Community-Based Diabetes Care for Korean American Immigrants

描述(申请人提供)：这项翻译研究的主要目标是为患有2型糖尿病的韩裔美国移民(KAI)进行一项基于社区的血糖控制干预计划的有效性试验。针对韩裔美国人的自助干预计划(SHIP-DM)专注于糖尿病控制的自助方面，通过增强糖尿病和饮食知识赋予患者权力，利用现有技术发展他们自我监控血糖控制状况的能力，促进与医疗保健提供者的更好沟通，并增强他们的健康素养和一般解决问题的技能。 通过NIDDK(R34)的“规划赠款”机制，已经开发了SHIP-DM并进行了试点测试。在我们的先导研究中，使用随机实验设计(N=80)，我们能够在干预后6个月内证明SHIP-DM合并CAIS的有效性和可行性。最终分析表明，SHIP-DM在显著降低HbA1c和空腹血糖以及改善样本中的心理社会变量方面都是有效的： 干预组参与者HbA1c水平的降低(18周时为1.19%，30周时为1.31%)不仅具有统计学意义，而且具有临床意义，干预组分别有10%和15%的人达到了建议的HbA1c和HbA1c水平7%的目标。与对照组相比，干预组在糖尿病知识、自我护理行为、糖尿病相关自我效能感以及对糖尿病、抑郁、生活质量的态度等方面均有显著改善。此外，我们意识到迫切需要传播有效的干预措施，这些干预措施在语言和文化上都是为非洲发展新伙伴关系量身定做的。随着我们研究的消息通过朝鲜族社区的媒体来源传播，我们被KAI家庭和社区组织(包括美国糖尿病协会)要求提供针对KAI人群的2型DM教育材料和文化相关干预措施的要求淹没了。由于试验项目的资源限制，我们被迫拒绝了大量希望参与我们研究的2型糖尿病KAI患者。 为了满足KAI社区的这一迫切需求，我们现在建议在我们的试点工作的基础上，进行一项分两个阶段的临床试验，在KAI的更大样本中测试SHIP-DM的有效性，并进行更长的随访(12个月)，同时建立重要的基础设施，以传播一系列旨在解决这一弱势群体的健康素养和资源必需品的干预材料。 公共卫生相关性：本申请提出了一项以社区为基础的行为干预的随机对照试验，对患有2型糖尿病的语言孤立的韩国移民进行干预，终点集中在(1)血糖控制和血压控制，(2)自我效能和自助技能，包括健康素养技能，以及(3)与健康相关的生活质量。

DESCRIPTION (provided by applicant): The primary objective of this translational study is to conduct an effectiveness trial of a community-based glucose control intervention program for Korean American immigrants (KAI) with type-2 diabetes mellitus (DM). The self-help intervention program for Korean Americans ( SHIP-DM) focuses on the self-help aspect of DM control by empowering patients through enhanced knowledge of DM and diet, utilizing available technology to develop their ability for self -monitoring their glucose control status, facilitating better communication with their health care providers, and enhancing their health literacy and general problem-solving skills. The SHIP-DM has been developed and pilot tested through a "planning grant" mechanism via NIDDK (R34). Using a randomized experimental design (N=80) in our pilot study, we were able to demonstrate the efficacy and feasibility of the SHIP-DM with KAIs up to 6 months post-intervention. The final analysis suggested that the SHIP-DM was effective in both significantly lowering HbA1c and fasting glucose as well as in improving psychosocial variables in the sample: The reduction of HbA1c levels among intervention group participants (1.19% at 18 weeks and 1.31% at 30 weeks) were not only statistically significant but clinically meaningful, with 10%and 15% of the intervention group achieving the suggested goal of HbA1c < 7%. In comparison to the control group, the intervention group showed significant improvement in DM knowledge, self-care activities, DM-related self-efficacy, and their attitudes toward diabetes, depression, and quality of life. In addition, we became aware of the urgent need for disseminating effective interventions which are both linguistically and culturally tailored to KAI. As news of our study spread through media sources in the Korean ethnic community, we became inundated by requests from KAI families and community organizations (including the American Diabetes Association) for type-2 DM educational materials and culturally relevant interventions targeted toward KAI audiences. Because of the resource limitations of the pilot project, we were forced to turn away substantial numbers of KAI with type 2 DM who wanted to participate in our study. To address this critical need within the KAI community, we now propose to build upon our pilot work by conducting a two-phase clinical trial to test the effectiveness of the SHIP-DM in a larger sample of KAI and a longer follow-up (12months) while building important infrastructures for disseminating an array of intervention materials designed to address the health literacy and resources necessities for this vulnerable population. PUBLIC HEALTH RELEVANCE: This application proposes a randomized controlled trial of a community-based behavioral intervention in linguistically isolated Korean immigrants with type-2 DM with endpoint focus on the improvement of (1) glycemic control and BP control, (2) self-efficacy and self-help skills including health literacy skills, and (3) health related quality of life.