LINK-IT: Leveraging vIdeos and commuNity health worKers to address socIal determinants of health in immigranTs

项目摘要 本拟议R 01是对PAR-21-081解决移民健康差异的回应 通过有效的干预措施。中国移民是美国第二大移民群体。 美国，患有不成比例的高2型糖尿病（T2 D）负担和糖尿病预后不良。 糖尿病自我管理教育和支持（DSMES）计划是基于证据的干预措施， 为患者提供重要的咨询和支持，以便在家中进行糖尿病自我管理。 然而，许多健康的社会决定因素（SDOH）障碍限制了DSMES计划的获得， 中国移民，包括贫困率高，英语水平有限（LEP），缺乏获得 护理和保险。鉴于中国移民的高T2 D负担和快速人口增长， 迫切需要进行研究，使这一少数群体能够获得DSMES。短信使用率高 在中国移民中，提出了一个有希望的机制，以提高获得DSMES。但这 单靠移动的健康干预不足以解决LEP报告的许多SDOH障碍 中国移民（例如，缺乏保险、财务障碍）。社区卫生工作者（CHW） 显示为解决健康差异人群中的SDOH障碍的有效模式。以《易经》为指导。 研究框架，我们认为，一个mHealth干预补充CHW的支持是一个新的 这是一个促进中国移民获得DSMES的模式。我们的试点工作证明了可行性， 可接受性和潜在的有效性的短信传递的视频为基础的DSMES干预。的目标 本R 01是为了检查基于视频的DSMES（以下简称视频）或基于视频的DSMES的有效性， DSMES+CHW（以下简称VIDEO+CHW）干预与等待名单对照组（以下简称 对照组），以改善纽约市患有不受控制的T2 D的中国移民的血糖控制。 受试者将随机平均分配至3组之一。视频组将收到1 DSMES每周通过短信进行简短视频，持续24周。VIDEO+CHW组将收到相同的 DSMES视频加上CHW每两周的支持电话，持续24周。CHW将评估参与者的 SDOH障碍T2 D护理，并将其与社区可用资源联系起来。对照组将 继续接受常规护理，研究结束时，他们将收到DSMES视频。主 结果是6个月时的HbA 1c。这项研究将提供关键信息，说明使用 现有的短信平台或短信加上CHW支持，以增强对DSMES的访问。如果任何一 干预措施被证明是有效的，这个项目可以为未来的项目提供重要的数据，以探索我们如何 可以在现实世界中实施这种可扩展的干预。这项研究可以作为一个程序模型， 其他高风险移民的慢性病护理，如LEP西班牙裔移民，他们也承受着高T2 D负担， 面临着类似的障碍，访问DMSES计划，并经常使用短信。

PROJECT SUMMARY This proposed R01 is in response to the PAR-21-081 Addressing Health Disparities among Immigrant Populations through Effective Interventions. 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 access 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 make DSMES accessible to this minority population. High text message use among Chinese immigrants suggests a promising mechanism for enhancing access to DSMES. Yet, this mobile health (mhealth) intervention alone is insufficient to address many SDOH barriers reported by LEP Chinese immigrants (e.g., lack of insurance, financial barriers). Community health worker (CHW) has been shown as an effective model to address SDOH barriers in health disparity populations. Guided by the NIMHD Research Framework, we argue that a mHealth intervention that is supplemented with CHW support is a novel model for enhancing access to DSMES in Chinese immigrants. Our pilot work demonstrates the feasibility, acceptability, and potential efficacy of a text message-delivered video-based DSMES intervention. The goal of this R01 is to examine the efficacy of the video-based DSMES (hereafter VIDEO) or the video-based DSMES+CHW (hereafter VIDEO+CHW) intervention compared with the wait-list control group (hereafter CONTROL) to improve glycemic control among Chinese immigrants with uncontrolled T2D in NYC. Participants will be randomized with equal allocation to one of the 3 groups. The VIDEO group will receive 1 DSMES brief video via text messages per week for 24 weeks. The VIDEO+CHW group will receive the same DSMES videos 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 CONTROL group will continue to receive their usual care and at the end of the study, they will receive DSMES videos. The primary outcome is HbA1c at 6 months. This study will provide critical information on whether it is efficacious to use an existing text messaging platform or text message plus CHW support to enhance access to DSMES. If either of the intervention is proven effective, this project can provide important data for future projects to explore how we can implement this scalable intervention in real-world settings. This study may serve as a program model for chronic care in other high-risk immigrants such as LEP Hispanic immigrants who also bear a high T2D burden, face similar barriers to accessing DMSES programs, and frequently use text messages.