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.

项目概要 非裔美国人 (AA) 的糖尿病 (DM) 负担尤为严重，其发病率是非裔美国人的两倍 白人（13% vs 7.5%），以及糖尿病相关并发症和合并症（例如截肢、 糖尿病前期的一个关键风险因素是超重/肥胖，近 70% 的 AA 超重或肥胖。 肥胖率较高，低收入地区的肥胖率较高，这是国家减少肥胖的努力的一个重要组成部分。 糖尿病预防计划 (DPP) 是一项生活方式干预措施，旨在提高肥胖率并预防糖尿病 经过严格的研究证明，通过改变饮食、锻炼和适度减肥 (5-7%) 可以减少或延缓 DM 的发生 基于群体的 DPP 版本已得到广泛传播和大量评估。 尽管取得了这些成功，但基于社区的试验支持其功效，但仍存在显着的健康差异。 在 DPP 出席率和结果方面，AA 的成功率存在很大的提高空间， 与白人相比，DPP 的体重减轻量往往是白人的一半。 我们有希望的试点研究通过健康透镜的社会决定因素 (SD) 来定制 DPP，以实现 DM 前 AA 的最佳 DPP 出勤率和具有临床意义的体重减轻 这包括定制。 与改善健康结果相关并与 主要是低收入且生活在资源匮乏的 AA 社区中的潜在需求。 我们建议对来自安全网医院 (SNH) 的 360 名 DM 前 AA 患者进行一项随机对照试验，以测试 标准 DPP (S-DPP) 与文化定制 DPP (TC-DPP；例如，语言、食物、价值观、 宗教信仰、规范、价值观）以及增强文化定制的 DPP 来解决与获取和支持相关的问题 经济（TCE-DPP；混合团体/在线/文本障碍 DPP；社区卫生工作者支持以改善 获得 DPP 课程、健康食品、锻炼以及其他社区和卫生资源和财务； 12 个月内，我们将： 1) 检查 TC-DPP 和 TCE-DDP 对体重减轻百分比的影响以及 出勤率（主要结果）和次要结果（体力活动、完成医生随访） 使用 SNH AA 在 6 个月和 12 个月时进行回访、hbA1c 和血压，2) 评估潜在介质/ 与 AA SNH 患者在 6 个月和 12 个月时的体重减轻和出勤率相关的调节因素，以确定 可修改的促进因素和障碍，以及 3) 进行过程评估以检查 TCE-DPP 的可接受性， 可行性、保真度，以及给药剂量、暴露、成本和结果之间的关系，以识别和 我们的多维 DPP 干预措施以我们过去的经验为指导。 试点，并基于所有组件，这些组件一起用于帮助推动临床上重要的结果 最初的 DPP 试验——当然需要与主要是低收入的 AA 取得类似的结果。 据我们所知，这是第一项通过 SD 镜头测试多维剪裁以真正影响 DPP 的研究 出勤率和结果，并有可能成为一种可行的、可扩展的模型，以减少 DM 之间的差异 有风险的 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。

• 发表时间: 2022-11
• 影响因子: 12.7
• 作者: Berkley;Thompson, Carole Bowe;Templeton, Turquoise;Burgin, Tacia;Derose, Kathryn P;Williams, Eric;Thompson, Frank;Catley, Delwyn;Simon, Stephen D;Allsworth, Jenifer E
• 通讯作者: Allsworth, Jenifer E