An Adolescent-mediated intervention to improve diabetes prevention and management in Pacific Islander Families

以青少年为媒介的干预措施，以改善太平洋岛民家庭的糖尿病预防和管理

• 批准号: 10582224
• 负责人: Nicola Hawley
• 金额: $ 2.87万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-14 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582224
• 关键词: Active Learning; Address; Adolescent; Adoption; Adult; American; American Samoa; Behavior; Blood Pressure; Body mass index; Caring; Child; Chronic Disease; Communication; Control Groups; Data Analyses; Diabetes Mellitus; Diabetes prevention; Diagnosis; Educational Curriculum; End stage renal failure; Evaluation; Exposure to; Face; Family; Family member; Foundations; Generations; Glycosylated hemoglobin A; Health; Health behavior change; Home; Household; Individual; Insurance; Intervention; Knowledge; Leadership; Life; Linguistics; Low income; Maintenance; Measures; Mediating; Minority Groups; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Parents; Participant; Personal Communication; Personal Satisfaction; Phase; Population; Prediabetes syndrome; Prevalence; Prevention; Prevention strategy; Primary Health Care; Program Acceptability; Public Health Schools; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Factors; Role; Samoan; Self Care; Testing; Training; Treatment Efficacy; United States; Work; barrier to care; base; behavior change; beneficiary; cardiovascular risk factor; clinical trial implementation; cost; diabetes control; diabetes management; diabetes prevention program; diabetes self-management; disorder risk; doctoral student; efficacy evaluation; efficacy outcomes; ethnic minority population; experience; family structure; glycemic control; grandparent; group intervention; health care availability; health disparity; health literacy; implementation evaluation; implementation outcomes; improved; innovation; intervention effect; learning strategy; literacy; mathematical ability; novel; novel strategies; pilot test; preventive intervention; program costs; programs; scale up; self-management program; skills; social relationships; therapy design; treatment program; treatment strategy; waist circumference

PROJECT SUMMARY The number of individuals diagnosed with Type 2 Diabetes in the United States (US) has more than doubled since 2000 to over 30 million, with an additional 84.1 million living with prediabetes. One minority group at particular risk is Pacific Islanders (PIs) who face many barriers (structural and cultural) to engaging in prevention or self-care. To address the critical need for diabetes prevention and treatment programs that target PIs, and building on the family-centered culture, our objective is to pilot test and evaluate a randomized controlled trial of an adolescent-mediated intervention designed to improve the glycemic control and self- care practices of a paired, adult family member with diagnosed diabetes. Building on our own prior work we have adapted an efficacious, primary care-based diabetes self-management program for delivery to adolescents. Specifically, we refined intervention content to focus on behaviors that contributed to glycemic control in prior iterations of the program, adapted the content to target adolescents as agents of change by adding communication and leadership skills, and incorporated experiential learning activities. We will examine the efficacy of the intervention with a pilot randomized controlled trial. We will randomize n=160 dyads (an adolescent (without diabetes) and a parent/grandparent diagnosed with diabetes who share a household). Adolescents will receive either the six-month diabetes intervention or a leadership and life skills-focused control curriculum in groups (n=10 participants in each group). Aside from planned research assessments we will have no contact with the adults in the dyad, who will proceed with their usual diabetes care. To test our hypothesis that adolescents receiving the intervention will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe that exposure to the intervention may encourage positive behavior change in the adolescent themselves we will measure similar outcomes in the adolescents. Outcomes will be measured at baseline, at the end of the active intervention phase (six months post-randomization) and at 12-months post-randomization, to examine maintenance of intervention effects in the absence of contact. To determine potential for long-term sustainability and scale up, we will examine program acceptability, feasibility, fidelity, reach, and cost. Successful completion of our aims and proof of efficacy would produce an innovative, scalable program with high potential for replication in other similar, low-resource, family-centered, ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

项目概要 美国 (US) 被诊断患有 2 型糖尿病的人数增加了一倍多 自 2000 年以来，这一数字已超过 3000 万，另有 8410 万患有糖尿病前期。一个少数群体在 特别的风险是太平洋岛民（PI），他们在参与活动时面临许多障碍（结构性和文化性） 预防或自我保健。满足针对糖尿病预防和治疗计划的迫切需求 PI，并建立在以家庭为中心的文化的基础上，我们的目标是试点测试和评估随机 青少年介导的干预措施的对照试验，旨在改善血糖控制和自我调节 一对患有糖尿病的成年家庭成员的护理实践。在我们之前的工作的基础上，我们 已采用有效的、基于初级保健的糖尿病自我管理计划，以交付给 青少年。具体来说，我们改进了干预内容，重点关注导致血糖升高的行为 在该计划的先前迭代中进行控制，调整内容以将青少年作为变革的推动者 增加沟通和领导技能，并纳入体验式学习活动。我们将检查 试点随机对照试验的干预效果。我们将随机化 n=160 个二元组（ 青少年（没有糖尿病）和同住一个家庭的被诊断患有糖尿病的父母/祖父母）。 青少年将接受为期六个月的糖尿病干预或以领导力和生活技能为重点的培训 分组控制课程（每组 10 名参与者）。除了计划的研究评估外，我们 将不会与二人组中的成年人接触，他们将继续进行通常的糖尿病护理。来测试我们的 假设接受干预的青少年将成为糖尿病知识的有效渠道，并且会 支持他们配对的成年人采用自我护理策略，我们的主要疗效结果将是成人 血糖控制和心血管危险因素（BMI、血压、腰围）。其次，自从 我们相信，接受干预可能会鼓励青少年积极的行为改变 我们将在青少年身上测量类似的结果。结果将在基线、 积极干预阶段结束时（随机化后 6 个月）和随机化后 12 个月， 检查在没有接触的情况下干预效果的维持情况。确定长期潜力 可持续性和扩大规模，我们将检查项目的可接受性、可行性、保真度、覆盖范围和成本。 成功完成我们的目标和功效证明将产生一个创新的、可扩展的计划， 在其他类似的、资源匮乏的、以家庭为中心的少数民族群体中复制的潜力很大 美国是降低慢性病风险和消除健康创新的理想受益者 差异。