Social Science Research Institute, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.
Shidler School of Business, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.
J Am Med Inform Assoc. 2021 Feb 15;28(2):261-275. doi: 10.1093/jamia/ocaa223.
Diabetes self-management (DSM) education, social support, and information technology interventions can improve patient engagement and health. A major challenge is animating, integrating, and accessing resources in under-resourced, rural communities. Set in an island community in Hawai'i, this study piloted a program that integrated friend-and-family support, community health services, telehealth-enabled DSM education, and mobile technologies by activating the community's social capital to support the program.
An action research approach informed the design and implementation of a community-based DSM program that included: friends and family support, telehealth classes, personalized consultations, Bluetooth-enabled blood glucose monitors, and text messaging support. Outcomes were evaluated using biometric data, surveys, interviews, and participant observations.
The study spanned 9 months with 7 dyads, each with 1 individual with type 2 diabetes and a friend or family member. Six of the 7 participants with diabetes experienced reduced hemoglobin A1c percentages, with 3 reducing by more than 1%. The seventh participant maintained a hemoglobin A1c level within American Diabetes Association recommended ranges. DSM knowledge and self-care behaviors improved overall. Interviews and participant observations highlighted program strengths and social challenges associated with the interpersonal relationships between the members of the dyads.
A community-centric diabetes program can enhance understanding of diabetes etiology, DSM activities, and communication skills for effective disease management support in under-resourced rural communities. Social capital among community members, leveraged with health information technology, can catalyze and integrate limited health system resources for DSM and social support as a cost-effective strategy to develop community-centric chronic healthcare management initiatives.
糖尿病自我管理（DSM）教育、社会支持和信息技术干预措施可以提高患者的参与度和健康水平。一个主要的挑战是在资源匮乏的农村社区中激发、整合和利用资源。本研究以夏威夷的一个岛屿社区为背景，试点了一个项目，该项目整合了朋友和家人的支持、社区卫生服务、远程医疗支持的 DSM 教育以及移动技术，通过激活社区的社会资本来支持该项目。
行动研究方法为基于社区的 DSM 项目的设计和实施提供了信息，该项目包括：朋友和家人的支持、远程医疗课程、个性化咨询、支持蓝牙的血糖仪以及短信支持。使用生物计量数据、调查、访谈和参与者观察来评估结果。
该研究持续了 9 个月，涉及 7 对 dyad，每对 dyad 中有 1 名 2 型糖尿病患者和 1 名朋友或家庭成员。7 名糖尿病患者中有 6 名的血红蛋白 A1c 百分比降低，其中 3 名降低超过 1%。第 7 名参与者的血红蛋白 A1c 水平保持在美国糖尿病协会建议的范围内。DSM 知识和自我保健行为总体上有所改善。访谈和参与者观察突出了项目的优势以及 dyad 成员之间人际关系所带来的社会挑战。
以社区为中心的糖尿病项目可以增强对糖尿病病因、DSM 活动和沟通技巧的理解，从而为资源匮乏的农村社区提供有效的疾病管理支持。社区成员之间的社会资本，加上健康信息技术，可以为 DSM 和社会支持催化和整合有限的卫生系统资源，作为开发以社区为中心的慢性医疗保健管理计划的一种具有成本效益的策略。
