Gender Differences in Response to Diabetes Self-Management Education among Mexican American Adults

墨西哥裔美国成年人对糖尿病自我管理教育反应的性别差异

• 批准号: 9430664
• 负责人: ALEX J KOPELOWICZ
• 金额: $ 8.19万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-22 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9430664
• 关键词: Accelerometer; Address; Adherence; Adult; Affect; Alcohol consumption; American; Applications Grants; Area; Back; Behavior; Belief; Caring; Chronic; Clinic; Clinical; Communities; Community Health Aides; Data; Diabetes Mellitus; Diet; Documentation; Education; Educational Intervention; Educational process of instructing; Effectiveness; Evaluation; Evidence based practice; Exercise; Failure; Family; Family member; Fostering; Foundations; Glucose; Glycosylated hemoglobin A; Goals; Health Personnel; Health Professional; Health Status; High Prevalence; Hispanics; Hour; Hypoglycemia; Individual; Informal Social Control; Intervention; Kidney Failure; Knowledge; Los Angeles; Medical; Mental disorders; Methods; Mexican Americans; Modeling; Monitor; Neuropathy; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nurses; Outcome; Participant; Patients; Pharmaceutical Preparations; Phase; Population; Prevalence; Primary Health Care; Public Health; Public Hospitals; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Reporting; Research; Research Design; Resources; Retinal Diseases; Science; Self Efficacy; Self Management; Severities; Social Facilitation; Study Subject; Testing; Time; Training; Treatment Effectiveness; United States; Variant; Work; base; behavior change; contextual factors; diabetes control; efficacy evaluation; evidence base; experience; family influence; family support; gender difference; glucose monitor; glycemic control; improved; individual patient; individualized medicine; medical complication; primary outcome; programs; public health priorities; public health relevance; randomized trial; response; skills; study population; success; theories; therapy design; treatment as usual; treatment duration; treatment effect; treatment group; treatment strategy

 DESCRIPTION (provided by applicant): This R-01 grant proposal is a response to PA-14-112 "A Family-Centered Self-Management of Chronic Conditions." The project (a) evaluates four culturally adapted, family-based treatments designed to improve health status, self-management behaviors and self-efficacy among Mexican-Americans with Type 2 diabetes using a Sequential, Multiple Assignment Randomized Trial in a public health setting, and (b) tests hypotheses about the applicability of Ryan and Sawin's Individual and Family Self-Management Theory, the conceptual foundation for the intervention's key constructs, to the study of diabetes self-management in this population. This conceptual model was selected for study because its emphasis on the integration of family members as partners in care while promoting illness self-management is highly germane to the study population and to the proposed intervention. Spanish speaking, Mexican-American patients with Type 2 diabetes and their families will be recruited from a primary care clinic affiliated with a large, urban public hospital located in a predominantly Mexican American area of Los Angeles. In the first phase of the study, subjects will be randomly assigned to six 2.5 hour sessions (three months) of either: 1) Tomando Control de su Diabetes (TC), a culturally tailored, community-based, Diabetes Self-Management program delivered in a group format by community health workers (promotoras) working with individual patients and families; or 2) TC delivered by health professionals (licensed nurses). Evaluations will be made at baseline, three months, six months and 12 months. After six weeks of treatment (at the midway point of the intervention), subjects will be assessed for improvement in diabetes self-management behaviors (the primary outcome). In the second phase of the study, those subjects who have improved their diabetes self-management behaviors by 50% over baseline will be continued in their assigned treatment for the duration of three months. Those subjects who do not meet this target will be re-randomized to receive either: 1) an augmented version of TC that has a specific focus on engaging family members; or 2) a multifamily group treatment led by nurses specially trained in teaching diabetes self-management skills for an additional three months. Subjects will be assessed on setting and adhering to self-management goals related to diabetes; self-management behaviors including adhering to the ADA diet, engaging in exercise activities, monitoring glucose levels and taking prescribed hypoglycemic medications; diabetes self-efficacy; and hemoglobin A1c levels. Family members will be assessed during these same time frames to determine their knowledge of diabetes care; levels of collaborative goal setting with their ill relative and the health care provider; and levels of family support. The results will advance the understanding of the factors that affect self-management for Mexican-Americans with Type 2 diabetes, and will provide valuable information towards constructing an adaptive intervention that will help to determine which treatment strategies work to improve diabetes self-management behaviors most efficiently and for whom.

 描述（由适用提供）：此R-01赠款提案是对PA-14-112的回应，“以家庭为中心的慢性病自我管理”。 The project (a) evaluates four culturally adapted, family-based treatments designed to improve health status, self-management behaviors and self-effective among Mexican-Americans with Type 2 diabetes using a Sequential, Multiple Assignment Randomized Trial in a public health setting, and (b) tests hypotheses about the applicability of Ryan and Sawin's Individual and Family Self-Management Theory, the conceptual foundation for the intervention's key constructs, to the study of糖尿病在这个人群中的自我管理。之所以选择这种概念模型，是因为它强调家庭成员作为护理的伴侣的整合，同时促进疾病自我管理对研究人群和拟议的干预措施高度依赖。西班牙语说，墨西哥裔美国人患有2型糖尿病及其家人的患者将从初级保健诊所分支机构招募，该诊所的分支机构与位于洛杉矶墨西哥裔美国地区的大型城市公立医院。在研究的第一阶段中，受试者将被随机分为六个2.5小时（三个月）的：1）Tomando Control de Su糖尿病（TC），这是一种以文化定制的，社区为基础的基于社区的，基于社区的糖尿病自我管理计划，该计划由社区卫生工作者（Propertoras）（Proportoras）与个人患者和家庭一起工作；或2）由卫生专业人员（有执照的护士）提供的TC。评估将在基线，三个月，六个月零12个月时进行。经过六周的治疗（在干预的中间），将评估受试者的糖尿病自我管理行为（主要结果）。在研究的第二阶段中，在三个月的时间内，将继续在分配的治疗中，将继续将其糖尿病自我管理行为提高50％的受试者将继续进行。那些不符合此目标的受试者将被重新融合以接收：1）TC的增强版本，该版本特别关注与家庭成员相关；或2）由经过专门培训的糖尿病自我管理技能的护士领导的多户会小组治疗，培训了三个月。将对受试者进行设定和遵守与糖尿病有关的自我管理目标的评估；自我管理行为，包括遵守ADA饮食，从事运动活动，监测葡萄糖水平和服用处方降血糖药物；糖尿病自我有效；和血红蛋白A1c水平。将在同一时间范围内评估家庭成员，以确定他们对糖尿病护理的了解；与生病的亲戚和医疗保健提供者的协作目标设定水平；和家庭支持水平。结果将进一步了解影响2型糖尿病墨西哥裔美国人自我管理的因素，并将提供有价值的信息来构建适应性干预措施，这将有助于确定哪些治疗策略最有效地改善了糖尿病自我管理行为，最有效地为谁而言。