PI: L. Sadler Minding the Baby: A Home Visiting Program for Young Families
38
,
39
|
Experimental—Phase II pilot study with cluster randomization by prenatal care groups from local community health centers (CHC) |
Attachment & reflective functioning theories; social ecology theory |
1. Test effects of MTB home visiting versus control condition with respect to maternal health & life course outcomes (delaying rapid subsequent childbearing); maternal reflective functioning; child health & attachment outcomes; rates of child abuse/neglect |
Eligibility criteria: women attending group‐based prenatal care at CHC; having first child; English speaking; no drug use (CHC screens all prenatal pts.) or major psychosis or terminal illness; ages 14–26 |
MTB home visiting program based on: (a) evidence‐based home visiting models
40
& (b) emerging neuroscience of early parenting
41
with innovative additions including home‐based mental health treatment & focus on reflective parenting
38
,
42
|
Preliminary pilot study outcomes in MTB families compared with control families: |
Funded by NINR, NICHD, & following foundations: Harris, AE Casey, Donaghue, Pritzker, Seedlings, Schneider, Edlow, & FAR Fund. |
Intervention group—usual prenatal, pediatric, and primary healthcare at CHCs & weekly home visits 3rd trimester of pregnancy through 1st birthday‐weekly visits with NP & SW; biweekly visits during 2nd year. Control group—usual healthcare at CHCs & monthly educational materials, & holiday cards |
Framework for community engagement—CBPR & Ethical Principles and Guidelines for Community‐University Research Partnerships
|
2. Monitor fidelity of intervention |
Control group = 43 mother‐child dyads |
Joint training & supervision of NPs & SWs. Manualized treatment flexible & individualized including supplemental curricula. Program maximizes interdisciplinary team & expertise of NPs & SWs |
‐fewer child abuse referrals; |
|
|
|
|
Intervention group = 64 dyads |
|
‐better compliance with pediatric immunizations & visits; |
|
|
|
|
60% of sample = adolescent mothers |
|
‐less rapid subsequent childbearing; |
|
|
|
|
|
|
‐children with more secure attachment & less disorganized attachment |
|
|
|
|
|
|
Additional data analysis in process |
PI: K. Newlin |
Longitudinal, qualitative focus group interviewing with inquiry group method
43
|
National Black Nurses’ Association Community Collaboration Model
44
|
Explore faith community values, disease threat, benefits & barriers to self‐care health behavior, & community‐based actions about diabetes among Black American faith community stakeholders |
Population: Faith communities with or at‐risk for T2D including diverse Black American ethnicities (Nicaraguan, Haitian, & African American) Eligibility criteria: Church member, leader, or nurse; English‐speaking; aged ≥21 years; with or at‐risk T2D. Sample size: N= 96 in 5 churches |
Based on findings, community diabetes programs were developed & implemented in coordination with church nurses &/or young professionals |
Analysis ongoing |
1. Study Title: Faith Communities & Black Women with Type 2 Diabetes |
|
|
|
|
Unit of analyses: (1) church; (2) individual |
|
Funding period: 2006–2009. Funding: NIH F32
|
|
|
|
|
|
|
2. Study Title: Church‐Based Diabetes Education in Nicaragua |
4‐Stage Study |
CBPR model augmented by work of Springer
45
,
46
|
Stage 4: |
Population: Creole & Miskito Indian adults with or at‐risk T2D |
Stage 1: Public service announcements, church‐based screening, & standard diabetes education provided as service to communities |
Stage 1 & 2 |
Funding period: |
Stage 1: Community dialogues |
|
(1) Test the efficacy of church‐based diabetes prevention & self‐management care & education in adults with or at‐risk for T2D |
Stage 1 Eligibility criteria: Community members, leaders, & health professionals |
Stage 2 &3: Same as stage 1 |
Barriers to care: Limited access to healthy foods, medications, & blood glucose testing supplies. |
|
|
|
|
|
|
Health beliefs about use of medications |
2008–2011 |
Stage 2: Qualitative—focus groups |
|
(2) Examine feasibility of implementation of intensive lifestyle intervention in faith‐based setting |
Sample N= 106 community members from 3 Nicaraguan coastal towns |
Stage 4: |
Facilitators of care: Free access to primary care, committed physicians, nurses, & church leaders. Positive spiritual beliefs supporting daily self‐care. |
Funding: Private donations; NIH T32; NYU College of Nursing‐Sponsored Research Award; NYU Global Health Challenge Grant |
Stage 3: Quantitative—cross‐sectional, survey |
|
|
Stage 2 Eligibility criteria: English‐speaking, aged ≥21 years, local nurse or physician, church leader, or lay community member self‐identified with or at‐risk T2D |
