MAKING A DIFFERENCE--THE ROLE OF FAMILY IN NAVAJO DIABETICS

该项目调查了家庭在促进纳瓦霍2型糖尿病患者疾病管理方面的作用，具体而言：1)家庭对糖尿病患者的支持；2)家庭支持和纳瓦霍哲学概念如何与印度卫生服务机构目前进行的两项糖尿病干预措施相互作用。在之前的MBRS研究项目中，家庭支持成为决定纳瓦霍人糖尿病患者坚持规定的自我护理行为（如饮食改变、体重控制和锻炼）程度的关键因素。某些传统的纳瓦霍哲学概念也与自我管理技术的使用有关。该项目将涉及两组不同的受访者。“家庭研究”将包括对12个有一个或多个糖尿病亲属的家庭成员（包括糖尿病患者和非糖尿病患者）进行人种学访谈和焦点小组讨论，以深入了解家庭支持的动态以及在帮助糖尿病家庭成员时使用传统哲学概念。“干预”将跟踪三组临床患者，观察他们在参与两种持续的糖尿病干预措施之一后的健康状况变化，或在类似的一段时间内不进行干预。这些干预措施在家庭参与和纳瓦霍哲学信条融合的程度上各不相同。在这两个部分的研究中，考虑的结果将包括从医疗记录中获得的糖尿病管理的客观措施，以及纳瓦霍糖尿病患者报告的自我管理行为。假设是：1)家庭提供持续、积极和多样化支持的个体比缺乏这种家庭支持的个体更能控制他们的糖尿病；2)表达上述传统纳瓦霍哲学观念的家庭更有可能为其糖尿病亲属提供支持；3)以家庭为目标的干预，包括主动学习，将对管理行为和最终血糖产生更大的影响，而不是以个人改变和强调教学的干预。这些研究领域的发现将对改善患有糖尿病的纳瓦霍人的疾病管理和卫生保健干预产生重大影响。

This project investigates the roles of the family in facilitating disease management among Navajo individuals with type 2 diabetes, specifically: 1) the support given to diabetics by their families; and 2) how family support and Navajo philosophical concepts interact with two current diabetes interventions conducted by the Indian Health Service. In the previous MBRS research project, family support emerged as a critical factor in determining the extent to which Navajos with diabetes adhere to prescribed self-care behaviors such as diet change, weight control, and exercise. Certain traditional Navajo philosophical concepts also were associated with use of self-management techniques. The project will involve two distinct groups of respondents. The "Family Study" will involve ethnographic interviews and focus groups with members of 12 families (both diabetics and non-diabetics) who have one or more diabetic relatives to provide a depth of understanding of the dynamics of family support and use of traditional philosophical concepts in assisting diabetic family members. The "Intervention" will follow three groups of clinic patients with regard to change in their health status either following participation in one of two ongoing diabetes interventions, or after a similar period of time with non intervention. The interventions vary in the degree to which family involvement and tenets of Navajo philosophy are incorporated. In both parts of the study, the outcomes considered will include objective measures of diabetes management taken from the medical record, as well as self-management behaviors as reported by the Navajo diabetics. Hypotheses are: 1) that individuals whose families offer consistent, active and varied support will manage their diabetes better than those lacking such family support; 2) that families expressing traditional Navajo philosophical concepts such as those described above will be more likely to provide support for their diabetic relative; and 3) that interventions which target family-wide change, and involve active learning will have a greater impact on management behaviors and ultimately blood glucose than interventions which target individual change and stress didactic presentation. The findings in each of these areas of study will have significant ramifications for improving disease management and health care interventions for Navajos with diabetes.