Culturally-adapted DPP intervention for Mexican Americans in primary care: An RCT

在初级保健中对墨西哥裔美国人进行文化适应的 DPP 干预：一项随机对照试验

• 批准号: 8755553
• 负责人: Jun Ma
• 金额: $ 25万
• 依托单位: PALO ALTO MEDICAL FOUNDATION RES INST
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8755553
• 关键词: Culturally; adapted; DPP; intervention; Mexican

DESCRIPTION (provided by applicant): Background: Latinos are the largest and fastest growing minority group (16% of the US population) and provide a potent example of existing health disparities among U.S. racial/ethnic groups. In particular, Mexican Americans-the largest US Latino subpopulation-have a notably higher prevalence of overweight and obesity (80%) than non-Hispanic whites (NHWs, 68%), and they are disproportionately affected by obesity-related risk factors (e.g., metabolic syndrome, pre-diabetes) and diseases (e.g., diabetes). Until efficacious lifestyle interventions for weight management are translated into practice, obesity and its comorbidities will continue to exact enormous and disproportionate burdens. Population-specific interventions are needed because undifferentiated interventions (often developed in white-dominant populations) may be inefficient-or even unintentionally increase health disparities. The Diabetes Prevention Program (DPP) trial demonstrated that an intensive lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults and that weight loss was the dominant predictor. Numerous DPP translation studies have been undertaken, including a pragmatic randomized trial our team recently completed ("E-LITE") with 241 participants (78% NHW) that showed success in integrating group counseling with health information technology (HIT) to operationalize the DPP intervention in primary care. To date, very few DPP translation studies have targeted Latinos. Design: We propose to culturally adapt the IT-enhanced group DPP intervention from E-LITE and test it among Spanish-speaking or bilingual Mexican Americans who are overweight or obese and have metabolic syndrome, pre-diabetes, or both. Participants (n=186) from 6 primary care practices in Santa Cruz, California (35% Latino residents; 91% of Mexican origin) will be randomly assigned to receive the culturally adapted intervention (CAI) or usual care. The primary aim is to determine the effectiveness of the CAI ("E" in the RE-AIM model). We hypothesize that the CAI will lead to a greater mean reduction in body mass index at 24 months (primary outcome) vs. usual care. Secondary outcomes will include cost-effectiveness, clinical (e.g., fasting glucose), psychosocial (e.g., quality of life), behavior change (e.g., diet, physical activity) measures. The secondary ai is to conduct process evaluation with mixed methods for the other RE-AIM attributes: Reach (e.g., participation rate of the target population), Adoption (e.g., participating clinic & provide characteristics), Implementation (e.g., intervention fidelity), and Maintenance (e.g., sustainabiliy in the practice setting). Implications: This health services research project (PA-13-045) falls within the AHRQ Research Portfolio areas of comparative effectiveness, HIT, and prevention and care management; it also targets a priority population. The findings will be of value to clinicians, patients, and other decision makers considering effective obesity and diabetes prevention programs for the millions of MAs who carry a disproportionate burden of these, with high potential for real-world applicability and impact on MA minority health and policies aimed to eliminate health disparities.

描述（由申请人提供）：背景：拉丁美洲人是增长最大，增长最快的少数群体（占美国人口的16％），并提供了一个有效的美国种族/族裔群体中健康差异的例子。特别是，墨西哥裔美国人是美国最大的拉丁裔亚群，超重和肥胖的患病率明显高于非西班牙裔白人（NHWS，68％），并且受肥胖相关的危险因素的影响不成比例（例如。 ，代谢综合征，糖尿病前）和疾病（例如糖尿病）。在将体重管理的有效生活方式干预转化为实践之前，肥胖及其合并症将继续造成巨大和不成比例的负担。需要特定于人群的干预措施，因为未分化的干预措施（通常是在白人主导的人群中开发的）可能是无效的，甚至无意间会增加健康差异。糖尿病预防计划（DPP）试验表明，高风险成年人的强化生活方式干预将2型糖尿病的发病率降低了58％，而体重减轻是主要的预测因子。已经进行了大量的DPP翻译研究，包括我们的团队最近完成的（“ e-lite”）与241名参与者（78％NHW）的一项务实的随机试验，这些试验在将小组咨询与健康信息技术（HIT）集成在一起以运营DPP方面取得了成功的成功。干预初级保健。迄今为止，很少有DPP翻译研究针对拉丁裔。设计：我们建议在文化上适应E-Lite的IT增强群体DPP干预，并在说西班牙语或双语的墨西哥裔美国人中对其进行测试，这些美国人超重或肥胖，患有代谢综合征，糖尿病前期或两者兼而有之。来自加利福尼亚州圣克鲁斯的6种初级保健实践的参与者（n = 186）（拉丁裔居民35％；墨西哥起源的91％）将被随机分配，以接受文化适应的干预措施（CAI）或通常的护理。主要目的是确定CAI的有效性（Re-Aim模型中的“ E”）。我们假设CAI将导致24个月（主要结果）与通常的护理时体重指数的平均减少。次要结果将包括成本效益，临床（例如，禁食葡萄糖），社会心理（例如，生活质量），行为改变（例如，饮食，体育锻炼）措施。次级AI是针对其他重复属性的混合方法进行过程评估：触及（例如，目标人群的参与率），采用率（例如参与诊所和提供特征），实施（例如，干预忠诚），和维护（例如，在实践环境中的可持续发展）。含义：该卫生服务研究项目（PA-13-045）属于AHRQ研究组合的比较有效性，命中以及预防和护理管理的领域；它还针对优先人群。这些发现将对临床医生，患者和其他决策者有价值旨在消除健康差异的政策。