尼加拉瓜少数民族糖尿病预防与疾病自我管理联合干预：一项试点研究。

Combined Diabetes Prevention and Disease Self-Management Intervention for Nicaraguan Ethnic Minorities: A Pilot Study.

作者信息

Lew Kelley Newlin, Mclean Yolanda, Byers Sylvia, Taylor Helen, Braizat Omar Musa

出版信息

Prog Community Health Partnersh. 2017;11(4):357-366. doi: 10.1353/cpr.2017.0043.

DOI:10.1353/cpr.2017.0043

PMID:29332849

Abstract

BACKGROUND

Informed by formative community-based participatory research (CBPR), we developed a combined model of diabetes prevention and self-management.

OBJECTIVES

To assess the feasibility, acceptability, and preliminary efficacy of our CBPR-inspired model.

METHODS

A mixed methods study was conducted using a pre-experimental design. The setting was a church-based clinic located on Nicaragua's rural Atlantic coast. Miskitos and Creoles with or at risk for diabetes were sampled. Preliminary efficacy was assessed with A1C, weight, and quality of life (QOL) measures at baseline, 3 months, and 6 months. An open-ended survey assessed intervention satisfaction. The 8-week, registered nurse (RN)-led intervention emphasized knowledge acquisition and behavioral strategies for dietary, physical activity, and medication regimen adherence. Paired t tests were computed to assess preliminary efficacy. Content analysis was conducted to assess intervention acceptability.

RESULTS

A total of 42 participants were enrolled. For participants completing follow-up data collection (n = 33), mean A1C improved from 8.8% to 8.3% (t = -2.19; p = .04) from baseline to 3 months. Among participants with a baseline A1C of greater than 7.5% (n = 24), the mean A1C decreased from 9.7% to 9.0% from baseline to 3 months (t = -2.86; p = .01), and to 8.7% at 6 months (t = -3.00; p = .01). Nonsignificant weight changes were observed. Mental health QOL improved, on average from baseline to 3 months (t = 2.20; p = .04) and 6 months (t = 4.7; p < .01) for the sample. An increase in mean physical health QOL was observed from baseline to 3 months (t = 2.91; p < .01). The intervention was found to be acceptable. Study feasibility was good, with successful research capacitation and achievement of sampling goals.

CONCLUSIONS

Findings suggest our novel intervention holds promise for wider application to reduce diabetes burden among Nicaraguan ethnic minorities.

摘要

背景

基于社区参与式研究（CBPR）的形成性研究，我们开发了一种糖尿病预防与自我管理的联合模型。

目的

评估我们受CBPR启发的模型的可行性、可接受性和初步疗效。

方法

采用预实验设计进行混合方法研究。研究地点是位于尼加拉瓜农村大西洋海岸的一家教会诊所。对患有糖尿病或有糖尿病风险的米斯基托人和克里奥尔人进行抽样。在基线、3个月和6个月时，通过糖化血红蛋白（A1C）、体重和生活质量（QOL）测量来评估初步疗效。通过一项开放式调查评估干预满意度。由注册护士（RN）主导的为期8周的干预强调饮食、体育活动和药物治疗方案依从性方面的知识获取和行为策略。计算配对t检验以评估初步疗效。进行内容分析以评估干预的可接受性。

结果

共招募了42名参与者。对于完成随访数据收集的参与者（n = 33），从基线到3个月，平均糖化血红蛋白从8.8%降至8.3%（t = -2.19；p = 0.04）。在基线糖化血红蛋白大于7.5%的参与者中（n = 24），从基线到3个月，平均糖化血红蛋白从9.7%降至9.0%（t = -2.86；p = 0.01），到6个月时降至8.7%（t = -3.00；p = 0.01）。观察到体重变化不显著。样本的心理健康生活质量从基线到3个月（t = 2.20；p = 0.04）和6个月（t = 4.7；p < 0.01）平均有所改善。从基线到3个月观察到身体健康生活质量平均有所提高（t = 2.91；p < 0.01）。该干预被认为是可接受的。研究可行性良好，成功实现了研究能力建设和抽样目标。