Reducing Diabetes Risk for Rural Appalachian Grandparent Headed Households

描述（由申请人提供）：肯塔基州阿巴拉契亚农村的居民患有II型糖尿病（DM）的比率是全国最高和增长最快的。祖父母为户主的家庭（GHH）是阿巴拉契亚肯塔基州和美国农村增长最快的家庭群体之一，其成员可能特别容易受到健康威胁，从而增加他们患糖尿病的风险。虽然文献为检查这种健康差异提供了起点，但人们对影响GHH中糖尿病风险的社会生态因素知之甚少。鉴于越来越多的患病率GHH，他们的健康威胁的脆弱性，以及目前缺乏有关他们的糖尿病风险因素的信息，我们建议全面检查GHH的健康在农村阿巴拉契亚肯塔基州的社会生态背景，以实施文化和上下文适当的家庭干预，以减少糖尿病的风险。我们将进行一个两阶段的混合方法研究，最终在肯塔基州阿巴拉契亚农村进行这种干预的可行性试验。一阶段 该研究将采用同步混合方法设计，通过调查、生物学测量、与家庭成员的深入访谈、关键知情人访谈和社区评估，评估GHH家庭成员患糖尿病的社会生态学和生物学风险。70个由祖父母领导的家庭，有一个或多个家庭成员有糖尿病风险，并且至少有一个10至14岁的孙子将被纳入本阶段的研究，其中20个家庭参加了深入的定性访谈。研究的第二阶段将包括选择和改进适当的干预措施，以降低家庭的糖尿病风险。根据第一阶段的调查结果和现有文献，我们将选择一种基于证据的干预措施，并与我们强大的社区合作伙伴网络合作，将其改进为适合本项目重点的阿巴拉契亚农村家庭的文化和背景。最后，我们将测试他的可行性和可接受性的精细干预与10 GHH。这项拟议的研究将作为其他农村地区糖尿病差异显著的家庭干预措施的基础。

DESCRIPTION (provided by applicant): Residents of rural Appalachian Kentucky suffer rates of type II diabetes mellitus (DM) that are among the highest and most rapidly increasing in the country. Members of grandparent headed households (GHH), one of the fastest growing family constellations in rural Appalachian Kentucky and the US, may be particularly vulnerable to health threats elevating their risk for DM. While the literature provides a starting point for the examination of this health disparity, little is known about the socioecological factors that influence the risk for DM among GHH. Given the increasing prevalence of GHH, their vulnerability to health threats, and the current lack of information about their DM risk factors, w propose to holistically examine the socio-ecological context of the health of GHH in rural Appalachian Kentucky in order to implement a culturally and contextually appropriate family intervention to reduce diabetes risk. We will conduct a two phase mixed methods study that culminates in a feasibility trial of such an intervention in rural Appalachian Kentucky. Phase I of the proposed study will utilize a simultaneous mixed methods design to assess socioecologic and biological risk of diabetes for GHH family members via surveys, biological measures, in-depth interviews with family members, key informants interviews, and a community assessment. Seventy families that are headed by a grandparent, have one or more family members at risk for diabetes, and include at least one grandchild ages 10 to 14 will be included in this phase of the study, with 20 of those families participating in the in-depth qualitative interviews. Phase II of he study will include selection and refinement of an appropriate intervention to reduce diabetes risk for the families. Based on phase I findings and existing literature we will select an evidence based intervention and refine it to be culturally and contextually appropriate for the rural Appalachian families that are the focus of this project, in collaboration with our strong network o community partners. Finally, we will test he feasibility and acceptability of the refined intervention with 10 GHH. The proposed study will serve as the foundation for interventions for families in other rural areas with notable diabetes disparities.