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：拉丁裔是最大且增长最快的少数群体（占美国人口的 16%），为美国种族/族裔群体之间现有的健康差异提供了有力的例子。特别是，墨西哥裔美国人（美国最大的拉丁裔亚群）的超重和肥胖患病率 (80%) 明显高于非西班牙裔白人（NHW，68%），并且他们受到肥胖相关风险因素（例如肥胖）的影响尤为严重。 、代谢综合征、糖尿病前期）和疾病（例如糖尿病）。在有效的体重管理生活方式干预措施转化为实践之前，肥胖及其合并症将继续带来巨大且不成比例的负担。需要针对特定​​人群的干预措施，因为无差异的干预措施（通常在白人为主的人群中制定）可能效率低下，甚至无意中增加了健康差距。糖尿病预防计划 (DPP) 试验表明，强化生活方式干预可将高危成年人的 2 型糖尿病发病率降低 58%，并且体重减轻是主要预测因素。已经进行了大量 DPP 转化研究，包括我们团队最近完成的一项实用随机试验（“E-LITE”），有 241 名参与者（78% NHW）参与，该试验显示成功地将团体咨询与健康信息技术 (HIT) 相结合，以实施 DPP初级保健干预。迄今为止，民进党的翻译研究很少针对拉丁裔。设计：我们建议在文化上适应 E-LITE 的 IT 增强型群体 DPP 干预措施，并在超重或肥胖且患有代谢综合征、糖尿病前期或两者兼而有之的讲西班牙语或双语墨西哥裔美国人中进行测试。来自加利福尼亚州圣克鲁斯 6 个初级保健机构的参与者 (n=186)（35% 为拉丁裔居民；91% 为墨西哥裔）将被随机分配接受文化适应干预 (CAI) 或常规护理。主要目的是确定 CAI（RE-AIM 模型中的“E”）的有效性。我们假设，与常规护理相比，CAI 将导致 24 个月时体重指数（主要结果）的平均下降幅度更大。次要结果将包括成本效益、临床（例如空腹血糖）、社会心理（例如生活质量）、行为改变（例如饮食、体力活动）措施。次要人工智能是使用混合方法对其他 RE-AIM 属性进行过程评估：达到（例如，目标人群的参与率）、采用（例如，参与诊所并提供特征）、实施（例如，干预保真度）、维护（例如实践环境中的可持续性）。影响：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、HIT 以及预防和护理管理领域；它还针对优先人群。这些研究结果对于临床医生、患者和其他决策者来说非常有价值，他们正在考虑为数百万承担着不成比例肥胖和糖尿病负担的 MA 制定有效的肥胖和糖尿病预防计划，并且具有很高的现实应用潜力以及对 MA 少数族裔健康和影响的潜力。旨在消除健康差距的政策。