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解决 1 型糖尿病中糖尿病技术使用不平等问题的方案:多学科利益相关者共同创造研讨会的结果。

Solutions to Address Inequity in Diabetes Technology Use in Type 1 Diabetes: Results from Multidisciplinary Stakeholder Co-creation Workshops.

机构信息

Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA.

NY-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA.

出版信息

Diabetes Technol Ther. 2022 Jun;24(6):381-389. doi: 10.1089/dia.2021.0496.

Abstract

Racial-ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.

摘要

种族和民族在 1 型糖尿病技术使用方面的不平等现象已有充分记录,并导致血糖和长期结果存在差异。然而,解决技术不平等的方法仍然很少,并且缺乏利益相关者的投入。我们采用以用户为中心的设计原则,与多学科利益相关者小组进行了研讨会,这是基于我们之前的研究,重点是患者确定的障碍和提出的解决方案。召集利益相关者审查我们之前的研究结果,并共同制定干预措施,以增加 1 型糖尿病服务不足人群对技术的使用。利益相关者包括最近使用技术的 1 型糖尿病患者;内分泌科和初级保健医生;护士;糖尿病教育者;心理学家;和社区卫生工作者。会议记录下来,并由多个编码员进行迭代分析,以找到共同的主题。我们在美国 11 个州召集了 7 次虚拟 2 小时研讨会,共有 32 名利益相关者参加。患者和提供者确认了之前发表的研究,这些研究强调了患者的障碍,并通过共同创造解决方案提出了新的想法。拟议干预措施的共同主题包括:(1)优先提供更公平的技术提供系统;(2)使用视觉和实践方法,增加技术和教育的可及性;(3)更多地纳入同伴和家庭支持系统;(4)协助保险导航和社会需求。我们的研究通过提供利益相关者认可的干预想法,在患者、提供者和系统层面上提出可行的改变,进一步推动了该领域的发展,以减少 1 型糖尿病中糖尿病技术使用的不平等。多学科利益相关者参与差异研究提供了对目标人群有影响且可接受的独特见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d11/9208861/5b0359a2ddd2/dia.2021.0496_figure1.jpg

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