之间不一致的 EM 很容易降低有效 沟通、遵守治疗建议并对健康结果产生负面影响。 这项研究将从妊娠期引出妊娠期糖尿病的解释模型 糖尿病患者 (n=40)、60 名非糖尿病孕妇 (n=60) 及其医疗保健提供者 (n=60) 病因、病程和治疗，以减少依从性障碍并改善糖尿病结局。 所有怀孕的受试者都是AI。 “医疗保健提供者”被定义为医生、有执照的护士、 认证糖尿病教育者 (CDE) 和部落社区健康代表 (CHR)： 接受过家访、筛查、健康教育、社区资源培训的专业人员辅助人员 身份识别以及前往医疗保健场所的交通）。与 Choctaw 和 Chicksaw 的合作 俄克拉荷马州将继续加强研究过程的各个阶段，并确保 将实现适当的研究目标。 具体目标#1：与乔克托和契卡索民族就有关问题的决定进行合作 问卷细化、研究实施和研究结果的应用。 具体目标#2：招募 60 名医疗保健提供者和 100 名怀孕患者作为研究对象 采访。 具体目标#3：描绘由 100 名孕妇持有的解释模型，其中 10 名将怀孕 孕前糖尿病，30岁就会有妊娠糖尿病，60岁不会有糖尿病。 假设：解释模型将根据疾病经历的类别而变化。 具体目标#4：描绘患者对孕产妇和婴儿结局的解释模型 与妊娠期糖尿病有关。 假设：患者对母婴结局的解释模型可以预测寻求帮助和 遵守行为。 具体目标#5：描绘提供者关于其糖尿病的解释模型 患者的糖尿病教育、就医行为以及遵守/不遵守治疗计划。 假设：糖尿病提供者解释模型可能与糖尿病患者模型不一致， 造成沟通障碍。对患者寻求帮助和依从性的看法可能是 促进或成为最佳护理的障碍。 具体目标#6：描绘护理服务的提供者模式。 假设：提供护理服务的提供者模式可能会促进或阻碍患者寻求帮助和帮助 遵守行为.. 具体目标#7：描绘受试者对传统人工智能文化或主流的认同程度 文化。 假设：受试者的文化认同可以预测他们的糖尿病解释模型。 具体目标#8：与乔克托和契卡索国家合作，传播调查结果 对两个部落的医疗保健提供者进行研究。