Health Behavior & Health Education Department, University of Michigan, Ann Arbor, MI, USA.
Institute for Social Research, University of Michigan, 330 Packard Street, Room G326, Ann Arbor, MI, 48104, USA.
J Community Health. 2018 Jun;43(3):508-517. doi: 10.1007/s10900-017-0444-2.
Social determinants of health likely play a significant role in the development of type 2 diabetes for women in vulnerable communities. Adult African American women diagnosed with or at-risk for diabetes in Inkster, Michigan (n = 113) and a group of demographically similar women in Flint, Michigan (n = 48) participated in programs aimed at increasing diabetes-related self-management behaviors through peer coaching, health literacy training, and social support. Participants completed surveys to measure changes in health, health behaviors, health literacy, and social support. We found that these diabetes programs with a focus on increasing women's capacity to practice health management behaviors, navigate the health care system, and connect with social support, led to an increase in healthy behaviors and a reported increase in both overall and diabetes-specific health over an 18 month period. Overall health, general diet and specific diet improved significantly (p < 0.05) from baseline to follow-up, when controlled for age, diabetes status and site. Exercise also improved, but the change was not statistically significant. Women who participated in the intervention changed health behaviors, and increased their sense of health literacy and social support. Improvement in women's access to and use of community preventive services, and the provision of outreach support using community health workers (CHWs) and peer mentorship was an integral part of creating these changes. Although this study found that a variety of diabetes prevention and management programs provided opportunities for positive health changes, findings also suggest that it is critical to address the burdens women from vulnerable communities face in order to participate in these programs.
社会决定因素可能在弱势社区女性 2 型糖尿病的发展中起重要作用。在密歇根州英克斯特（n=113）和密歇根州弗林特（n=48）的两组年龄和人口统计学特征相似的被诊断患有糖尿病或有糖尿病风险的成年非裔美国女性中，参与了旨在通过同伴指导、健康素养培训和社会支持来增加糖尿病相关自我管理行为的项目。参与者完成了调查，以衡量健康、健康行为、健康素养和社会支持方面的变化。我们发现，这些专注于提高女性实践健康管理行为、驾驭医疗保健系统和获得社会支持能力的糖尿病项目，导致健康行为增加，并在 18 个月的时间内报告了整体和糖尿病特定健康状况的改善。在控制年龄、糖尿病状况和地点的情况下，总体健康、一般饮食和特定饮食从基线到随访显著改善（p<0.05）。运动也有所改善，但变化没有统计学意义。参加干预的女性改变了健康行为，并提高了她们的健康素养和社会支持感。改善妇女获得和利用社区预防服务的机会，并利用社区卫生工作者（CHW）和同伴指导提供外展支持，是实现这些变化的重要组成部分。尽管这项研究发现，各种糖尿病预防和管理计划为积极的健康变化提供了机会，但研究结果还表明，必须解决弱势社区妇女在参与这些计划时面临的负担，才能实现这些变化。
