Stories for Change (S4C): Digital Storytelling for Diabetes Self-Management among Hispanic Adults

项目总结/摘要 西班牙裔成年人患2型糖尿病（T2D）的可能性是2倍，死于糖尿病的可能性是1.5倍。 比非西班牙裔白人更容易得这种病。这些差异部分是由健康水平较低的 体力活动、饮食质量、药物依从性和血糖自我监测 白人考虑到影响这些行为的复杂的社会文化力量， 研究（CBPR）方法被要求解决这些问题。罗切斯特健康社区伙伴关系是一个 由社区组织、卫生服务组织和 在集体部署方案拟订和成果评估方面经验丰富的学者 移民人口。在过去的三年里，来自西班牙裔社区的RHCP合作伙伴共同- 为T2D自我管理创建了一个数字讲故事干预，该干预已在初级保健中试行 跨多个机构设置。数字讲故事干预是基于叙事的视频， 通过CBPR方法，使参与者克服健康障碍的真实声音浮出水面 促进行为，在这种情况下，与糖尿病自我管理相关的行为（身体活动，健康的 饮食、药物依从性和血糖监测）。这些视频可以塑造健康行为， 通过对态度和信仰的影响来影响观众。目的是：1）评估社区的效能- 在T2D控制不佳的西班牙裔成年人中进行数字故事讲述干预，以及2）探索 干预措施对拟议的基于理论的变革调解人的影响。使用两组设计，450 患有T2D控制不良的西班牙裔成年人将被随机分配观看12分钟的数字故事讲述 常规护理干预或仅接受常规临床护理。两组都将接受糖尿病教育 材料和资源指南，以联系他们的糖尿病护理团队，符合现有的标准， 在乎在干预实施后6个月内测量的主要结局将是血糖控制， 通过血红蛋白A1c测量。次要结果将包括糖尿病自我管理行为，血液 血压、LDL-胆固醇和体重指数。伴随协变量（包括性别、年龄、 和社会经济地位，对干预效果的敏感性也将进行探讨。这项工作测试了一个 在初级保健环境中实施针对弱势群体的可扩展的低成本干预措施， 快速翻译练习的机会。我们将建立一个可传播的框架， 参与慢性病管理的数字故事制作，提供一个可以 适用于其他社区和卫生优先事项。

PROJECT SUMMARY/ABSTRACT Hispanic adults are twice as likely to have type 2 diabetes mellitus (T2D) and 1.5 times more likely to die from the disease than non-Hispanic whites. These disparities are mediated, in part, by less healthful levels of physical activity, dietary quality, medication adherence, and self-monitoring of blood glucose than non-Hispanic whites. Given the complex sociocultural forces that influence these behaviors, a community-based participatory research (CBPR) approach is called for to address them. The Rochester Healthy Community Partnership is a robust CBPR partnership consisting of community-based organizations, health service organizations, and academics who are experienced at collectively deploying programming and outcomes assessment among immigrant populations. Over the past three years, RHCP partners from the Hispanic community have co- created a digital storytelling intervention for T2D self-management that has been piloted in primary care settings across multiple institutions. Digital storytelling interventions are narrative-based videos elicited through a CBPR approach to surface the authentic voices of participants overcoming obstacles to health promoting behaviors, in this case, behaviors related to diabetes self-management (physical activity, healthful diet, medication adherence, and blood glucose monitoring). These videos can shape health behaviors of viewers through influences on attitudes and beliefs. The aims are: 1) To evaluate the efficacy of a community- derived digital storytelling intervention among Hispanic adults with poorly controlled T2D, and 2) to explore the effect of the intervention on proposed theory-based mediators of change. Using a two-group design, 450 Hispanic adults with poorly controlled T2D will be randomly assigned to view the 12-minute digital storytelling intervention with usual care or receive usual clinical care only. Both groups will receive diabetes education materials and a resource guide for contacting their diabetes care team, consistent with existing standards of care. The primary outcome, measured up to six months after intervention delivery, will be glycemic control as measured by hemoglobin A1c. Secondary outcomes will include diabetes self-management behaviors, blood pressure, LDL-cholesterol, and body mass index. The impact of concomitant covariates, including sex, age, and socio-economic status, on the sensitivity of the intervention effect will also be explored. This work tests a scalable, low cost intervention targeting vulnerable populations implemented in primary care settings with the opportunity for rapid translation to practice. We will establish a disseminable framework for community participation in digital storytelling production for chronic disease management, providing a model that may be applied to other communities and health priorities.