Decreasing Diabetes Disparities: Building Mexican American Family Social Capital

描述（由申请人提供）：糖尿病，主要是2型糖尿病（T2 DM），在美墨边境地区的墨西哥裔美国人中已达到流行比例，使这一独特的地缘政治区域成为消除高度脆弱人群中T2 DM健康差异的目标之一。边境地区的多种多样的特点，如贫困，语言和健康素养的障碍传播T2 DM的健康差距。此外，针对个人的糖尿病自我管理教育计划，对家庭环境的考虑非常有限，这也导致了有限的医疗保健机会。家庭是墨西哥裔美国T2 DM成人进行疾病管理的关键社会背景。然而，很少有研究利用了强大的文化价值的家庭（familismo）的T2 DM管理成人在这一地区。我们提出了一种独特的方法，以减少T2 DM的健康不公平和建立家庭社会资本-社区参与性研究（CBPR）的原则与墨西哥裔美国人的T2 DM成年人和他们的家庭合作伙伴的应用程序，设计和测试文化定制的糖尿病自我管理教育，社会支持干预。将分两个阶段实施混合方法，以实现3个目标。在第1阶段（目标1）中，使用CBPR的原则，我们将让墨西哥裔美国T2 DM成年人和家庭伴侣（n=20）在家庭环境中完善糖尿病教育和社会支持干预。在第2阶段（目标2，3），采用随机实验设计，我们将实施为期6个月的干预，并测试其即时和持续效果。共有168名35-74岁的墨西哥裔美国T2 DM成年人及其18岁及以上的家庭伴侣将被随机分配到干预组或等待名单对照组。将在基线、干预后即刻和干预后6个月收集数据，以测量行为结果（糖尿病自我管理、糖尿病自我效能、糖尿病痛苦、营养和体力活动行为）、生物学结局（血糖控制）和家庭社会资本结果（社会融合、家庭效能、家庭社会支持、卫生知识普及、医疗保健准入）研究结果预计将通过扩大支持T2 DM自我管理教育计划的方法来减少T2 DM健康差异，并改善和维持血糖控制，对个人的家庭和社区也有潜在的积极下游影响。 公共卫生相关性：糖尿病是美国（US）-墨西哥边境地区的第五大死亡原因，而全国排名第七。本研究的目的是通过改善和维持糖尿病自我管理行为和增加2型糖尿病管理的家庭社会资本来减少墨西哥裔美国成年2型糖尿病患者的糖尿病健康差异。

DESCRIPTION (provided by applicant): Diabetes, primarily type 2 diabetes (T2DM), has reached epidemic proportions among Mexican Americans in the US-Mexico border region, making this unique geopolitical region one that should be targeted for eliminating T2DM health disparities among a highly vulnerable population. Multiple and diverse characteristics of the border region such as poverty, language and health literacy barriers propagate T2DM health disparities. In addition, diabetes self-management education programs that target individuals and have very limited consideration of the family context have contributed to limited health care access. The family is a critical social context in which disease management occurs for Mexican American adults with T2DM. Yet few studies have capitalized on the strong cultural value of family (familismo) for T2DM management among adults in this region. We propose a unique approach for reducing T2DM health inequities and building family social capital - the application of community based participatory research (CBPR) principles with Mexican American adults with T2DM and their family partners to design and test a culturally tailored diabetes self-management education, social support intervention. A mixed method approach will be implemented in two phases to address 3 aims. In Phase 1 (Aim 1) using the principles of CBPR we will engage Mexican Americans adults with T2DM and a family partner (n=20) to refine a diabetes education and social support intervention within a family context. In Phase 2 (Aims 2, 3) using a randomized experimental design, we will implement the 6-month intervention and test its immediate and sustained effects. A total of 168 Mexican American adults with T2DM, ages 35-74, and their family partner, age 18 and older, will be randomly assigned to either intervention or wait list control groups. Data will be collected at baseline, immediately post intervention, and 6 months post intervention to measure behavioral outcomes (diabetes self management, diabetes self efficacy, diabetes distress, nutrition and physical activity behaviors), biologic outcomes (glycemic control) and family social capital outcomes (social integration, family efficacy, family social support, health literacy, health care access) Findings are expected to reduce T2DM health disparities by expanding the approach underpinning T2DM self management education programs, and improve and sustain glycemic control, with potential positive downstream effects for the individual's family and community as well. PUBLIC HEALTH RELEVANCE: Diabetes is the fifth leading cause of death in the United States (US)-Mexico border region compared to seventh nationally. The goal of this study is to reduce diabetes health disparities among Mexican American adults with type 2 diabetes by improving and sustaining diabetes self-management behaviors and increasing family social capital for type 2 diabetes management.