Expanding the Diabetes Homelessness Medication Support (D-Homes) program to Spanish speaking Hispanics

将糖尿病无家可归者药物支持 (D-Homes) 计划扩大到讲西班牙语的西班牙裔

• 批准号: 10510094
• 负责人: Katherine Diaz Vickery
• 金额: $ 9.72万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10510094
• 关键词: Adult; Aftercare; Age; Award; Behavior Therapy; Behavioral; Behavioral trial; COVID-19; COVID-19 pandemic; Caring; Cessation of life; Chronic Disease; Clinical Trials; Communities; Data; Diabetes Mellitus; Diagnosis; Enrollment; Face; Feedback; Foundations; Fright; Funding; Future; Goals; Health Insurance; Health behavior; Health system; Healthcare; Hispanic; Hispanic Populations; Home; Homeless persons; Homelessness; Housing; Individual; Intervention; Interview; Language; Leadership; Link; Logistics; Low income; Mentored Patient-Oriented Research Career Development Award; Mexican; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Outcome Assessment; Participant; Persons; Pharmaceutical Preparations; Population; Prevalence; Procedures; Protocols documentation; Qualitative Research; Research; Resources; Risk; Risk Factors; Role; Services; Shelter facility; Structure; Time; Translating; Well in self; Work; acceptability and feasibility; arm; base; bilingualism; demographics; diabetes education; diabetes management; driving behavior; experience; glycemic control; health equity; high risk population; hispanic community; homeless shelters; improved; informant; innovation; medication compliance; pilot test; premature; programs; recruit; retention rate; safety net; satisfaction; skills; social

PROJECT SUMMARY/ABSTRACT Homeless people in the US face disproportionate risk for early death in part due to poorly controlled chronic diseases including diabetes. 1.5 million unique US adults access homeless shelters annually. People experiencing diabetes and homelessness develop complications 10 years earlier and die prematurely compared to their housed counterparts. This project works to achieve health equity for these people. Substantial evidence links medication adherence as a leading modifiable health behavior driving poor diabetes outcomes in low-income and homeless populations. Behavioral support for improved medication adherence among people experiencing diabetes and homelessness is the focus of our team’s ongoing work (K23DK118117). We’ve used qualitative data and community engaged approaches to develop a tailored behavioral intervention (the Diabetes Homeless Medication Support program [D-Homes]); pilot testing of this new intervention is ongoing. D-Homes offers 10 coaching sessions over 12 weeks targeting glycemic control via improved medication adherence. Coaching includes diabetes education and structured goal setting targeting medication adherence and psychological wellness. To date English fluency has been an enrollment criterion due to limited resources in the existing K23 award. Yet the Hispanic community has disproportionately higher rates of both homelessness and diabetes. This R-03 award will expand the D-Homes intervention to include Spanish speakers in two aims: (1) Adapt D-Homes protocols and translated treatment materials based on feedback from people with diabetes and homelessness who speak Spanish and are Hispanic (DH-SH). We will conduct 8-10 interviews to review materials, planned recruitment and retention strategies, and study logistics. (2) Assess feasibility and acceptability of the adapted D-Homes for DH-SH. We will recruit 12 DH-SH into a single-arm trial to assess acceptability and feasibility of (i) recruitment and retention; (ii) coaching content and treatment materials; (iii) outcome assessments. Data will include systematic tracking of recruitment and retention efforts, staff feedback, program satisfaction and post-treatment qualitative interviews. We hypothesize unique recruitment/retention needs and unique facilitators/barriers to medication adherence among DH-SH compared to English-speaking participants. Data will define solutions for use in future work. This study is significant because findings will enable a future, fully powered clinical trial of D-Homes that will enroll both English and Spanish speakers. Our team’s experience provides a robust foundation for this work: (1) Our bilingual/bicultural research staff supports our ongoing NIDDK-funded trial with Hispanic participants with type 2 diabetes (R01 DK113999); (2) The PI’s Mexican heritage, Spanish language skills, and leadership role at the local Health Care for the Homeless program; (3) Our team’s successful recruitment and retention of diverse participants in several behavioral trials with difficult-to-reach populations. This study is innovative as it will define necessary tailoring based on language and a key social risk factor to diabetes care, homelessness.

项目摘要/摘要 美国无家可归的人面临早期死亡的不成比例的风险，部分原因是慢性控制不善 包括糖尿病在内的疾病。每年有150万独特的美国成年人无家可归者庇护所。人们 10年前经历糖尿病和无家可归的发展并发症，过早死亡 与他们的同行相比。该项目旨在为这些人实现健康公平。 大量证据将药物依从性链接为驱动较差的领先的可修改健康行为 低收入和无家可归者人群中的糖尿病结果。改进药物的行为支持 我们团队正在进行的工作的重点是经历糖尿病和无家可归的人的遵守 （K23DK118117）。我们已经使用定性数据和社区参与的方法来开发量身定制的 行为干预（糖尿病无家可归的药物支持计划[D-Homes]）；试点测试 新干预正在进行中。 D-Homes在12周内为血糖控制提供了10次教练课程 通过改进的药物依从性。教练包括糖尿病教育和结构化目标设定 针对药物依从性和心理健康。迄今为止，英语流利度一直是注册 由于现有K23奖的资源有限而导致的标准。然而西班牙裔社区的比例不成比例 无家可归和糖尿病的率更高。该R-03奖项将将D-Homes干预扩展到 在两个目的中包括西班牙语者：（1）调整D-Homes协议和基于翻译的治疗材料 关于说西班牙语和西班牙裔（DH-SH）的糖尿病和无家可归者的反馈。我们 将进行8-10次访谈，以审查材料，计划的招聘和保留策略，并研究 后勤。 （2）评估适用于DH-SH的D-HOMES的可行性和可接受性。我们将招募12 DH-SH 进行一项单臂试验，以评估（i）招聘和保留的可接受性和可行性； （ii）教练内容 和治疗材料； （iii）结果评估。数据将包括系统的招聘跟踪和 保留工作，员工反馈，计划满意度和治疗后定性访谈。我们 假设独特的招聘/保留需求以及独特的辅助因素/药物遵守的障碍 与讲英语的参与者相比，DH-SH中的参与者。数据将定义用于未来工作的解决方案。 这项研究很重要，因为发现将使D-Homes的未来，全功率的临床试验能够 注册英语和西班牙语的人。我们团队的经验为这项工作提供了强大的基础： （1）我们的双语/双文化研究人员支持我们正在进行的NIDDK资助的试验 2型糖尿病（R01 DK113999）; （2）PI的墨西哥遗产，西班牙语技能和领导才能 无家可归计划的当地医疗保健中的角色； （3）我们团队的成功招募和保留 潜水员参与者参加了一些难以到达人群的行为试验。这项研究具有创新性 将根据语言和糖尿病护理，无家可归的关键社会风险因素定义必要的裁缝。