Addressing Social Determinants of Health to Improve Diabetes Prevention Program Outcomes Among Underserved African Americans

解决健康的社会决定因素，以改善服务不足的非裔美国人的糖尿病预防计划成果

• 批准号: 10602549
• 负责人: Jannette Yvonne Berkley-Patton
• 金额: $ 66.13万
• 依托单位: UNIVERSITY OF MISSOURI KANSAS CITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10602549
• 关键词: Address; Affect; African American population; Amputation; Behavior; Black church; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Caring; Clinical; Communities; Community Health Aides; Diabetes Mellitus; Diet; Dimensions; Disparity; Dose; Economics; Effectiveness; Evidence based intervention; Exercise; Face; Food; Glycosylated hemoglobin A; Health; Health Food; Health Resources; Health education; Hospitals; Hybrids; Improve Access; Intervention; Language; Literature; Low income; Mediator; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Office Visits; Outcome; Overweight; Participant; Patients; Persons; Physical activity; Physicians; Pilot Projects; Population; Randomized; Randomized, Controlled Trials; Religiosity; Reporting; Resources; Risk; Risk Factors; Social support; Testing; Text; Time; Translations; Visit; Work; arm; community setting; comorbidity; cost; diabetes prevention program; experience; financial incentive; flexibility; follow-up; health disparity; improved; improved outcome; intervention program; lens; lifestyle intervention; novel; prevent; primary outcome; process evaluation; randomized trial; safety net; secondary outcome; social culture; social determinants; social health determinants; sociocultural determinant; socioeconomics; success; theories; translational study; weight loss program

PROJECT SUMMARY African Americans (AAs) are disproportionately burdened by diabetes mellitus (DM) with rates twice as high as Whites (13% vs 7.5%), and increased rates of DM-related complications and comorbidities (e.g. amputations, cardiovascular disease). A key pre-DM risk factor is overweight/obesity. Nearly 70% of AAs are overweight or obese, with higher rates among AAs with low-income. A critical component of national efforts to reduce growing obesity rates and prevent DM is the Diabetes Prevention Program (DPP), a lifestyle intervention proven to reduce or delay DM onset with diet change, exercise, and modest weight loss (5-7%) in a rigorously evaluated national trial. A group-based version of the DPP has been widely disseminated and numerous community-based trials support its efficacy. In spite of these successes, there are significant health disparities in DPP attendance and outcomes and considerable room exists for improving success rates among AAs, a population that tends to experience half the amount of DPP weight loss compared to Whites. We aim to build on our promising pilot studies by tailoring the DPP via a social determinants (SD) of health lens to achieve optimal DPP attendance and clinically meaningful weight loss with pre-DM AAs. This includes tailoring on cultural and socioeconomic SD mechanisms that are associated with improving health outcomes and align with predisposing needs among AAs who are primarily of low-income and live in low-resource AA communities. We propose a randomized controlled trial of 360 pre-DM AA patients from a safety net hospital (SNH) to test a standard DPP (S-DPP) against a culturally tailored DPP (TC-DPP; e.g., tailoring of language, foods, values, religiosity, norms, values) alone and a culturally tailored DPP enhanced to address access and support related economic barriers (TCE-DPP; hybrid group/online/text DPP; community health worker support to improve access to DPP classes, healthy food, exercise, and other community and health resources; and financial incentives) over 12 months. We will: 1) examine effects of TC-DPP and TCE-DDP on percent weight loss and attendance (primary outcomes) and on secondary outcomes (physical activity, completion of physician follow- up visit, hbA1c, and blood pressure) at 6 and 12 months with SNH AAs, 2) evaluate potential mediators/ moderators related to weight loss and attendance among AA SNH patients at 6 and 12 months to determine modifiable facilitators and barriers, and 3) conduct a process evaluation to examine TCE-DPP acceptability, feasibility, and fidelity, and relationships between delivery dose, exposure, costs, and outcomes to identify and improve essential intervention components. Our multidimensional DPP interventions are guided by our past pilots, and based on components that, all together, were used to help drive clinically important outcomes in the original DPP trial – and are certainly needed to achieve similar outcomes with AA primarily of low-income. To our knowledge this is the first study to test multidimensional tailoring via an SD lens to truly impact DPP attendance and outcomes, and has potential to be a feasible, scalable model to reduce DM disparities among at-risk AA.

