LINK-IT: Leveraging vIdeos and commuNity health worKers to address socIal determinants of health in immigranTs

LINK-IT：利用视频和社区卫生工作者解决移民健康的社会决定因素

• 批准号: 10736695
• 负责人: Lu Hu
• 金额: $ 84.75万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736695
• 关键词: Address; Adherence; Asian; Asian Americans; Behavior; Caring; Certification; Chinese; Communities; Community Health Aides; Control Groups; Counseling; Data; Diabetes Mellitus; Education; Evidence based intervention; Evidence based program; Face; Future; Glucose; Glycosylated hemoglobin A; Goals; Health Services Accessibility; Healthy Eating; Hispanic; Hispanic Populations; Home; Hour; Immigrant; Insurance; Intervention; Knowledge; Limited English Proficiency; Linguistics; Link; Measurement; Minority Groups; Modeling; National Institute on Minority Health and Health Disparities; New York City; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Participant; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Physical activity; Population; Population Growth; Poverty; Prediabetes syndrome; Public Health; Randomized; Reporting; Research; Resources; Self Efficacy; Subgroup; Text Messaging; Time; Uninsured; United States; Visit; Waiting Lists; Work; arm; barrier to care; chronic care model; clinical care; comparison intervention; diabetes control; diabetes educator; diabetes prevention program; diabetes self-management; effective intervention; efficacy evaluation; evidence base; glycemic control; health disparity; health disparity populations; high risk; improved; mHealth; novel; poor health outcome; primary outcome; programs; response; secondary outcome; skills; social determinants; social health determinants; test strip; treatment as usual; video delivery

PROJECT SUMMARY This proposed R01 is in response to the PAR-21-081 Addressing Health Disparities among Immigrant Populations through Effective Interventions. Chinese immigrants are the second largest immigrant group in the U.S., who suffer a disproportionately high type 2 diabetes (T2D) burden and have poor diabetes outcomes. Diabetes Self-Management Education and Support (DSMES) programs are evidence-based interventions that provide patients with important counseling and support to navigate diabetes self-management at home. However, numerous social determinants of health (SDOH) barriers limit the access of DSMES programs to Chinese immigrants, including high rates of poverty, limited English proficiency (LEP), and lack of access to care and insurance. Given the high T2D burden and rapid population growth in Chinese immigrants, there is an urgent need for research to make DSMES accessible to this minority population. High text message use among Chinese immigrants suggests a promising mechanism for enhancing access to DSMES. Yet, this mobile health (mhealth) intervention alone is insufficient to address many SDOH barriers reported by LEP Chinese immigrants (e.g., lack of insurance, financial barriers). Community health worker (CHW) has been shown as an effective model to address SDOH barriers in health disparity populations. Guided by the NIMHD Research Framework, we argue that a mHealth intervention that is supplemented with CHW support is a novel model for enhancing access to DSMES in Chinese immigrants. Our pilot work demonstrates the feasibility, acceptability, and potential efficacy of a text message-delivered video-based DSMES intervention. The goal of this R01 is to examine the efficacy of the video-based DSMES (hereafter VIDEO) or the video-based DSMES+CHW (hereafter VIDEO+CHW) intervention compared with the wait-list control group (hereafter CONTROL) to improve glycemic control among Chinese immigrants with uncontrolled T2D in NYC. Participants will be randomized with equal allocation to one of the 3 groups. The VIDEO group will receive 1 DSMES brief video via text messages per week for 24 weeks. The VIDEO+CHW group will receive the same DSMES videos plus bi-weekly support calls from a CHW for 24 weeks. The CHW will assess participants’ SDOH barriers to T2D care and link them to available resources in the community. The CONTROL group will continue to receive their usual care and at the end of the study, they will receive DSMES videos. The primary outcome is HbA1c at 6 months. This study will provide critical information on whether it is efficacious to use an existing text messaging platform or text message plus CHW support to enhance access to DSMES. If either of the intervention is proven effective, this project can provide important data for future projects to explore how we can implement this scalable intervention in real-world settings. This study may serve as a program model for chronic care in other high-risk immigrants such as LEP Hispanic immigrants who also bear a high T2D burden, face similar barriers to accessing DMSES programs, and frequently use text messages.

项目摘要 该提出的R01是对解决移民健康差异的PAR-21-081的回应 人口通过有效的干预措施。中国移民是第二大移民群体 美国，患有不成比例的2型糖尿病（T2D）燃烧，糖尿病结局较差。 糖尿病自我管理教育和支持（DSMES）计划是基于证据的干预措施 为患者提供重要的咨询和支持，以在家中应对糖尿病自我管理。 但是，众多的健康社会决定者（SDOH）障碍将DSMES计划的访问限制为 中国移民，包括高贫困率，有限的英语能力（LEP），以及无法获得 护理和保险。鉴于中国移民的T2D伯恩（T2D）伯恩（T2D）和人口迅速增长，有一个 迫切需要研究使DSME可容纳这一少数人群。高短信使用 在中国移民中，提出了一种有前途的机制，可以增强获得DSME的访问权限。但是，这个 仅移动健康（MHealth）干预就不足以解决LEP报告的许多SDOH障碍 中国移民（例如，缺乏保险，财务障碍）。社区卫生工作者（CHW）已经 显示为解决健康差异人群中SDOH障碍的有效模型。在NIMHD的指导下 研究框架，我们认为，补充CHW支持的MHealth干预措施是一种新颖 增强中国移民访问DSME的模型。我们的飞行员工作证明了可行性， 基于视频的DSMES干预的文本消息传递的可接受性和潜在有效性。目标 此R01是要检查基于视频的DSME（以下哪个视频）或基于视频的效率 与等待名单对照组相比 控制）在纽约市不受控制的T2D中，中国移民的血糖控制。 参与者将被随机分配给3组之一。视频组将收到1个 DSMES每周通过短信简要介绍24周。视频+CHW组将收到相同的 DSMES视频加上每两周一次的CHW呼叫，持续了24周。 CHW将评估参与者的 SDOH障碍T2D护理并将其链接到社区中的可用资源。对照组将 继续接受他们通常的护理，在研究结束时，他们将收到DSMES视频。主要 结果是6个月时的HBA1C。这项研究将提供有关是否有效使用的关键信息 现有的文本消息平台或短信以及CHW支持，以增强对DSME的访问。如果有 这项干预被证明有效，该项目可以为未来的项目提供重要的数据，以探索我们的方式 可以在现实世界中实施此可扩展干预措施。这项研究可能是 在其他高风险移民（例如LEP西班牙裔移民）的慢性护理 面对访问DMSES程序的类似障碍，并经常使用短信。