Understanding Barriers to Engagement in the Diabetes Prevention Program among Low-Income Latino Patients: Design and Implementation of an Intervention in Community Health Centers

了解低收入拉丁裔患者参与糖尿病预防计划的障碍：社区卫生中心干预措施的设计和实施

• 批准号: 10626825
• 负责人: Yelba Castellon-Lopez
• 金额: $ 20.44万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2023-03-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626825
• 关键词: Address; Adopted; Amputation; Area; Award; Blindness; Blood Pressure; Body Weight Changes; Body Weight decreased; Budgets; California; Cardiovascular Diseases; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Clinical Trials; Communities; Community Trial; Complications of Diabetes Mellitus; Data; Data Analyses; Development; Diabetes Mellitus; Diabetes prevention; Disparity; Effectiveness; Eligibility Determination; Epidemic; Face; Federally Qualified Health Center; Food; Future; Goals; Grant; Health; Health Disparities Research; Health Insurance; Health system; Incidence; Income; Insurance Coverage; Intervention; Intervention Studies; K-Series Research Career Programs; Kidney Failure; Language; Latino; Latino Population; Laws; Learning; Life Style; Limited English Proficiency; Link; Los Angeles; Low Income Population; Low income; Measures; Medicaid; Medicaid eligibility; Mentors; Metformin; Minority Groups; Natural experiment; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Study; Overweight; Participant; Patients; Physical activity; Pilot Projects; Policies; Pragmatic clinical trial; Prediabetes syndrome; Prevalence; Process; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk; Structure; Techniques; Translating; United States; Vulnerable Populations; Work; acceptability and feasibility; arm; beneficiary; career; career development; community barrier; cost; design; diabetes prevention program; diabetes risk; effectiveness evaluation; evidence base; experience; health disparity; health equity promotion; health plan; high risk; implementation barriers; implementation intervention; improved; improved outcome; interest; intervention program; marginalized population; minority communities; minority engagement; minority health disparity; mortality; obese person; patient oriented; personalized approach; pilot trial; prevent; primary outcome; programs; randomized trial; recruit; safety net; secondary outcome; skill acquisition; skills; social health determinants; success

ABSTRACT: My long-term career goal is to be an independent investigator in minority health disparities research, working to improve outcomes for vulnerable and marginalized populations. My short-term (five-year) career goal is to gain quantitative skills in secondary data analysis, strengthen my expertise in causal inference, and learn to implement pragmatic community-based clinical trials that address structural barriers to health. Among US Latinos, the prevalence of type 2 diabetes (T2D) is alarmingly high, with approximately 1 in 2 at risk for developing T2D during their lifetime. The Diabetes Prevention Program (DPP) study demonstrated that a structured lifestyle change program to achieve 5-7% weight loss and/or use of metformin in overweight and obese individuals with prediabetes can prevent and/or delay the onset of T2D. California recently passed a law (SB 97) mandating that Medicaid (Medi-Cal) plans cover the DPP for interested and eligible Medi-Cal beneficiaries with prediabetes. However, Latinos and low-income patients face significant barriers to DPP participation. We need new, sustainable approaches to recruit, engage, and retain Latino and low- income populations in the DPP, including community-partnered approaches linking participants with low-cost resources that support lifestyle change and weight loss. My Specific Aims are as follows: 1. In a difference-in-difference analysis with data from two large California health systems, to determine the effect of SB 97 on 12-month weight change, achieving >5% weight loss (primary outcomes), systolic blood pressure, and T2D incidence (secondary outcomes) among Latino Medi-Cal patients with prediabetes compared with Latino patients of similar SES with prediabetes covered by the health insurance exchange. 2. Through a community-partnered approach and a community advisory board (CAB), to assess barriers and facilitators to recruitment, engagement, and retention at three health clinics that provide DPP programs serving LEP Latino patients, and develop an intervention that enhances recruitment and retention and improves existing Spanish-language DPP programs by addressing structural-level barriers. 3. To conduct a one-arm feasibility and acceptability pilot trial of a community-informed intervention (Aim 2) to recruit, engage, and retain Spanish-speaking patients who are eligible to participate in DPP classes at 3 FQHCs in South Los Angeles. Process outcomes include success with recruitment, ability to deliver the intervention in a clinical setting, and ability to measure study outcomes. Clinical outcomes include weight change, physical activity, and social determinants of health. This award will enable me to work with an experienced team of mentors to gain career development skills in community-based pragmatic clinical trials, best practices to engage minority populations in research, and interventions promoting health equity. The preliminary data collected will support a future R01 grant for a larger randomized trial of the community-partnered DPP intervention for Spanish-speaking Latinos with prediabetes.

抽象的： 我的长期职业目标是成为少数民族健康差异研究的独立研究者 改善脆弱和边缘化人群的结果。我的短期（五年）职业目标是 在二级数据分析中获得定量技能，增强我在因果推理方面的专业知识，并学会 实施基于务实的基于社区的临床试验，以解决健康的结构性障碍。我们中间 拉丁美洲人，2型糖尿病（T2D）的患病率令人震惊，大约有1分之一的风险 在他们的一生中开发T2D。糖尿病预防计划（DPP）研究表明 结构化生活方式改变计划，以实现超重和/或在超重和/或使用二甲双胍的5-7％ 患有糖尿病前期的肥胖个体可以预防和/或延迟T2D的发作。加利福尼亚最近通过了法律 （SB 97）要求医疗补助计划（MEDI-CAL）涵盖DPP，以供感兴趣且合格的Medi-Cal 具有糖尿病前期的受益人。但是，拉丁裔和低收入患者面临着DPP的重大障碍 参与。我们需要新的，可持续的方法来招募，参与和保留拉丁裔和低 - DPP中的收入人群，包括将参与者与参与者联系起来的社区合作方法 支持生活方式变化和体重减轻的低成本资源。我的具体目的如下： 1。在与两个大加利福尼亚州卫生系统的数据的差异分析中，以确定 SB 97对12个月重量变化的影响，体重减轻> 5％（主要结果），收缩血 拉丁裔Medi-Cal患者的压力和T2D发病率（次要结果） 与健康保险交易所涵盖的类似SE的拉丁裔患者相比。 2。通过社区合作的方法和社区顾问委员会（CAB），评估障碍和 在提供DPP计划的三个健康诊所的招聘，参与和保留的促进者 为LEP拉丁裔患者服务，并制定一种干预措施，以增强招聘和保留率和 通过解决结构级别的障碍来改善现有的西班牙语DPP计划。 3。进行社区信息干预的单臂可行性和可接受性试验试验（AIM 2） 招募，参与并保留有资格参加DPP课程的讲西班牙语的患者 洛杉矶南部的FQHC。过程成果包括在招聘方面的成功，交付能力 干预临床环境和测量研究结果的能力。临床结果包括体重 变革，体育锻炼和健康的社会决定因素。 该奖项将使我能够与经验丰富的导师团队合作，以获得职业发展技能 基于社区的务实临床试验，参与研究参与少数民族的最佳实践以及 促进健康公平的干预措施。收集的初步数据将为更大的R01赠款提供支持 对社区合作的DPP干预的随机试验，用于讲西班牙语的拉丁美洲人的前糖尿病。