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基于社区的参与性研究整合行为和生物学研究以实现夏威夷原住民的健康公平。

Community-Based Participatory Research Integrates Behavioral and Biological Research to Achieve Health Equity for Native Hawaiians.

作者信息

Townsend Claire K M, Dillard Adrienne, Hosoda Kelsea K, Maskarinec Gregory G, Maunakea Alika K, Yoshimura Sheryl R, Hughes Claire, Palakiko Donna-Marie, Kehauoha Bridget Puni, Kaholokula Joseph Keawe'aimoku

机构信息

Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA.

Kula no na Po'e Hawai'i, P.O. Box 2368, Honolulu, HI 96823, USA.

出版信息

Int J Environ Res Public Health. 2015 Dec 22;13(1):ijerph13010004. doi: 10.3390/ijerph13010004.

Abstract

Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai'i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes. The purpose of this paper is to describe the community-based participatory research (CBPR) approach and research process we employed to integrate behavior and biological sciences with community health priorities. A CBPR approach was used to test a 3-month evidence-based, diabetes self-management intervention (N = 65). To investigate the molecular mechanisms linking inflammation with glucose homeostasis, a subset of participants (n = 16) provided peripheral blood mononuclear cells. Community and academic researchers collaborated on research design, assessment protocols, and participant recruitment, prioritizing participants' convenience and education and strictly limiting the use of the data collected. Preliminary results indicate significant changes in DNA methylation at gene regions associated with inflammation and diabetes signaling pathways and significant improvements in hemoglobin A1c, self-care activities, and diabetes distress and understanding. This study integrates community, behavioral, and epigenomic expertise to better understand the outcomes of a diabetes self-management intervention. Key lessons learned suggest the studies requiring biospecimen collection in indigenous populations require community trust of the researchers, mutual benefits for the community and researchers, and for the researchers to prioritize the community's needs. CBPR may be an important tool in providing communities the voice and protections to participate in studies requiring biospecimens.

摘要

与夏威夷的所有其他群体(如白人、日本人、韩国人)相比,夏威夷原住民承受着不成比例的2型糖尿病及相关并发症负担。这些社区中的不信任是参与旨在更好地了解疾病过程的表观遗传学研究的重大障碍。本文的目的是描述我们采用的基于社区的参与性研究(CBPR)方法和研究过程,以将行为科学和生物科学与社区健康优先事项相结合。采用CBPR方法对一项为期3个月的循证糖尿病自我管理干预措施(N = 65)进行测试。为了研究将炎症与葡萄糖稳态联系起来的分子机制,一部分参与者(n = 16)提供了外周血单核细胞。社区研究人员和学术研究人员在研究设计、评估方案和参与者招募方面进行了合作,将参与者的便利性和教育放在优先位置,并严格限制所收集数据的使用。初步结果表明,与炎症和糖尿病信号通路相关的基因区域的DNA甲基化发生了显著变化,糖化血红蛋白、自我护理活动、糖尿病困扰及认知方面也有显著改善。本研究整合了社区、行为和表观基因组学专业知识,以更好地了解糖尿病自我管理干预的效果。获得的关键经验表明,在原住民群体中开展需要收集生物样本的研究,需要社区对研究人员的信任、社区与研究人员的互利,以及研究人员将社区需求放在优先位置。CBPR可能是一种重要工具,能让社区有机会发声并得到保护,从而参与到需要生物样本的研究中。

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