Evaluation of the effectiveness of Ajjmuurur Baamḷe DSMES in the RMI

摘要 马绍尔群岛共和国(RMI)的健康差距非常显著， 糖尿病和其他心脏代谢性疾病。RMI中记录的2型糖尿病(T2 DM)比率 从20%到50%不等。这远远高于全球(8.5%)和美国(11%)的利率。极端的 RMI的差距因缺乏研究、缺乏资金、缺乏服务和 文化上适当的干预措施。RMI的居民在自我管理方面遇到了独特的障碍 T2 DM，并拥有独特的文化资产，可以利用这些资产来帮助缓解这些障碍。这个 研究小组与阿肯色州的Marshallese社区合作，开发并评估了一种文化- 改编的家庭模式：DSMES(Jjmuurur Baam Desmes)。Ajjmuurur Baamḷe DSMES基于 集体主义的方法，结合马绍尔的文化实践，并使用“谈话故事”作为一种对话， 有节奏感的文化偏好的分享知识的方式。Ajjmuurur Baamḷe DSMES包括家庭 成员作为参与者，重点关注家庭动机访谈、家庭目标设定和家庭 行为改变，特别注重关于支持性和非支持性家庭行为的教育。这个 课程是基于资产的，它致力于克服马绍尔患者面临的障碍 特定于文化的健康行为改变的促进者。我们的中心假设是，那些接受 家庭型号DSMES“Jjjmuurur Baamḷe”将改善HbA1c(主要结果)、血压、 血脂、体重指数、知识的增加、自我效能、赋权和生活质量 糖尿病相关并发症和糖尿病相关痛苦。这项研究的目标是进行一项集群随机对照试验 使用等待名单控制来评估Jjmuurur Baamḷe DSMES在真诚交付时的有效性- 由社区卫生工作者(CHW)建立的组织(FBO)。我们的具体目标是：1.测试 ḷ在改善马绍尔患者糖尿病相关预后方面的有效性； 2.评估Ajjmuurur Baamḷe DSMES对家庭成员的影响；3.进行土著 评估以了解干预在多大程度上遵守太平洋岛民的文化价值观和 评估研究的文化适宜性。数据将从患者(目标1)和他们的 家庭成员(目标2)基线，干预后立即(12周)，4个月和12个月 干预后几个月。将在六个月和每年进行一次土著评价(目标3) 之后，记录研究实施中的过程改进工作并提供信息。而当 马绍尔人是一个很小的群体，这一群体在研究中代表不足，他们正在经历 一场必须解决的健康危机。这项拟议的研究提供了一种有希望的干预措施，它具有 有可能严重影响马绍尔人和其他太平洋岛民在 USAPI。

ABSTRACT Health disparities in the Republic of the Marshall Islands (RMI) are striking with extremely high rates of diabetes and other cardiometabolic diseases. Documented rates of type 2 diabetes mellitus (T2DM) in the RMI range from 20%-50%. This is significantly higher than global (8.5%) and US (11%) rates. The extreme disparities in the RMI are exacerbated by a lack of research, lack of funding, a lack of services, and a lack of culturally-appropriate interventions. Residents of the RMI experience unique barriers to self-management of T2DM, as well as possess unique cultural assets that can be leveraged to help mitigate these barriers. The research team worked with the Marshallese community in Arkansas to develop and evaluate a culturally- adapted family model of DSMES (Ājjmuurur Baamḷe DSMES). Ājjmuurur Baamḷe DSMES is based on a collectivist approach, incorporates Marshallese cultural practices, and uses “talk story” as a conversational, rhythmic, and culturally preferred way of sharing knowledge. Ājjmuurur Baamḷe DSMES includes family members as participants and focuses on family motivational interviewing, family goal setting, and family behavioral change with specific focus on education about supportive and nonsupportive family behaviors. The curriculum is assets based and it works to overcome barriers facing Marshallese patients by leveraging culturally specific facilitators of healthy behavior change. Our central hypothesis is that persons who receive the Family Model DSMES "Ājjmuurur Baamḷe" will have improved HbA1c (primary outcome), blood pressure, lipids, BMI, increased knowledge, self-efficacy, empowerment, and quality of life, along with decreased diabetes-related complications and diabetes-related distress. This study's objective is to conduct a cluster RCT using a wait-list control to evaluate the effectiveness of Ājjmuurur Baamḷe DSMES when delivered in faith- based organizations (FBOs) by Community Health Workers (CHWs). Our specific aims are: 1. Test the effectiveness of Ājjmuurur Baamḷe DSMES to improve diabetes-related outcomes among Marshallese patients; 2. Evaluate the effect of Ājjmuurur Baamḷe DSMES on family members; and 3. Conduct an indigenous evaluation to understand the extent to which the intervention adheres to Pacific Islander cultural values and evaluate the cultural appropriateness of the research. Data will be collected from patients (Aim 1) and their family members (Aim 2) at baseline, immediately post-intervention (12 weeks), at four months and twelve months post-intervention. An indigenous evaluation (Aim 3) will be conducted at six months and each year thereafter to document and inform process improvement efforts in study implementation. While the Marshallese are a small population, this population is underrepresented in research, and they are experiencing a health crisis that must be addressed. The proposed study offers a promising intervention that has the potential to affect substantially health disparities experienced by Marshallese and other Pacific Islanders in the USAPI.