Decreasing Diabetes Disparities: Building Mexican American Family Social Capital

描述(申请人提供)：糖尿病，主要是2型糖尿病(T2 DM)，已经在美墨边境地区的墨西哥裔美国人中流行，使这个独特的地缘政治地区成为消除高度脆弱人口中T2 DM健康差距的目标之一。边境地区的多种不同特征，如贫困、语言和健康素养障碍，加剧了T2 DM健康差距。此外，针对个人的糖尿病自我管理教育计划对家庭背景的考虑非常有限，这导致了医疗保健机会有限。家庭是一个关键的社会背景，在这个背景下，墨西哥裔美国成年人患有T2 DM时会发生疾病管理。然而，很少有研究利用家庭(家庭主义)在该地区成年人中对T2 DM管理的强大文化价值。我们提出了一种减少T2 DM健康不平等和建立家庭社会资本的独特方法--应用基于社区的参与性研究(CBPR)原则，与患有T2 DM的墨西哥裔美国成年人及其家庭伴侣一起设计和测试文化定制的糖尿病自我管理教育和社会支持干预。将分两个阶段实施混合方法办法，以实现3个目标。在第一阶段(目标1)，利用CBPR的原则，我们将让墨西哥裔美国人、成年T2 DM患者和一名家庭伴侣(n=20)在家庭背景下完善糖尿病教育和社会支持干预。在第二阶段(目标2、3)，采用随机实验设计，实施为期6个月的干预，并测试其即时和持续效果。总共168名患有T2 DM的墨西哥裔美国成年人，年龄在35-74岁之间，以及他们的家庭伴侣，年龄在18岁及以上，将被随机分配到干预或等待名单对照组。将在基线、干预后立即和干预后6个月收集数据，以衡量行为结果(糖尿病自我管理、糖尿病自我效能、糖尿病痛苦、营养和体力活动行为)、生物结果(血糖控制)和家庭社会资本结果(社会融合、家庭效能、家庭社会支持、健康素养、医疗保健获得机会)，这些发现预计将通过扩大支持T2 DM自我管理教育计划的方法来减少T2 DM健康差距，改善和维持血糖控制，对个人的家庭和社区也具有潜在的积极下游影响。

DESCRIPTION (provided by applicant): Diabetes, primarily type 2 diabetes (T2DM), has reached epidemic proportions among Mexican Americans in the US-Mexico border region, making this unique geopolitical region one that should be targeted for eliminating T2DM health disparities among a highly vulnerable population. Multiple and diverse characteristics of the border region such as poverty, language and health literacy barriers propagate T2DM health disparities. In addition, diabetes self-management education programs that target individuals and have very limited consideration of the family context have contributed to limited health care access. The family is a critical social context in which disease management occurs for Mexican American adults with T2DM. Yet few studies have capitalized on the strong cultural value of family (familismo) for T2DM management among adults in this region. We propose a unique approach for reducing T2DM health inequities and building family social capital - the application of community based participatory research (CBPR) principles with Mexican American adults with T2DM and their family partners to design and test a culturally tailored diabetes self-management education, social support intervention. A mixed method approach will be implemented in two phases to address 3 aims. In Phase 1 (Aim 1) using the principles of CBPR we will engage Mexican Americans adults with T2DM and a family partner (n=20) to refine a diabetes education and social support intervention within a family context. In Phase 2 (Aims 2, 3) using a randomized experimental design, we will implement the 6-month intervention and test its immediate and sustained effects. A total of 168 Mexican American adults with T2DM, ages 35-74, and their family partner, age 18 and older, will be randomly assigned to either intervention or wait list control groups. Data will be collected at baseline, immediately post intervention, and 6 months post intervention to measure behavioral outcomes (diabetes self management, diabetes self efficacy, diabetes distress, nutrition and physical activity behaviors), biologic outcomes (glycemic control) and family social capital outcomes (social integration, family efficacy, family social support, health literacy, health care access) Findings are expected to reduce T2DM health disparities by expanding the approach underpinning T2DM self management education programs, and improve and sustain glycemic control, with potential positive downstream effects for the individual's family and community as well.