LeBrón Alana M W, Espitia Nicolaus R, Kieffer Edith C, Sinco Brandy R, Hawkins Jaclynn M, Nicklett Emily J, Palmisano Gloria, Heisler Michele, Spencer Michael S
Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, USA; Department of Chicano/Latino Studies, University of California, Irvine, Irvine, CA, USA.
School of Social Work, University of Michigan, Ann Arbor, MI, USA.
Patient Educ Couns. 2022 Jul;105(7):2166-2173. doi: 10.1016/j.pec.2021.11.025. Epub 2021 Nov 28.
To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes.
The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c.
The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress.
Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os.
Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.
研究针对特定文化背景定制的社区卫生工作者（CHW）干预措施的哪些组成部分能够改善患有糖尿病的拉丁裔和非裔美国参与者的血糖控制及中间结果。
样本包括密歇根州底特律市326名患有2型糖尿病的非裔美国人和拉丁裔成年人。在为期6个月的干预期内，社区卫生工作者提供互动式小组糖尿病自我管理课程和家访，并陪同客户前往诊所就诊。我们使用路径分析来模拟每个干预组成部分影响糖尿病自我效能感、糖尿病相关困扰、糖尿病管理知识和糖化血红蛋白（HbA1c）变化的过程。
基于小组的健康生活方式组成部分与知识水平的提高显著相关。基于小组的自我管理部分与糖尿病相关困扰的减轻显著相关。参加干预课程与自我效能感呈正相关。糖尿病自我管理介导了与糖尿病困扰减轻相关的糖化血红蛋白降低。
路径分析允许同时分析干预中每个潜在的变化途径，以确定社区卫生工作者干预措施的哪些方面促成了非裔美国人和拉丁裔糖尿病患者与糖尿病相关行为及结果的变化。
研究结果强化了互动式小组会议在改善患有糖尿病的拉丁裔和非裔美国成年人糖尿病管理及结果方面的重要性。
