Using Multifamily Groups to Improve Family-Centered Self-Management of Type 2 Diabetes among Mexican Americans

 描述(申请人提供)：这份R-01拨款提案是对PA-14-112“慢性病以家庭为中心的自我管理”的回应。该项目(A)在公共卫生环境下使用序贯、多任务随机试验评估四种旨在改善墨西哥裔美国人2型糖尿病患者健康状况、自我管理行为和自我效能的文化适应的、基于家庭的治疗方案，并(B)测试有关Ryan和Sawin的个人和家庭自我管理理论对这一人群中糖尿病自我管理研究的适用性的假设。之所以选择这一概念模型进行研究，是因为它强调将家庭成员作为护理的合作伙伴，同时促进疾病自我管理，这与研究人群和拟议的干预措施高度相关。说西班牙语，墨西哥裔美国2型糖尿病患者及其家人将从一家附属于一家大型城市公立医院的初级保健诊所招募，该医院位于洛杉矶一个以墨西哥裔美国人为主的地区。在研究的第一阶段，受试者将被随机分配到6个2.5小时的疗程(三个月)：1)托曼多控制糖尿病(TC)，这是一种文化定制的、以社区为基础的糖尿病自我管理计划，由社区卫生工作者(推动者)与个别患者和家庭一起以小组形式授课；或2)TC由卫生专业人员(有执照的护士)授课。将在基线、三个月、六个月和12个月进行评价。经过六周的治疗(在干预的中途)，受试者将接受糖尿病自我管理行为的改善(主要结果)的评估。在研究的第二阶段，那些糖尿病自我管理行为比基线改善50%的受试者将继续接受为期三个月的分配治疗。那些没有达到这一目标的受试者将被重新随机分组，接受以下两种治疗中的一种：1)强化版的TC，特别侧重于吸引家庭成员；或2)由接受过专门培训、传授糖尿病自我管理技能的护士领导的多家庭小组治疗，为期额外三个月。受试者将接受以下方面的评估：制定和遵守与糖尿病有关的自我管理目标；自我管理行为，包括坚持ADA饮食、从事运动活动、监测血糖水平和服用处方降血糖药物；糖尿病自我效能；以及血红蛋白A1c水平。在相同的时间范围内，将对家庭成员进行评估，以确定他们对糖尿病护理的知识；与患病亲属和医疗保健提供者合作制定目标的水平；以及家庭支持的水平。这些结果将促进对影响墨西哥裔美国人2型糖尿病患者自我管理的因素的理解，并将为构建适应性干预提供有价值的信息，这将有助于确定哪些治疗策略最有效地改善糖尿病患者的自我管理行为，以及对谁有效。

 DESCRIPTION (provided by applicant): This R-01 grant proposal is a response to PA-14-112 "A Family-Centered Self-Management of Chronic Conditions." The project (a) evaluates four culturally adapted, family-based treatments designed to improve health status, self-management behaviors and self-efficacy among Mexican-Americans with Type 2 diabetes using a Sequential, Multiple Assignment Randomized Trial in a public health setting, and (b) tests hypotheses about the applicability of Ryan and Sawin's Individual and Family Self-Management Theory, the conceptual foundation for the intervention's key constructs, to the study of diabetes self-management in this population. This conceptual model was selected for study because its emphasis on the integration of family members as partners in care while promoting illness self-management is highly germane to the study population and to the proposed intervention. Spanish speaking, Mexican-American patients with Type 2 diabetes and their families will be recruited from a primary care clinic affiliated with a large, urban public hospital located in a predominantly Mexican American area of Los Angeles. In the first phase of the study, subjects will be randomly assigned to six 2.5 hour sessions (three months) of either: 1) Tomando Control de su Diabetes (TC), a culturally tailored, community-based, Diabetes Self-Management program delivered in a group format by community health workers (promotoras) working with individual patients and families; or 2) TC delivered by health professionals (licensed nurses). Evaluations will be made at baseline, three months, six months and 12 months. After six weeks of treatment (at the midway point of the intervention), subjects will be assessed for improvement in diabetes self-management behaviors (the primary outcome). In the second phase of the study, those subjects who have improved their diabetes self-management behaviors by 50% over baseline will be continued in their assigned treatment for the duration of three months. Those subjects who do not meet this target will be re-randomized to receive either: 1) an augmented version of TC that has a specific focus on engaging family members; or 2) a multifamily group treatment led by nurses specially trained in teaching diabetes self-management skills for an additional three months. Subjects will be assessed on setting and adhering to self-management goals related to diabetes; self-management behaviors including adhering to the ADA diet, engaging in exercise activities, monitoring glucose levels and taking prescribed hypoglycemic medications; diabetes self-efficacy; and hemoglobin A1c levels. Family members will be assessed during these same time frames to determine their knowledge of diabetes care; levels of collaborative goal setting with their ill relative and the health care provider; and levels of family support. The results will advance the understanding of the factors that affect self-management for Mexican-Americans with Type 2 diabetes, and will provide valuable information towards constructing an adaptive intervention that will help to determine which treatment strategies work to improve diabetes self-management behaviors most efficiently and for whom.