一项针对夏威夷原住民和太平洋岛民的糖尿病自我管理教育干预的文化适应性实施结果。
Implementation outcomes of a culturally adapted diabetes self-management education intervention for Native Hawaiians and Pacific islanders.
机构信息
Institute for Research and Education to Advance Community Health, College of Nursing, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.
Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.
出版信息
BMC Public Health. 2020 Oct 20;20(1):1579. doi: 10.1186/s12889-020-09690-6.
BACKGROUND
Native Hawaiians and Pacific Islanders (NHPIs) experience a disproportionate burden of type 2 diabetes and related complications. Although diabetes self-management education and support (DSMES) interventions have generally yielded positive results, few NHPIs have been included in these studies, and even fewer studies have been evaluated using a randomized controlled trial design and/or implementation research methods. The purpose of this pilot study was to evaluate implementation outcomes of a culturally adapted diabetes self-management education intervention delivered by peer educators to Native Hawaiians and Pacific Islanders residing in Honolulu, Hawai'i.
METHODS
In three study sites, the peer educators and 48 participants randomized to the intervention were invited to participate in the mixed methods implementation research. We used a convergent parallel design to collect implementation data including fidelity, feasibility, acceptability, appropriateness, adoption, and sustainability. Data were collected from class observations, participants' class feedback, and post-intervention focus groups with participants and peer educators.
RESULTS
In 314 end-of-class feedback surveys, 97% of respondents expressed that they were satisfied or highly satisfied with the class content and activities, 98% reported that the classes and materials were very useful, 94% reported very applicable, and 93% reported materials were culturally appropriate. Respondents identified several aspects of the program as especially enjoyable: interactions with peer educators, meeting in groups, learning about other participants' experiences with diabetes, and the information presented in each class. Major themes that emerged from the end-of-intervention focus groups were the relevance of the educational materials, strategies to manage blood glucose, hands-on activities, cultural aspects of the program, including the stories and analogies used to convey information, and appreciation of the group format and peer educators.
CONCLUSIONS
Results from this research support a culturally tailored, peer educator approach to DSMES among NHPIs. Delivery of the Partners in Care program is feasible in health care and community settings and is a reimbursable DSMES program.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT01093924 prospectively registered 01.20.09.
背景
美属夏威夷人和太平洋岛民（NHPIs）患有 2 型糖尿病及相关并发症的比例过高。尽管糖尿病自我管理教育和支持（DSMES）干预措施通常会产生积极的结果，但很少有 NHPIs 参与这些研究，而且使用随机对照试验设计和/或实施研究方法评估的研究就更少了。本研究的目的是评估由同伴教育者向居住在夏威夷檀香山的美属夏威夷人和太平洋岛民提供的经过文化适应性调整的糖尿病自我管理教育干预措施的实施结果。
方法
在三个研究点，邀请同伴教育者和随机分配到干预组的 48 名参与者参与混合方法实施研究。我们使用收敛平行设计收集实施数据，包括忠实度、可行性、可接受性、适当性、采用和可持续性。数据来自课堂观察、参与者的课堂反馈以及参与者和同伴教育者的课后焦点小组。
结果
在 314 份课后反馈调查中，97%的受访者表示对课程内容和活动非常满意或满意，98%的受访者表示课程和材料非常有用，94%的受访者表示非常适用，93%的受访者表示材料具有文化适宜性。受访者认为该计划的几个方面特别有趣：与同伴教育者的互动、分组学习、了解其他参与者的糖尿病经验以及每节课中呈现的信息。课后焦点小组中出现的主要主题包括教育材料的相关性、管理血糖的策略、实践活动、计划的文化方面，包括用于传达信息的故事和类比，以及对小组形式和同伴教育者的欣赏。
结论
这项研究的结果支持在 NHPIs 中采用文化适应性强、由同伴教育者主导的 DSMES 方法。在医疗保健和社区环境中提供 Partners in Care 计划是可行的，并且是一项可报销的 DSMES 计划。
试验注册
Clinicaltrials.gov 标识符：NCT01093924 于 2009 年 1 月 20 日前瞻性注册。
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