Evaluation of the effectiveness of Ajjmuurur Baamḷe DSMES in the RMI

Ajjmuurur Baamá¸e DSMES 在 RMI 中的有效性评估

• 批准号: 10557126
• 负责人: Sheldon Riklon
• 金额: $ 64.6万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557126
• 关键词: Acquired Blindness; Address; Adherence; Affect; Arkansas; Behavior; Behavioral; Blood Pressure; Body mass index; Cardiometabolic Disease; Certification; Communities; Community Health Aides; Complications of Diabetes Mellitus; Data; Diabetes Mellitus; Disparity; Distress; Education; Educational Curriculum; Eligibility Determination; Evaluation; Faith-based organization; Family; Family member; Fasting; Free Association; Funding; Glycosylated hemoglobin A; Goals; Health; Health Expenditures; Healthcare; Indigenous; Intervention; Kidney Failure; Knowledge; Life Expectancy; Lipids; Lower Extremity; Marshall Islands; Measures; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Pacific Islands; Participant; Patient-Focused Outcomes; Patients; Periodicity; Persons; Physicians; Population; Prevalence; Quality of life; Randomized; Research; Resources; Risk Factors; Self Efficacy; Self Management; Services; United States; United States National Institutes of Health; Waiting Lists; Work; arm; behavior change; behavioral adherence; cardiometabolic risk; community based participatory research; community organizations; comparison group; cultural values; diabetes educator; diabetes self-management; effectiveness evaluation; effectiveness testing; empowerment; experience; family influence; family support; fasting glucose; glycemic control; health care service; health disparity; heart disease risk; improved; innovation; limb amputation; medication compliance; minority communities; motivational enhancement therapy; patient engagement; post intervention; primary outcome; process improvement; public health relevance; treatment group; waist circumference

ABSTRACT Health disparities in the Republic of the Marshall Islands (RMI) are striking with extremely high rates of diabetes and other cardiometabolic diseases. Documented rates of type 2 diabetes mellitus (T2DM) in the RMI range from 20%-50%. This is significantly higher than global (8.5%) and US (11%) rates. The extreme disparities in the RMI are exacerbated by a lack of research, lack of funding, a lack of services, and a lack of culturally-appropriate interventions. Residents of the RMI experience unique barriers to self-management of T2DM, as well as possess unique cultural assets that can be leveraged to help mitigate these barriers. The research team worked with the Marshallese community in Arkansas to develop and evaluate a culturally- adapted family model of DSMES (Ājjmuurur Baamḷe DSMES). Ājjmuurur Baamḷe DSMES is based on a collectivist approach, incorporates Marshallese cultural practices, and uses “talk story” as a conversational, rhythmic, and culturally preferred way of sharing knowledge. Ājjmuurur Baamḷe DSMES includes family members as participants and focuses on family motivational interviewing, family goal setting, and family behavioral change with specific focus on education about supportive and nonsupportive family behaviors. The curriculum is assets based and it works to overcome barriers facing Marshallese patients by leveraging culturally specific facilitators of healthy behavior change. Our central hypothesis is that persons who receive the Family Model DSMES "Ājjmuurur Baamḷe" will have improved HbA1c (primary outcome), blood pressure, lipids, BMI, increased knowledge, self-efficacy, empowerment, and quality of life, along with decreased diabetes-related complications and diabetes-related distress. This study's objective is to conduct a cluster RCT using a wait-list control to evaluate the effectiveness of Ājjmuurur Baamḷe DSMES when delivered in faith- based organizations (FBOs) by Community Health Workers (CHWs). Our specific aims are: 1. Test the effectiveness of Ājjmuurur Baamḷe DSMES to improve diabetes-related outcomes among Marshallese patients; 2. Evaluate the effect of Ājjmuurur Baamḷe DSMES on family members; and 3. Conduct an indigenous evaluation to understand the extent to which the intervention adheres to Pacific Islander cultural values and evaluate the cultural appropriateness of the research. Data will be collected from patients (Aim 1) and their family members (Aim 2) at baseline, immediately post-intervention (12 weeks), at four months and twelve months post-intervention. An indigenous evaluation (Aim 3) will be conducted at six months and each year thereafter to document and inform process improvement efforts in study implementation. While the Marshallese are a small population, this population is underrepresented in research, and they are experiencing a health crisis that must be addressed. The proposed study offers a promising intervention that has the potential to affect substantially health disparities experienced by Marshallese and other Pacific Islanders in the USAPI.

抽象的 马歇尔群岛共和国（RMI）的健康差异正在引人注目，速度极高 糖尿病和其他心脏代谢疾病。 RMI中的2型糖尿病（T2DM）的记录率 范围为20％-50％。这显着高于全球（8.5％）和美国（11％）的利率。极端 不足的研究，缺乏资金，缺乏服务以及缺乏研究，RMI的差异加剧了 具有文化的干预措施。 RMI的居民经历了自我管理的独特障碍 T2DM以及可以利用的潜在独特文化资产来帮助缓解这些障碍。 研究团队与阿肯色州马歇尔社区合作开发和评估文化 - DSMES的改编家庭模型（ājjmuururbaamḷedsmes）。 集体主义方法，结合马歇尔文化实践，并以“谈话故事”为对话， 有节奏和文化上的共享知识的方式。 ājjmuururbaamḷedsmes包括家庭 成员作为参与者，并专注于家庭励志面试，家庭目标和家庭 行为改变，特别关注有关支持和非支持家庭行为的教育。这 课程是基于资产的，它致力于克服马歇尔患者面临的障碍 健康行为改变的文化特定促进者。我们的中心假设是接受的人 家族模型DSMES“ājjmuururbaamḷe”将改善HBA1C（主要结果），血压， 脂质，BMI，增加知识，自我效能感，赋权和生活质量以及下降 与糖尿病有关的并发症和与糖尿病有关的困扰。这项研究的目标是进行集群RCT 使用等待名单控制来评估以信仰交付时ājjjmuururbaamḷedsmes的有效性 - 社区卫生工作者（CHW）的基于组织（FBO）。我们的具体目的是：1。测试 ājjjmuururbaamḷedsmes可以改善大教堂患者中与糖尿病相关的结果； 2。评估ājjmuururbaamḷedsmes对家庭成员的影响；和3。进行土著 评估以了解对太平洋岛民文化价值和 评估研究的文化适用性。数据将从患者（AIM 1）及其 家庭成员（AIM 2）在干预后立即（12周），四个月和十二 干预后几个月。本地评估（AIM 3）将在六个月和每年进行 此后，以记录并为研究实施的过程改进工作提供信息。而 马歇尔人的人口很少，这一人口在研究中的人数不足，他们正在经历 必须解决的健康危机。拟议的研究提供了一种承诺干预措施 可能影响马歇尔和其他太平洋岛民经历的实质性健康差异的潜力 USAPI。