Addressing Marshallese Immigrant Barriers to Diabetes Self-Management through Family DSMES

通过家庭 DSMES 解决马绍尔移民糖尿病自我管理的障碍

• 批准号: 10573211
• 负责人: Pearl Mcelfish
• 金额: $ 87.14万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-29 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573211
• 关键词: Acculturation; Address; Adherence; Arkansas; Behavior; Biometry; Blood Pressure; Body mass index; Communities; Community Health Aides; Complications of Diabetes Mellitus; Cost Effectiveness Analysis; Data; Diabetes Mellitus; Distress; Education; Educational process of instructing; Evaluation; Faith-based organization; Family; Family member; Fasting; Glycosylated hemoglobin A; Goals; Health; Heterogeneity; Home; Immigrant; Immigrant community; Intervention; Lipids; Literature; Measures; Mediation; Medical Records; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Participant; Patient-Focused Outcomes; Patients; Persons; Population; Prediabetes syndrome; Quality of life; Research; Risk Factors; Self Efficacy; Self Management; Testing; Time; United States; Waiting Lists; Work; arm; behavioral adherence; cardiometabolic risk; community partnership; comparison group; cost; cost effective; cost per quality-adjusted life year; diabetes self-management; effectiveness evaluation; effectiveness testing; experience; family influence; family support; fasting glucose; glycemic control; health disparity; improved; intervention cost; intervention effect; medication compliance; minority communities; post intervention; public health relevance; sex; social; treatment effect; waist circumference

ABSTRACT Marshallese are a subpopulation of Pacific Islanders that are experiencing significant health disparities, with some of the highest documented rates of type 2 diabetes mellitus (T2DM) in the world.1-6 Estimates of T2DM in the Marshallese range from 20% to 50%, compared to 8.3% for the US population.1-6 Pilot data (n = 401) documented that Marshallese immigrants in Arkansas have extremely high rates of T2DM (38.4%), and pre- diabetes (32.6%), and only 10% engage in self-management behaviors. The Marshallese immigrant population has increased rapidly in United States (US). Marshallese immigrants experience unique barriers to self- management of T2DM, as well as unique cultural assets that can be leveraged to help mitigate these barriers. The research team worked with the Marshallese community to develop a culturally-adapted family model of DSMES (Family-DSMES). The intervention uses an asset-based approach predicated upon Marshallese’s collectivist culture and leverages the influence of family to help Marshallese immigrants engage in self- management behaviors. The initial implementation and evaluation of Family-DSMES was taught to one family at a time in patients’ homes. While the Family-DSMES was successful at improving patient outcomes, there are challenges and expenses for delivery in a home setting to one family at a time that make the intervention unsustainable. The proposed study will test the intervention in faith-based organizations (FBOs) (as opposed to patients’ homes) with groups of families (as opposed to one family at a time). With these significant changes, we hypothesize that the Family-DSME will be effective and sustainable. Our specific aims are: 1) Test the effectiveness of Family-DSMES to improve diabetes-related outcomes among Marshallese patients; 2) Evaluate the effect of Family-DSMES on family members; and 3) Conduct a cost-effectiveness analysis to understand intervention costs in relationship to outcomes. We will conduct a fully-powered cluster RCT that includes 288 Marshallese patients with T2DM and 288 of their family members. A wait-list control arm that includes patients and family members will serve as an untreated comparison group during the study. The RCT will be conducted at 24 Marshallese FBOs, and it will be taught by Marshallese community health workers. Data will be collected from patients and their family members in both arms of the study at baseline, immediately post-intervention, six months, and 12 months post-intervention. We will also obtain a medical records release to abstract participants’ biometric outcomes at 18 and 24 months post-intervention. In addition to our primary analyses, we will examine the potential mediation effect perceived social (family) support has on patients’ outcomes. We will also evaluate potential heterogeneity of treatment effects according to sex, nativity, and level of acculturation. While the Marshallese are a small population, this immigrant community is underrepresented in research, and they are experiencing a health crisis that must be addressed. Testing group delivery in FBOs is imperative to expanding the reach and long-term sustainability of the Family-DSMES.

