Mobile Health App to Reduce Diabetes in Latina Women with Prior Gestational Diabetes

移动健康应用程序可减少患有妊娠期糖尿病的拉丁女性的糖尿病

• 批准号: 9806892
• 负责人: Dharma E CORTES
• 金额: $ 48.24万
• 依托单位: ENVIRONMENT AND HEALTH GROUP, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-22 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9806892
• 关键词: Achievement; Address; Age; Body Weight decreased; Centers for Disease Control and Prevention (U.S.); Communities; Counseling; Country; Data Analytics; Databases; Development; Diabetes Mellitus; Diagnosis; Effectiveness; Ensure; Equilibrium; Exercise; Feedback; Female; First Pregnancy Trimester; Funding; Future; Gestational Diabetes; Glucose Intolerance; Glycosylated hemoglobin A; Health; Healthy Eating; Hispanics; Home environment; Intervention; Latina; Latino; Life Style; Life Style Modification; Minority Groups; Mobile Health Application; Modeling; Motivation; Music; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Obesity Epidemic; Online Systems; Participant; Patients; Phase; Physical activity; Population; Postpartum Period; Pregnancy; Preventive; Preventive Intervention; Preventive care; Program Acceptability; Provider; Recipe; Recommendation; Recording of previous events; Reporting; Resources; Risk; Risk Factors; Self Efficacy; Small Business Innovation Research Grant; Suggestion; System; Technology; Testing; Text Messaging; Time; Translating; United States; Weight; Woman; Women' s Health; base; child bearing; cost; ethnic disparity; ethnic minority population; evidence base; girls; health disparity; health management; healthy lifestyle; healthy weight; improved; intervention program; medically underserved population; mobile application; modifiable risk; population health; primary outcome; programs; response; secondary outcome; success; trend

Abstract Despite Latinos being the largest ethnic minority, with almost 56.5 million latinos living in the US, they are one of the most medically underserved groups. Latina women have one of the highest rates of gestational diabetes mellitus (GDM) in the U.S. Moreover, GDM is a major risk factor for type 2 diabetes (T2DM), with up to 60% of women developing T2DM within 10 years of a GDM pregnancy. Given the growing obesity epidemic, rates of GDM and T2DM are likely to increase in the absence of preventive interventions. Addressing the risk of T2DM after GDM is critical to reducing health disparities faced by Latina women. The postpartum period is widely-recognized as representing a “window of opportunity” to improve the future health of women who have had complicated pregnancies, including GDM. However, delivery of preventive interventions is challenging due to systems-related factors, including lack of time and resources for providers to provide lifestyle modification counseling, as well as patient challenges, including multiple demands of the postpartum period leaving little time for women to engage in preventive activities. Technology can help overcome these barriers, as demonstrated by the success of our web-based CDC-funded Balance after Baby (BAB) intervention, which successfully promoted weight loss in women with recent GDM. Qualitative results from BAB, which revealed that women strongly wanted the program delivered via an app, led us, in partnership with Latina women with recent GDM, to develop a Phase I m-health intervention program for Latina women, called ¡Hola Bebé, Adiós Diabetes!, in which we tested the preliminary effectiveness of a mobile app in reducing risk factors for the development of T2DM in Latina women who had GDM in the prior 5 years. The proposed Phase II application builds on the promising Phase I results which showed acceptability of the program, increased self-efficacy for healthy lifestyle and weight loss in Latina women with recent GDM. Phase II Specific Aims are as follows: Aim 1: Enhance Hola Bebé to include: a) an IOS version b) integrated databases and data analytics to enable population health management and reporting c) expanded content based on Phase I participant recommendations. Aim 2: Evaluate the effectiveness of Hola Bebé in RCT with Latina women with recent GDM. We hypothesize that participants receiving Hola Bebé will show: increased self-efficacy for healthy eating and physical activity (Primary Outcomes), greater weight loss (Secondary Outcomes), and a greater decrease in HbA1C levels (Exploratory hypothesis) compared to controls. Successful achievement of study aims will result in a culturally tailored, user-centered, low-cost, high- reach, and easy to use evidence-based m-health intervention to reduce risk factors for T2DM in Latina women with a recent history of GDM. The intervention can help reduce the stark ethnic disparities in T2DM among the Latino population while providing a model for an m-health solution that addresses the many systems-based, time, and cost barriers to preventive care typically seen in community-based settings.

抽象的 尽管拉丁裔是最大的少数族裔，有近 5650 万拉丁裔生活在美国，但他们 拉丁裔女性是医疗服务最匮乏的群体之一，也是妊娠率最高的群体之一。 美国糖尿病 (GDM) 此外，GDM 是 2 型糖尿病 (T2DM) 的主要危险因素，高达 鉴于肥胖流行病的日益严重，60% 的女性在妊娠期糖尿病 (GDM) 后 10 年内患上 T2DM。 如果不采取预防性干预措施，GDM 和 T2DM 的发病率可能会增加。 GDM 之后 T2DM 的发生对于减少拉丁裔女性面临的健康差异至关重要。 产后时期被广泛认为是改善生育能力的“机会之窗”。 经历过复杂妊娠（包括 GDM）的妇女未来的健康状况。 由于系统相关因素，包括缺乏时间和资源，预防性干预措施具有挑战性 提供者提供生活方式改变咨询以及患者挑战，包括多种要求 产后妇女几乎没有时间参与预防活动，技术可以提供帮助。 克服这些障碍，正如我们基于网络的 CDC 资助的婴儿出生后平衡计划的成功所证明的那样 （BAB）干预，成功促进了最近 GDM 女性的减肥。 BAB 透露，女性强烈希望通过应用程序提供该计划，并带领我们合作 与近期患有 GDM 的拉丁裔女性合作，为拉丁裔女性制定第一阶段移动健康干预计划， ¡ 称为Hola Bebé，再见糖尿病！，我们在其中测试了移动应用程序的初步有效性 减少过去 5 年内患有 GDM 的拉丁裔女性发展为 T2DM 的危险因素。 拟议的第二阶段申请建立在有希望的第一阶段结果的基础上，该结果表明了 计划，提高了近期 GDM 阶段的拉丁裔女性健康生活方式和减肥的自我效能。 II 具体目标如下： 目标 1：增强 Hola Bebé，包括：a) IOS 版本 b) 集成 数据库和数据分析，以实现人口健康管理和报告 c) 扩展内容 根据第一阶段参与者的建议，目标 2：评估 Hola Bebé 在 RCT 中的有效性。 最近患有 GDM 的拉丁裔女性接受 Hola Bebé 的参与者会表现出：增加。 健康饮食和身体活动的自我效能（主要结果），更大程度的减肥（次要结果） 与对照组相比，HbA1C 水平下降幅度更大（探索性假设）。 成功实现学习目标将导致基于文化、以用户为中心、低成本、高 覆盖范围广且易于使用的基于证据的移动健康干预措施可减少拉丁裔女性 T2DM 的危险因素 近期有 GDM 病史的人，干预措施可以帮助减少 T2DM 中明显的种族差异。 拉丁裔人口同时提供移动医疗解决方案模型，解决许多基于系统的问题， 预防性护理的时间和成本障碍通常出现在社区环境中。