Decreasing Diabetes Disparities: Building Mexican American Family Social Capital

描述（由申请人提供）：糖尿病，主要是2型糖尿病（T2DM），在美墨边境地区的墨西哥裔美国人中已经达到流行病的程度，使这个独特的地缘政治地区成为消除高度脆弱人群中T2DM健康差异的目标。边境地区的贫困、语言和卫生素养障碍等多种多样的特点加剧了2型糖尿病的健康差异。此外，糖尿病自我管理教育计划以个人为目标，对家庭背景的考虑非常有限，这导致了有限的医疗保健机会。家庭是墨西哥裔美国成年2型糖尿病患者进行疾病管理的关键社会环境。然而，很少有研究利用家庭（familismo）对该地区成人T2DM管理的强烈文化价值。我们提出了一种减少2型糖尿病健康不平等和建立家庭社会资本的独特方法——应用基于社区的参与式研究（CBPR）原则，对墨西哥裔美国2型糖尿病成年人及其家庭伴侣进行设计和测试，以设计和测试适合文化的糖尿病自我管理教育，社会支持干预。混合方法将分两个阶段实施，以实现3个目标。在第一阶段（目的1），我们将采用CBPR的原则，让患有2型糖尿病的墨西哥裔美国成年人和一个家庭伴侣（n=20）在家庭背景下完善糖尿病教育和社会支持干预。在第二阶段（目标2,3）中，我们将采用随机实验设计，实施为期6个月的干预，并测试其即时和持续效果。168名年龄在35-74岁的墨西哥裔美国成年人及其18岁及以上的家庭伴侣将被随机分配到干预组或等待名单对照组。将在基线、干预后立即和干预后6个月收集数据，以测量行为结果（糖尿病自我管理、糖尿病自我效能、糖尿病困扰、营养和体育活动行为）、生物学结果（血糖控制）和家庭社会资本结果（社会整合、家庭效能、家庭社会支持、健康素养、健康知识和健康水平）。研究结果有望通过扩大T2DM自我管理教育计划的基础方法，减少T2DM健康差异，改善和维持血糖控制，对个人家庭和社区也有潜在的积极下游影响。

DESCRIPTION (provided by applicant): Diabetes, primarily type 2 diabetes (T2DM), has reached epidemic proportions among Mexican Americans in the US-Mexico border region, making this unique geopolitical region one that should be targeted for eliminating T2DM health disparities among a highly vulnerable population. Multiple and diverse characteristics of the border region such as poverty, language and health literacy barriers propagate T2DM health disparities. In addition, diabetes self-management education programs that target individuals and have very limited consideration of the family context have contributed to limited health care access. The family is a critical social context in which disease management occurs for Mexican American adults with T2DM. Yet few studies have capitalized on the strong cultural value of family (familismo) for T2DM management among adults in this region. We propose a unique approach for reducing T2DM health inequities and building family social capital - the application of community based participatory research (CBPR) principles with Mexican American adults with T2DM and their family partners to design and test a culturally tailored diabetes self-management education, social support intervention. A mixed method approach will be implemented in two phases to address 3 aims. In Phase 1 (Aim 1) using the principles of CBPR we will engage Mexican Americans adults with T2DM and a family partner (n=20) to refine a diabetes education and social support intervention within a family context. In Phase 2 (Aims 2, 3) using a randomized experimental design, we will implement the 6-month intervention and test its immediate and sustained effects. A total of 168 Mexican American adults with T2DM, ages 35-74, and their family partner, age 18 and older, will be randomly assigned to either intervention or wait list control groups. Data will be collected at baseline, immediately post intervention, and 6 months post intervention to measure behavioral outcomes (diabetes self management, diabetes self efficacy, diabetes distress, nutrition and physical activity behaviors), biologic outcomes (glycemic control) and family social capital outcomes (social integration, family efficacy, family social support, health literacy, health care access) Findings are expected to reduce T2DM health disparities by expanding the approach underpinning T2DM self management education programs, and improve and sustain glycemic control, with potential positive downstream effects for the individual's family and community as well. PUBLIC HEALTH RELEVANCE: Diabetes is the fifth leading cause of death in the United States (US)-Mexico border region compared to seventh nationally. The goal of this study is to reduce diabetes health disparities among Mexican American adults with type 2 diabetes by improving and sustaining diabetes self-management behaviors and increasing family social capital for type 2 diabetes management.