项目摘要 非洲裔美国人（AAS）被糖尿病（DM）烧毁，比率高两倍 白人（13％vs 7.5％），以及与DM相关并发症和合并症的率提高（例如截肢， 心血管疾病）。 DM前风险因素是超重/肥胖。近70％的AA超重或 肥胖，低收入AA的比率更高。国家努力减少的重要组成部分 肥胖率和预防DM是预防糖尿病计划（DPP），这是一种生活方式干预 被证明可以减少或延迟DM发作，随着饮食的改变，运动和适度的体重减轻（5-7％） 评估国家审判。基于小组的DPP版本已被广泛传播，许多 基于社区的试验支持其有效性。尽管取得了成功，但健康差异很大 在DPP的出勤和成果和相当大的房间中，有可提高AAS成功率的房间 与白人相比，人口往往会经历一半的DPP体重减轻。我们旨在建造 在我们的承诺试点研究中，通过通过健康镜头的社会确定剂（SD）来量身定制DPP来实现 DPP前AAS的最佳DPP出勤率和临床上有意义的体重减轻。这包括裁缝 文化和社会经济SD机制与改善健康结果并与之保持一致 低收入主要居住在低资源的AA社区的AA中的AAS中的需求诱发。 我们提出了来自安全网医院（SNH）的360例DM AA患者的随机对照试验，以测试A 标准DPP（S-DPP）针对文化量身定制的DPP（TC-DPP； 宗教信仰，规范，价值观）单独使用文化量身定制的DPP，以解决与访问相关的访问和支持 经济障碍（TCE-DPP； Hybrid Group/Online/Text DPP；社区卫生工作者支持以改善 获得DPP课程，健康食品，运动以及其他社区和健康资源；和财务 激励措施）超过12个月。我们将：1）检查TC-DPP和TCE-DDP对体重减轻百分比和 出勤率（主要结果）和次要结果（体育活动，身体跟随的完成 - SNH AAS在6和12个月时向上访问，HBA1C和血压），2）评估潜在的介体/ 与体重减轻和AA SNH患者在6和12个月的出勤率有关的主持人以确定 可修改的促进因子和障碍，以及3）进行过程评估以检查TCE-DPP的可接受性， 可行性和忠诚度以及交付剂量，暴露，成本和结果之间的关系，以识别和 改善基本干预组件。我们的多维DPP干预措施受到过去的指导 飞行员，并基于所有这些组件，这些组件共同用于帮助推动临床上重要的结果 原始的DPP试验 - 当然需要使用低收入的AA初级实现类似的结果。到 我们的知识是通过SD镜头测试多维调整以真正影响DPP的第一项研究 出勤率和结果，并且有可能成为可行的，可扩展的模型，以减少DM分布 高危AA。

项目成果

COVID-19 Testing in African American Churches Using a Faith-Health- Academic Partnership.

利用信仰-健康-学术合作伙伴关系在非裔美国教会进行 COVID-19 检测。

• DOI: 10.2105/ajph.2022.306981
• 发表时间: 2022
• 期刊: American journal of public health
• 影响因子: 12.7
• 作者: Berkley-Patton,Jannette;Thompson,CaroleBowe;Templeton,Turquoise;Burgin,Tacia;Derose,KathrynP;Williams,Eric;Thompson,Frank;Catley,Delwyn;Simon,StephenD;Allsworth,JeniferE
• 通讯作者: Allsworth,JeniferE