抽象的 马绍尔人是太平洋岛民的一个亚群，他们的健康状况存在显着差异， 世界上一些记录最高的 2 型糖尿病 (T2DM) 发病率。1-6 T2DM 估计 马绍尔人的这一比例为 20% 至 50%，而美国人口的比例为 8.3%。1-6 试点数据 (n = 401) 据记载，阿肯色州的马绍尔移民 T2DM 发病率极高（38.4%），并且预 糖尿病患者（32.6%），只有 10% 的人有自我管理行为。马绍尔移民人口 在美国（US）增长迅速。马绍尔移民经历着独特的自我障碍 T2DM 的管理，以及可用来帮助缓解这些障碍的独特文化资产。 研究小组与马绍尔社区合作开发了一种适应文化的家庭模式 DSMES（家庭-DSMES）。该干预措施采用基于资产的方法，以马绍尔人的 集体主义文化并利用家庭的影响力帮助马绍尔移民进行自我保护 管理行为。向一个家庭教授了 Family-DSMES 的初步实施和评估 一次在病人家里。虽然 Family-DSMES 成功地改善了患者的治疗效果，但也存在一些问题 在家中一次向一个家庭分娩的挑战和费用使干预成为可能 不可持续的。拟议的研究将测试对基于信仰的组织（FBO）（而不是 与一组家庭（而不是一次一个家庭）一起前往患者家中。凭借这些重大 变化，我们假设 Family-DSME 将是有效且可持续的。我们的具体目标是：1） 测试 Family-DSMES 改善马绍尔患者糖尿病相关结局的有效性； 2) 评估Family-DSMES对家庭成员的影响； 3) 进行成本效益分析 了解干预成本与结果的关系。我们将进行一次全功能集群 RCT 包括 288 名马绍尔 T2DM 患者及其 288 名家庭成员。等待名单控制臂 包括患者和家庭成员在内的患者将作为研究期间未经治疗的对照组。随机对照试验 该课程将在 24 个马绍尔 FBO 进行，并由马绍尔社区卫生工作者授课。 将从基线研究的患者及其家庭成员那里收集数据， 干预后立即、干预后六个月和干预后 12 个月。我们还将获得医疗证明 记录发布以提取参与者在干预后 18 个月和 24 个月的生物识别结果。此外 在我们的初步分析中，我们将研究感知的社会（家庭）支持对 患者的结果。我们还将根据性别、出生地、 和文化适应水平。虽然马绍尔人人口不多，但这个移民社区 他们在研究中的代表性不足，而且他们正在经历一场必须解决的健康危机。测试组 FBO 的交付对于扩大 Family-DSMES 的影响范围和长期可持续性至关重要。

项目成果

Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics.

• DOI: 10.4103/jfmpc.jfmpc_327_22
• 发表时间: 2022-10
• 期刊: Journal of family medicine and primary care
• 影响因子: 1.4
• 作者: McElfish PA;Rowland B;Hall S;CarlLee S;Reece S;Macechko MD;Shah SK;Rojo MO;Riklon S;Richard-Davis G;Marin LP;Laelan M;Maddison BK;Alik E;Selig JP
• 通讯作者: Selig JP

COVID-19 vaccine hesitancy and racial discrimination among US adults.

• DOI: 10.1016/j.pmedr.2022.102074
• 发表时间: 2023-02
• 期刊: PREVENTIVE MEDICINE REPORTS
• 影响因子: 2.8
• 作者: Willis, Don E.;Montgomery, Brooke E. E.;Selig, James P.;Andersen, Jennifer A.;Shah, Sumit K.;Li, Ji;Reece, Sharon;Alik, Derek;McElfish, Pearl A.
• 通讯作者: McElfish, Pearl A.

Factors influencing COVID-19 vaccine decision-making among hesitant adopters in the United States.

• DOI: 10.1080/21645515.2022.2114701
• 发表时间: 2022-11-30
• 期刊: Human vaccines & immunotherapeutics
• 影响因子: 4.8

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations.

• DOI: 10.1016/j.conctc.2022.101007
• 发表时间: 2022-12
• 期刊: Contemporary clinical trials communications
• 影响因子: 1.5