Ongoing Diabetes Self-Management Support in Church-Based Settings

 描述(由申请者提供)：证据表明糖尿病自我管理教育(DSME)在糖尿病知识和自我护理行为、临床结果、生活质量、初级和预防服务的使用以及较低成本方面的好处。虽然DSME最初的好处是有据可查的，但在DSME后大约六个月，效果就会下降。此外，这一领域的大多数研究都是非常集中的，多种方法之间的比较有限。2012年DSME和支持国家标准强调了提供初始DSME和持续的糖尿病自我管理支持(DSM)的重要性，以帮助糖尿病患者在一生中保持有效的自我管理。虽然人们对如何提供有效的DSME了解很多，但对如何提供有效的DSMM却知之甚少。此外，DSME是医疗系统中的一项覆盖福利，而DSM不是。这最终限制了DSM计划的访问和可用性；因此，迫切需要开发、评估和了解有效的DSM模式，这些模式是持续的、以患者为导向的、对变化做出反应并嵌入现有社区基础设施的。非洲裔美国人教堂是传递这种干预的潜在有效场所。这项提议的目标是检查三种DSM方法与教会范围内加强的日常护理相比的有效性。将实施一项包含三个平行干预组的整群随机实用行为试验。底特律大都会的21个教会将被随机分为1)堂区护士+同辈领袖DSM 2)堂区护士DSM，或3)Peer Leader DSM。所有参与者将从加强日常护理开始，并根据教会成员的身份过渡到各自的DSM小组。每个教会将招收20-23名2型糖尿病患者，他们将接受6周的DSME，随后由教区护士、同龄人领袖或两者兼而有之领导的12个月的支持小组会议。在DSM之后，所有参与者和教会将过渡到为期一年的持续支持期，以评估参与者是否通过利用教会的基础设施来维持教区护士和同辈领袖的自我管理努力。我们假设1)堂区护士DSM和同辈领袖DSM的参与者将比加强的日常护理有更好的结果，以及2)DSME+Peer Leader DSM的参与者将在显著高于Parish Nurse DSM和Peer Leader DSM的参与者的情况下持续改善所取得的结果。我们预计，为同行领导者提供正式的基础设施和监督对于DSM的普及至关重要。所有的干预措施都将优于强化的日常护理。预计血压、体重和心脏质量也会有类似的发现。 生活。将确定每种方法的成本效益和长期影响。这些信息将对公共卫生产生重大影响，并将在确定有效的可持续战略和方法方面发挥关键作用，以解决服务不足社区的DSM问题。

 DESCRIPTION (provided by applicant): Evidence demonstrates the benefits of diabetes self-management education (DSME) on diabetes knowledge and self-care behavior, clinical outcomes, quality of life, use of primary and preventive services, and lower costs. While the initial benefits of DSME are well documented, the effects decline approximately six months following DSME. Additionally, the majority of studies in this area are singularly focused and comparisons between multiple approaches are limited. The 2012 National Standards for DSME and Support emphasize the importance of providing both initial DSME and on-going diabetes self-management support (DSMS) to assist people with diabetes in maintaining effective self-management throughout a lifetime. While a great deal is understood about how to provide effective DSME, less is known about how to provide effective DSMS. Additionally, DSME is a covered benefit in the healthcare system, while DSMS is not. This ultimately limits access and availability of DSMS programs; therefore posing a critical need to develop, evaluate, and understand effective DSMS models that are ongoing, patient-driven, responsive to change, and embedded in existing community infrastructures. African-American churches are a potentially effective venue for delivering such interventions. The goal of this proposal is to examine the effectiveness of three DSMS approaches compared to enhanced usual care within the context of churches. A cluster randomized, practical behavioral trial with three parallel intervention groups will be implemented. Twenty-one churches in metro-Detroit will be randomized to either 1) Parish Nurse+Peer Leader DSMS 2) Parish Nurse DSMS, or 3) Peer Leader DSMS. All participants will begin with enhanced usual care and transition into the respective DSMS groups based on church membership. Each church will enroll 20-23 individuals with type 2 diabetes, who will be offered six weeks of DSME, followed by 12 months of support group sessions led by either the parish nurse, peer leader, or a combination of both. Following DSMS, all participants and churches will transition into a one-year period of on-going support to evaluate if participants parish nurses, and peer leaders sustain self-management efforts by capitalizing on the infrastructure of the church. We hypothesize that 1) participants in both Parish Nurse DSMS and Peer Leader DSMS will have improved outcomes over enhanced usual care, and that 2) participants in Parish Nurse + Peer Leader DSMS will sustain improvements in outcomes achieved following DSME at significantly higher levels than participants in Parish Nurse DSMS and Peer Leader DSMS. We anticipate that providing formal infrastructure and supervision for peer leaders is critical in the uptake of DSMS. All interventions will be superior to enhanced usual care. A similar pattern of findings is anticipated for blood pressure, weight, and quality of life. The cost effectiveness and long term impact of each approach will be determined. This information will have significant public health impact and will be pivotal in determining effective sustainable strategies and approaches to address DSMS in underserved communities.