Integrating Education Group Support and Case Management for Diabetic Hispanics

描述(申请人提供)：斯塔尔县是德克萨斯州-墨西哥边境的一个农村社区，98%是墨西哥裔美国人，是得克萨斯州糖尿病相关死亡率最高的。自1988年以来，我们通过有文化能力的糖尿病自我管理教育证明了糖化血红蛋白的降低，但随着时间的推移，效果逐渐减弱。结果表明，社会文化和个人障碍依然存在，阻碍了个人实现最佳健康结果。拟议的规划研究将探索一种在农村社区相对未经测试的战略，该战略将协调个人糖尿病护理的所有方面，包括参与我们的自我管理干预。我们建议对我们之前测试过的由护士病例经理加强的“压缩”自我管理干预进行试点测试，以便：1)通过在斯塔尔县与不同群体开展焦点小组，定义和细化农村边境社区护士病例经理(NCM)的角色：a)参与我们之前的干预研究；b)在边境两侧为德克萨斯州边境居民提供糖尿病护理的医生；c)当地社区卫生官员；d)提供糖尿病护理的其他卫生保健提供者(护士、营养师、当地医院和诊所雇用的社区卫生工作者)；E)社区中的主要权威人物(如当地天主教牧师、县官员)；和f)经验丰富的新农合。2)通过比较两组来确定采用糖尿病NCM以增强我们自我管理干预的积极效果的可行性：a)包括护士CM和我们先前测试的“压缩”版本的糖尿病自我管理干预的组合策略；以及b)单独的“压缩”糖尿病自我管理干预。我们将在斯塔尔县进行一项先导性研究，采用前测/后测控制组设计。目前基因研究的96名参与者将被招募并分配到其中一项干预措施中。我们将在基线以及3个月和6个月时收集我们之前测量的结果的数据-HbA1c、空腹血糖、血脂、血压、知识、健康行为(体力活动、饮食摄入量、血糖监测和药物使用)和BMI。我们计划增加两个新的变量：1)医疗保健利用率和2)成本。在拟议的试点项目期间，将进行最少的数据分析，因为其目的是确定干预的可行性。将进行基本的描述性分析(均值、频率)和非参数比较；HLM将用于探索性目的。这项拟议的研究是确定在墨西哥裔美国人中维持糖尿病自我管理效果的有效方法的关键一步。

DESCRIPTION (provided by applicant): Starr County is a rural Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. Since 1988 we have demonstrated reductions in HbA1c through culturally competent diabetes self-management education, but effects diminished overtime. Results indicated that socio-cultural and personal barriers remained, preventing individuals from achieving optimal health outcomes. The proposed planning study will explore a strategy relatively untested in rural communities that will provide coordination of all aspects of an individual's diabetes care, including participation in our self-management intervention. We propose to conduct a pilot test of our previously tested 'compressed" self-management intervention enhanced by a nurse case manager in order to: 1) Define and refine the role of the nurse case manager (NCM) for a rural border community by conducting focus groups with a variety of groups in Starr County: a) participants in our previous intervention studies; b) physicians practicing on either side of the border who provide diabetes care for Texas border residents; c) local community health officials; d) other health care providers who provide diabetes care (nurses, dietitians, community health workers employed by local hospitals and clinics); e) key authority figures in the community (such as local Catholic priests, County officials); and f) experienced NCMs. 2) Determine the feasibility of employing a diabetes NCM in order to enhance the positive effects of our self- management interventions by comparing 2 groups: a) a combined strategy involving the nurse CM PLUS the "compressed" version of our diabetes self-management intervention previously tested; and b) "compressed" diabetes self-management intervention ALONE. We will conduct a pilot study in Starr County using a pretest/posttest control group design. 96 participants of current genetic studies will be recruited and assigned to 1 of the interventions. We will collect data at baseline and at 3 and 6 months on outcomes we have measured previously-HbA1c, FBG, lipids, blood pressure, knowledge, health behaviors (physical activity, dietary intake, glucose monitoring, and medication usage), and BMI. We plan to add 2 new variables: 1) health care utilization and 2) cost. Minimal data analysis will be performed during the proposed pilot project, since the intent is to determine intervention feasibility. Basic descriptive analyses (means, frequencies) and non-parametric comparisons will be performed; HLM will be used for exploratory purposes. The proposed study is a critical step in determining effective ways of sustaining the effects of diabetes self-management in Mexican American populations.