Implementing an effective Diabetes intervEntion Among Low-income immigrants (IDEAL Study)

项目摘要 本拟议R18是对RFA-HS-23-002《以公平为重点的 医疗保健提供系统中的循证干预。中国移民是第二大 美国的移民群体，2型糖尿病（T2 D）负担不成比例高， 糖尿病结局糖尿病自我管理教育和支持（DSMES）计划是证据- 基于干预措施，为患者提供重要的咨询和支持，以引导糖尿病自我， 在家管理。然而，许多健康的社会决定因素（SDOH）障碍限制了 向中国移民传播DSMES项目，包括高贫困率，有限的英语 此外，他们还缺乏熟练程度（LEP）以及缺乏获得护理和保险的机会。鉴于T2 D的高负担和快速人口增长， 随着中国移民的增长，迫切需要研究如何在中国传播和实施DSMES。 这个少数民族。我们提议的R18 IDEAL研究的总体目标（实施有效的 低收入移民糖尿病干预）的有效性和实施过程进行测试 一个创新的多层次护理模式，为低收入群体提供文化上适合的糖尿病干预措施， 中国移民糖尿病基于我们强大的试点数据和与临床 和社区伙伴，我们建议进行第一类混合研究， 检查IDEAL干预血糖控制的有效性和实施过程， 270名中国移民患有不受控制的T2 D。受试者将被随机化，平均分配至 两组之一。IDEAL小组将收到一份文化和语言定制的DSMES简报 通过短信链接提供视频/周，持续24周，另加CHW每两周的支持电话，持续24周 周CHW将评估参与者对T2 D护理的SDOH障碍，并将其与可用资源联系起来， 社会各界等待名单对照组（以下简称对照组）将继续接受常规护理， 研究结束后，他们将收到DSMES视频。主要结局为6个月时的HbA 1c，次要结局为 结果包括12个月时的HbA 1c以及6个月和12个月时的心理社会因素。这项研究涉及的 迫切需要在服务不足的人群中传播和实施循证糖尿病干预措施 减少健康差距。研究结果将为潜在的可扩展策略提供重要证据， 促进传播有效执行、复制和可持续的循证 用于医疗保健和社区环境的干预措施。它也可以作为其他高等教育的程序模型。 风险LEP移民人口，如西班牙裔移民谁也承担高T2 D负担，面临类似的 SDOH障碍访问DSMES程序，并经常使用短信。

PROJECT SUMMARY This proposed R18 is in response to the RFA-HS-23-002 Dissemination and Implementation of Equity-Focused Evidence-Based Interventions in Healthcare Delivery Systems. Chinese immigrants are the second largest immigrant group in the U.S., who suffer a disproportionately high type 2 diabetes (T2D) burden and have poor diabetes outcomes. Diabetes Self-Management Education and Support (DSMES) programs are evidence- based interventions that provide patients with important counseling and support to navigate diabetes self- management at home. However, numerous social determinants of health (SDOH) barriers limit the dissemination of DSMES programs to Chinese immigrants, including high rates of poverty, limited English proficiency (LEP), and lack of access to care and insurance. Given the high T2D burden and rapid population growth in Chinese immigrants, there is an urgent need for research to disseminate and implement DSMES in this minority population. The overarching goal for our proposed R18 IDEAL study (Implementing an effective Diabetes intervEntion Among Low-income immigrants) is to test the effectiveness and implementation process of an innovative multi-level care model for delivering a culturally tailored diabetes intervention to low-income Chinese immigrants with diabetes. Building upon our strong pilot data and established partnerships with clinical and community partners in Chinese immigrant communities, we propose to conduct a type 1 hybrid study to examine the effectiveness and implementation process of the IDEAL intervention for glycemic control among 270 Chinese immigrants with uncontrolled T2D in NYC. Participants will be randomized with equal allocation to one of the two groups. The IDEAL group will receive 1 culturally and linguistically tailored DSMES brief video/week for 24 weeks delivered via text message links plus bi-weekly support calls from a CHW for 24 weeks. The CHW will assess participants’ SDOH barriers to T2D care and link them to available resources in the community. The wait-list control (hereafter CONTROL) group will continue to receive usual care and at the end of the study, they will receive DSMES videos. The primary outcome is HbA1c at 6 months and secondary outcomes include HbA1c at 12 months and psychosocial factors at 6 and 12 months. This study addresses the urgent need to disseminate and implement evidence-based diabetes interventions in underserved populations to reduce health disparities. Study findings will provide important evidence on potential scalable strategies to foster the dissemination of effective implementation, replication, and sustainability of evidence-based interventions for use in healthcare and community settings. It can also serve as a program model for other high risk LEP immigrant populations such as Hispanic immigrants who also bear a high T2D burden, face similar SDOH barriers to accessing DSMES programs, and frequently use text messages.