Community-Based Intervention to Improve Diabetes Outcomes in Older African American Women with Multi-Caregiving Burden

以社区为基础的干预措施，以改善承担多重护理负担的老年非洲裔美国妇女的糖尿病结局

• 批准号: 10409770
• 负责人: Joni Strom Williams
• 金额: $ 19.37万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-11 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409770
• 关键词: 18 year old; Address; Adult; Adult Children; African American; African American population; Age; Aging; Anger; Behavior; Blood Glucose; Caring; Cessation of life; Child; Communities; Complications of Diabetes Mellitus; Coping Skills; Data; Diabetes Mellitus; Diet; Diet Habits; Distress; Elderly; Elements; Emotional; End stage renal failure; Financial Hardship; Focus Groups; Frustration; Future; Generations; Glycosylated hemoglobin A; Goals; Health; High Prevalence; Household Heads; Intervention; Literature; Measures; Metabolic Control; Monitor; Morbidity - disease rate; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Ophthalmic examination and evaluation; Outcome; Parents; Participant; Persons; Physical activity; Population; Prevalence; Problem Solving; Quality of life; Randomized; Risk; SF-12; Self Care; Social isolation; Stress; Structure; Study Section; Symptoms; Telephone Interviews; Testing; Time; Training and Education; United States; Visual impairment; Woman; Work; base; behavior change; blood pressure control; blood pressure reduction; burden of illness; care giving burden; caregiving; design; diabetes education; effective intervention; experience; feasibility testing; foot; glucose monitor; glycemic control; grandparent; improved; improved outcome; inner city; intervention mapping; medication compliance; mortality; multi-component intervention; neglect; novel; peer support; recruit; skills training; stress reduction; stressor; treatment adherence; treatment as usual; uptake

PROJECT SUMMARY/ABSTRACT African Americans (AA) with type 2 diabetes (T2DM) have a higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to Whites. AA Women (AAW) have a higher rate of diabetes, higher prevalence of visual impairment, higher rate of end-stage renal disease, and higher age-adjusted mortality rate compared to White women. While the reasons for higher diabetes-related morbidity and mortality in AAW have not been clearly elucidated, multi-caregiving responsibilities, or the provision of care (emotional, physical/tangible, financial, spiritual) to parents/grandparents, children/grandchildren, significant others, and their larger community, is a significant barrier to effective diabetes care and contributes to the higher disease burden and increased mortality in AAW with T2DM. This is particularly true for AAW in the Sandwich Generation (adults in their 40s and 50s who are wedged between elderly parents and adult children/grandchildren), and the Club Sandwich Generation (adults in their 50s and 60s, who are wedged between aging parents/grandparents, adult children, and grandchildren), where multi- caregiving responsibilities have resulted in increased stress, poorer glycemic control, and suboptimal self-care behaviors. In addition, there is limited evidence on effective interventions that address multi-caregiving burden in inner city AAW with T2DM. Preliminary data from our group suggests that a community-based, nurse- facilitated, group-based, peer-support intervention that incorporates storytelling, problem solving and goal setting, coping strategies, and diabetes education and skills training may be effective in this population. Therefore, we propose a pilot randomized study to test the feasibility and preliminary efficacy of a novel, community-informed, multicomponent intervention on mitigating stressors associated with multi- caregiving responsibilities to improve diabetes outcomes compared to diabetes enhanced usual care. The long-term goal of the project is to identify effective strategies for improving metabolic control and reducing diabetes complications and mortality rates in AAW with T2DM.

项目摘要/摘要 具有2型糖尿病（T2DM）的非裔美国人（AA）患糖尿病患病率较高，较差 与白人相比，代谢控制，并发症和死亡的风险更大。 aa妇女（aaw）有 较高的糖尿病发生率，较高的视觉障碍患病率，较高的终末期肾脏疾病率和 与白人妇女相比，年龄调整后的死亡率更高。而与糖尿病有关的原因 AAW中的发病率和死亡率尚未清楚地阐明，多职责或 向父母/祖父母提供护理（情感，身体/有形，财务，精神）， 儿童/孙子，重要的其他人及其更大的社区，是有效的重大障碍 糖尿病护理，并导致疾病负担更高，并增加了T2DM的AAW死亡率。这是 对于三明治一代中的AAW尤其如此（40多岁和50多岁的成年人 老年父母和成年子女/孙子）和俱乐部三明治一代（成年人50多岁， 60年代，他们在老年父母/祖父母，成年子女和孙子之间楔入），那里 护理责任导致压力增加，血糖控制较差和次优的自我护理 行为。此外，关于有效干预措施的有限证据，可以解决多重护理负担 在内城，带有T2DM。来自我们小组的初步数据表明，一个基于社区的护士 - 促进，基于团体的，同伴支持干预措施，结合了讲故事，解决问题和 目标设定，应对策略以及糖尿病教育和技能培训可能在此有效 人口。因此，我们提出了一项试点随机研究，以测试A的可行性和初步疗效 新颖的，社区信息的多组分干预措施减轻与多种压力相关的压力源 与糖尿病相比，护理责任可以改善糖尿病结局。这 该项目的长期目标是确定改善代谢控制和减少的有效策略 T2DM AAW中的糖尿病并发症和死亡率。

项目成果

Intersection of Structural Racism, Social Determinants of Health, and Implicit Bias With Emergency Physician Admission Tendencies.

• DOI: 10.1001/jamanetworkopen.2021.26375
• 发表时间: 2021-09-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Egede LE;Walker RJ;Williams JS
• 通讯作者: Williams JS

Nonmedical Interventions For Type 2 Diabetes: Evidence, Actionable Strategies, And Policy Opportunities.

• DOI: 10.1377/hlthaff.2022.00236
• 发表时间: 2022-07
• 期刊: HEALTH AFFAIRS
• 影响因子: 9.7
• 作者: Egede, Leonard E.;Walker, Rebekah J.;Linde, Sebastian;Campbell, Jennifer A.;Dawson, Aprill Z.;Williams, Joni S.;Ozieh, Mukoso N.
• 通讯作者: Ozieh, Mukoso N.

Gender invariance in the relationship between social support and glycemic control.

• DOI: 10.1371/journal.pone.0285373
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Williams, Joni S.;Walker, Rebekah J.;Egede, Leonard E.
• 通讯作者: Egede, Leonard E.

Integrating Medical and Social Care to Reduce Diabetes Inequities: Lessons from the Bridging the Gap Program.

整合医疗和社会护理以减少糖尿病不平等：弥合差距计划的经验教训。

• DOI: 10.1007/s11606-022-07977-5
• 发表时间: 2023
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Williams,JoniS;Walker,RebekahJ;Peek,MonicaE;Chin,MarshallH
• 通讯作者: Chin,MarshallH