An Adolescent-mediated intervention to improve diabetes prevention and management in Pacific Islander Families

以青少年为媒介的干预措施，以改善太平洋岛民家庭的糖尿病预防和管理

• 批准号: 10582224
• 负责人: Nicola Hawley
• 金额: $ 2.87万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-14 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582224
• 关键词: Active Learning; Address; Adolescent; Adoption; Adult; American; American Samoa; Behavior; Blood Pressure; Body mass index; Caring; Child; Chronic Disease; Communication; Control Groups; Data Analyses; Diabetes Mellitus; Diabetes prevention; Diagnosis; Educational Curriculum; End stage renal failure; Evaluation; Exposure to; Face; Family; Family member; Foundations; Generations; Glycosylated hemoglobin A; Health; Health behavior change; Home; Household; Individual; Insurance; Intervention; Knowledge; Leadership; Life; Linguistics; Low income; Maintenance; Measures; Mediating; Minority Groups; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pacific Islander; Parents; Participant; Personal Communication; Personal Satisfaction; Phase; Population; Prediabetes syndrome; Prevalence; Prevention; Prevention strategy; Primary Health Care; Program Acceptability; Public Health Schools; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Factors; Role; Samoan; Self Care; Testing; Training; Treatment Efficacy; United States; Work; barrier to care; base; behavior change; beneficiary; cardiovascular risk factor; clinical trial implementation; cost; diabetes control; diabetes management; diabetes prevention program; diabetes self-management; disorder risk; doctoral student; efficacy evaluation; efficacy outcomes; ethnic minority population; experience; family structure; glycemic control; grandparent; group intervention; health care availability; health disparity; health literacy; implementation evaluation; implementation outcomes; improved; innovation; intervention effect; learning strategy; literacy; mathematical ability; novel; novel strategies; pilot test; preventive intervention; program costs; programs; scale up; self-management program; skills; social relationships; therapy design; treatment program; treatment strategy; waist circumference

PROJECT SUMMARY The number of individuals diagnosed with Type 2 Diabetes in the United States (US) has more than doubled since 2000 to over 30 million, with an additional 84.1 million living with prediabetes. One minority group at particular risk is Pacific Islanders (PIs) who face many barriers (structural and cultural) to engaging in prevention or self-care. To address the critical need for diabetes prevention and treatment programs that target PIs, and building on the family-centered culture, our objective is to pilot test and evaluate a randomized controlled trial of an adolescent-mediated intervention designed to improve the glycemic control and self- care practices of a paired, adult family member with diagnosed diabetes. Building on our own prior work we have adapted an efficacious, primary care-based diabetes self-management program for delivery to adolescents. Specifically, we refined intervention content to focus on behaviors that contributed to glycemic control in prior iterations of the program, adapted the content to target adolescents as agents of change by adding communication and leadership skills, and incorporated experiential learning activities. We will examine the efficacy of the intervention with a pilot randomized controlled trial. We will randomize n=160 dyads (an adolescent (without diabetes) and a parent/grandparent diagnosed with diabetes who share a household). Adolescents will receive either the six-month diabetes intervention or a leadership and life skills-focused control curriculum in groups (n=10 participants in each group). Aside from planned research assessments we will have no contact with the adults in the dyad, who will proceed with their usual diabetes care. To test our hypothesis that adolescents receiving the intervention will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe that exposure to the intervention may encourage positive behavior change in the adolescent themselves we will measure similar outcomes in the adolescents. Outcomes will be measured at baseline, at the end of the active intervention phase (six months post-randomization) and at 12-months post-randomization, to examine maintenance of intervention effects in the absence of contact. To determine potential for long-term sustainability and scale up, we will examine program acceptability, feasibility, fidelity, reach, and cost. Successful completion of our aims and proof of efficacy would produce an innovative, scalable program with high potential for replication in other similar, low-resource, family-centered, ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

项目摘要 美国诊断为2型糖尿病的人数（美国）增加了一倍以上 自2000年以来，超过3000万，越来越多的8410万生活糖尿病。一个少数群体 太平洋岛民（PIS）的特殊风险面临许多障碍（结构和文化） 预防或自我保健。解决针对糖尿病预防糖尿病和治疗计划的关键需求 PI，并以家庭为中心的文化建立，我们的目标是试点测试和评估随机的 青少年介导的干预措施的对照试验，旨在改善血糖控制和自我 配对的成年家庭成员患有诊断糖尿病的护理练习。以我们自己的先前工作为基础 已经适应了有效的，基于初级保健的糖尿病自我管理计划，以交付 青少年。具体而言，我们完善了干预内容，以关注导致血糖的行为 在该程序的先前迭代中控制内容，将内容调整为将青少年作为变化的推动者。 增加沟通和领导能力，并结合体验式学习活动。我们将检查 通过试验随机对照试验进行干预的功效。我们将随机化n = 160个二元组（一个 青少年（无糖尿病）和父母/祖父母被诊断为共享家庭的糖尿病）。 青少年将接受六个月的糖尿病干预或以领导和生活技能为中心 控制组中的课程（每组中n = 10名参与者）。除了计划的研究评估，我们 将与二元组中的成年人没有接触，他们将继续进行通常的糖尿病护理。测试我们的 假设接受干预措施的青少年将是糖尿病知识的有效管道，并且将是 支持他们配对的成年人采用自我保健策略，我们的主要疗效结果将是成人 血糖控制和心血管危险因素（BMI，血压，腰围）。其次，从那以后 我们认为，接触干预可能会鼓励青少年的积极行为改变 他们本身将衡量青少年的类似结果。结果将在基线时测量 主动干预阶段（随机后六个月）和随机后12个月的结束， 在没有接触的情况下检查干预效果的维持。确定长期的潜力 可持续性和规模扩大，我们将研究计划的可接受性，可行性，忠诚度，覆盖范围和成本。 成功完成我们的目标和效力证明将与 在其他相似的，以家庭为中心的少数民族群体中，重复的潜力很高 美国是降低慢性疾病风险并消除健康的理想受益者 差异。