Supporting AI/AN Mothers and Daughters in Reducing Gestational Diabetes Risk

支持 AI/AN 母亲和女儿降低妊娠糖尿病风险

基本信息

批准号：
9244685
负责人：
DENISE Cecile CHARRON-PROCHOWNIK
金额：
$ 67.92万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-08 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9244685
关键词：
Abstinence Address Adolescence Adolescent Adopted Adoption Affect Age Alaska Native American American Indians Awareness Behavior Belief Body mass index Caregivers Caring Centers for Disease Control and Prevention (U.S.)Cherokee Indian Child Clinical Cognitive Communication Communities Community Health Services Community Healthcare Complications of Diabetes Mellitus Congenital Abnormality Continuing Education Counseling Daughter Development Diabetes Mellitus Disadvantaged Effectiveness of Interventions Elderly Elements Epidemic Evaluation Exposure to Family Planning Family member Feasibility Studies Feedback Female Female Adolescents Fetus Focus Groups Food Future Future Generations Generations Gestational Diabetes Health Health Personnel Health Professional Health Promotion Health behavior Healthcare Incidence Individual Instruction Intention Intervention Interview Knowledge Life Life Style Maternal Health Services Metabolic Metabolic syndrome Methods Monitor Morbidity - disease rate Mothers Names Native Americans Navajo Non-Insulin-Dependent Diabetes Mellitus Nurses Oklahoma Outcome Patients Perinatal mortality demographics Phase Physical activity Population Prediabetes syndrome Pregnancy Prevention Prevention program Preventive Intervention Primary Prevention Puberty Randomized Controlled Trials Recommendation Reproductive Health Research Research Personnel Resources Risk Risk Factors Ritual compulsion Self Management Services Sexual Health Site Social support Sustainable Development Teenagers Testing Training Training and Education Tribes United States United States Indian Health Service Woman Youth adolescent patient base behavioral outcome child bearing community based participatory research cost delay sexual debut design diabetes education diabetes risk disorder prevention efficacy testing experience follow-up girls health care disparity health disparity health knowledge healthy lifestyle high risk improved innovation interest maternal diabetes member mortality native youth next generation novel offspring patient population perinatal complications prevent programs psychosocial public health relevance response satisfaction sexual debut skills social teenage mother theories treatment effect tribal health tribal leader unintended pregnancy uptake vigilance young woman

Abstinence Address Adolescence Adolescent Adopted Adoption Affect Age Alaska Native American American Indians Awareness Behavior Belief Body mass index Caregivers Caring Centers for Disease Control and Prevention (U.S.)Cherokee Indian Child Clinical Cognitive Communication Communities Community Health Services Community Healthcare Complications of Diabetes Mellitus Congenital Abnormality Continuing Education Counseling Daughter Development Diabetes Mellitus Disadvantaged Effectiveness of Interventions Elderly Elements Epidemic Evaluation Exposure to Family Planning Family member Feasibility Studies Feedback Female Female Adolescents Fetus Focus Groups Food Future Future Generations Generations Gestational Diabetes Health Health Personnel Health Professional Health Promotion Health behavior Healthcare Incidence Individual Instruction Intention Intervention Interview Knowledge Life Life Style Maternal Health Services Metabolic Metabolic syndrome Methods Monitor Morbidity - disease rate Mothers Names Native Americans Navajo Non-Insulin-Dependent Diabetes Mellitus Nurses Oklahoma Outcome Patients Perinatal mortality demographics Phase Physical activity Population Prediabetes syndrome Pregnancy Prevention Prevention program Preventive Intervention Primary Prevention Puberty Randomized Controlled Trials Recommendation Reproductive Health Research Research Personnel Resources Risk Risk Factors Ritual compulsion Self Management Services Sexual Health Site Social support Sustainable Development Teenagers Testing Training Training and Education Tribes United States United States Indian Health Service Woman Youth adolescent patient base behavioral outcome child bearing community based participatory research cost delay sexual debut design diabetes education diabetes risk disorder prevention efficacy testing experience follow-up girls health care disparity health disparity health knowledge healthy lifestyle high risk improved innovation interest maternal diabetes member mortality native youth next generation novel offspring patient population perinatal complications prevent programs psychosocial public health relevance response satisfaction sexual debut skills social teenage mother theories treatment effect tribal health tribal leader unintended pregnancy uptake vigilance young woman

