Lai Charlene W, Craven Meghan, Hershey Jennifer A, Lipman Terri H, Hawkes Colin P
Division of Pediatric Endocrinology, Oregon Health and Sciences University, 700 SW Campus Drive, Portland, OR 97239, USA.
Division of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, 6701 Fannin Street Suite 1020, Houston, TX 77030, USA.
Pediatr Diabetes. 2024 Jan 23;2024:8810609. doi: 10.1155/2024/8810609. eCollection 2024.
There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, high-risk populations. The purpose of this qualitative study was to describe the prevalence and the impact of adverse social determinants of health (SDOH) on diabetes care soon after a diagnosis of pediatric T1D, and investigate the potential supportive role of a CHW. . Caregivers of youth <17-year old, with new onset T1D, and government insurance at the time of diagnosis were enrolled. Baseline demographic and SDOH questionnaires were administered at the time of enrollment. Semistructured interviews were performed at 3 months after diagnosis to explore the effect of SDOH on diabetes care and the impact of a CHW.
Seventeen caregivers were enrolled, 10 were randomly assigned to a CHW. Two-thirds of caregivers identified at least one SDOH need at enrollment; 35% of caregivers identified two SDOH needs. Interviews revealed that the two major themes identified as barriers to diabetes care were caregivers' employment and financial issues. Social support was identified as a facilitator. The transition from hospital to home after the diagnosis of T1D was improved for families working with a CHW, and the CHW was identified as a strong source of support.
There is a high prevalence of adverse SDOH in families from lower socioeconomic status at the time of diagnosis of pediatric T1D. These SDOH have a significant impact on families' abilities to care for their children. Preliminary data suggest that CHWs can be a facilitator to the diabetes care. This trial is registered with NCT04238949.
1型糖尿病（T1D）患儿在血糖控制方面存在显著的社会经济和种族差异。社区卫生工作者（CHW）已被证明能改善边缘化的高危人群的治疗效果。这项定性研究的目的是描述儿科T1D诊断后不久，不良健康社会决定因素（SDOH）对糖尿病护理的普遍性和影响，并调查CHW的潜在支持作用。纳入了年龄<17岁、新诊断为T1D且诊断时拥有政府保险的青少年的照顾者。在入组时发放了基线人口统计学和SDOH问卷。在诊断后3个月进行半结构化访谈，以探讨SDOH对糖尿病护理的影响以及CHW的作用。
共纳入17名照顾者，其中10名被随机分配到CHW组。三分之二的照顾者在入组时确定至少有一项SDOH需求；35%的照顾者确定有两项SDOH需求。访谈显示，被确定为糖尿病护理障碍的两个主要主题是照顾者的就业和财务问题。社会支持被确定为一个促进因素。对于与CHW合作的家庭，T1D诊断后从医院到家的过渡得到了改善，并且CHW被认为是一个强大的支持来源。
在儿科T1D诊断时，社会经济地位较低的家庭中不良SDOH的患病率很高。这些SDOH对家庭照顾孩子的能力有重大影响。初步数据表明，CHW可以促进糖尿病护理。该试验已在ClinicalTrials.gov注册，注册号为NCT04238949。