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项目摘要

DESCRIPTION (provided by applicant): Gestational diabetes mellitus (GDM) has escalated to epidemic proportion and can cause maternal and child complications. GDM is a significant maternal risk factor for subsequent development of type 2 diabetes (T2D) and places the fetus at increased risk for congenital morbidity/mortality and for future onset of diabetes. American Indian and Alaska Native (AI/AN) women are twice as likely to develop GDM and T2D; mostly due to healthcare disparities (e.g., limited access to resources, lack of culturally relevant programs). The need for an inexpensive accessible GDM intervention in this population is compelling. The intervention should be delivered during adolescence and prior to sexual debut. Preconception counseling (PC) prevents unplanned pregnancies and significantly reduces risks of complications. If GDM in a previous pregnancy is an indicator of high risk in subsequent pregnancies, then preventing GDM in a first pregnancy is imperative. For a significant and innovative shift in paradigm, we propose a primary prevention PC intervention for AI/adolescent females at risk for GDM to enhance healthy lifestyle behaviors and family planning vigilance prior to this first pregnancy. We will target girls starting at the age of 12 to coincide with boththe Coming-of-Age rituals for AI/AN girls during which many receive womanly advice from elder female family members, and the American Diabetes Association recommendation that PC in all females should start at puberty. This new directive will require support from the teens mothers (or their female caregiver) and well-informed community health care professionals (HCP). Our objective is to adapt our current PC intervention (validated for teens with diabetes) using a sequential mixed-method design with a multi-tribal AI/AN community-based participatory research (CBPR) approach (e.g., Navajo, Cherokee, 40 Oklahoma tribes; 8 project members are AI/AN) by first using focus groups of teens, mothers, HCP, and Tribal leaders; and then testing this culturally appropriate PC theory-based intervention named STOP-GDM in AI/AN adolescent females 12 to <20yrs at risk for GDM (e.g., pre-diabetes or BMI> 85%). Teens and their mothers will receive STOP-GDM to raise their awareness of the risks of GDM and benefits of healthy lifestyle to reduce these risks. By also providing mothers with PC knowledge and skills they can naturally weave cultural/social influences into their communications with their daughters. The multi-level intervention will be directed at the individual, familial and institutioal levels simultaneously. AI/AN community-researcher partnerships have been established. A randomized controlled trial with a 15mos follow-up will test the effects of receiving online STOP-GDM on mother-daughter (M-D) cognitive/psychosocial and behavioral outcomes, and daughter family planning vigilance. The final online STOP- GDM program will be provided at no cost to the Indian Health Service (IHS) for dissemination to all their sites. HCPs at each clinical facilit will be given free access to a continuing education program for PC training. This proposal provides a unique opportunity for a broad dissemination to significantly impact all IHS AI/AN female teens at risk for GDM, and help to prevent them and their future children from developing T2D.

描述（由适用提供）：妊娠糖尿病（GDM）已升级为流行比例，可能导致母亲和儿童并发症。 GDM是随后发展2型糖尿病（T2D）的重要母体危险因素，并使胎儿的先天性发病率/死亡率和未来糖尿病发作的风险增加。美国印第安人和阿拉斯加人（AI/AN）妇女发展GDM和T2D的可能性是两倍。主要是由于医疗保健分布（例如，获得资源的访问权限，缺乏文化相关计划）。在该人群中需要廉价的GDM干预措施是令人信服的。干预措施应在青少年期间和性行为之前进行。先入为主（PC）防止计划外怀孕，并显着降低并发症的风险。如果先前怀孕中的GDM是随后序列妊娠的高风险的指标，则必须在第一次怀孕中防止GDM。为了实现范式的重大转变，我们提出了针对GDM风险的AI/青少年女性的主要预防PC干预措施，以增强健康的生活方式行为和在第一次怀孕之前的健康生活方式行为和计划生育的警惕。我们将从12岁开始的女孩瞄准女孩，以与AI/AN女孩的成年仪式重合，在此期间，许多人都会收到老年女性家庭成员的女性建议，而美国糖尿病协会建议所有女性的PC都应在青春期开始。该新指令将需要青少年母亲（或其女性护理人员）和知名社区保健专业人员（HCP）的支持。我们的目标是使用顺序混合使用方法设计与多部队AI/A基于社区的参与研究（CBPR）方法（例如Navajo，Cherokee，Cherokee，40个俄克拉荷马州部落；首先使用Teenens，Mothers，Mothers，Mothers，Mothers，Hcps and Mothers，Mothers，H.然后在AI/A/A/A A A A A/A A A A A A A AI/A A A A A A A/A A A A A A A A A/A A A A A A A A A/A <20岁的<20岁的基于PC理论的干预措施（例如，糖尿病前期或BMI> 85％）中进行测试。青少年和他们的母亲将获得定格GDM，以提高人们对GDM风险的认识和健康生活方式的好处，以降低这些风险。通过为母亲提供PC知识和技能，他们可以自然地将文化/社会影响力编织到与女儿的交流中。多层干预将仅针对个人，家庭和研究所级别。 AI/社区研究者的伙伴关系已建立。进行15 MOS随访的随机对照试验将测试接收在线op-gdm对母女（M-D）认知/社会心理和行为成果的影响，以及女儿的计划生育警惕。最终的在线停止计划将免费提供给印度卫生服务（IHS）以将其传播到所有站点。每个临床机构的HCP将免费访问继续进行PC培训的继续教育计划。该提案为广泛的传播提供了一个独特的机会，可以显着影响所有有GDM风险的IHS AI/A AI少年，并有助于防止他们及其未来的孩子发展T2D。