(1) Intervention translates evidence‐based standards of diabetes self‐management education & components of Diabetes Prevention Program for low‐income Nicaraguan communities |
Community goals: |
|
Stage 4: One‐group pretest‐posttest design |
|
|
Sample N= 39 (participants); N= 4 (churches) |
(2) Training church‐based nurses in intervention, data collection, & management & ethical conduct of research |
Church‐based diabetes prevention & education led by nurses & community health workers under direction of physicians
47
,
48
|
|
|
|
|
Stage 3 Eligibility criteria: English‐speaking, aged ≥21 years, self‐identified with or at‐risk T2D |
(3) (a) Manualized intervention delivered by church‐based nurses tailored to individual & contextual factors and (b) Church‐based intervention delivered in one‐to‐one and group formats with weekly coaching visits and case management |
Stage 3: |
|
|
|
|
Sample: N= 112 (participants); N= 4 (churches) |
|
62.5% subjects with T2D: Poor glycemic control, obesity, hypertension 37.5% subjects at‐risk for T2D: Obesity & elevated body mass index (BMI)
47
|
|
|
|
|
Stage 4 Eligibility criteria: English‐speaking, aged ≥21 years, self‐identified with or at‐risk T2D |
|
Stage 4: |
|
|
|
|
Sample size (projected power analysis): N= 40 (participants); N= 1 (church) |
|
Physiological outcomes: A1c, lipid, & blood pressure (BP) levels; psychosocial outcomes: depression & quality of life; process outcomes; |
|
|
|
|
|
|
Analysis in process |
3. Study Title: Translating the Diabetes Prevention Program and Diabetes Self‐Management Education into aBlack American Faith‐Based Setting |
One‐group pretest‐posttest design |
RE‐AIM
49
|
(1) Examine the effect of a diabetes lifestyle intervention on physiological (blood glucose, HbA1c, & lipid levels in addition to BMI & BP), diabetes knowledge, & psychosocial (quality of life, depression, & diabetes risk perception) outcomes in Black women at‐risk or with T2D;
(2) Examine feasibility of implementation of intensive lifestyle intervention in faith‐based setting on participation, attrition, satisfaction, & intervention fidelity |
Population: Black American women with or at‐risk for T2D (church nurses requested study be limited to female adults with or at‐risk for T2D) |
Intervention same as described in stage 4 above but tailored to specific individuals & community contexts |
(1) Physiological outcomes: A1c, lipid, & BP levels; (2) Psychosocial outcomes: depression & quality of life; and (3) Process outcomes |
Funding period: 2010–2012 |
|
|
|
Eligibility criteria: church member; female; English‐speaking; aged ≥21 years; self‐identified as with or at‐risk T2D (e.g., family history, ethnicity, obesity, advancing age) |
|
Analysis in process |
Funding: NIH KL2 |
|
|
|
Sample size projected, based on power analysis: N= 40 (participants); N= 1 (church) |
|
|
PI: T. Garvey |
Mixed methods |
Community empowerment |
Goal: Create a registry of 400 African American families affected with T2D, |
African American families born or raised on the Sea Islands with T2D. |
First 12 months—conducted community assessment, hired & trained staff/ volunteers, obtained formalized agreements with Federal Qualified CHC |
Results from linkage analysis—novel T2D locus in an African‐American population on 14q that appears to reduce age of disease onset; confirmed two loci on chromosome. 7
53
|
Coinvestigator: I. Spruill |
Nonexperiential design |
Community‐based—Participatory Model |
Aims |
Enrolled 672 African American families |
Identified formal & informal leaders & organized CAC, which has met quarterly since inception |
Created registry & DNA bank of 652 African American families affected with T2DM |
Project SuGar Sea Islands of South Carolina
50
|
Genetic linkage analysis |
CBPR |
1) Ascertain sib‐pairs and pedigrees with T2DM, obesity, |
Sea Island families received suboptimal diabetes care
51
,
52
|
Project Sugar mobile health unit provided free diabetes screenings & education to over 7,000 residents of the Low Country |
Implications for personalized medicine, and cultural specific educational interventions. Documented that Gullah families participating in study received suboptimal diabetes care
51
. Genome‐wide Association study (GWAS) not yet completed. |
Funded by NIH/NIDDK, ADA,W.M. Keck Foundation |
GWAS |
“Coordinated research” |
2) Study genes contributing to diabetes and obesity |
|
Quarterly Newsletter to research participants |
|
|
|
Recruitment model used principles from CBPR with input from CAC and was called, CPR, community, plan, rewards (community involvement, flexible protocol plan, and rewards to the community) |
3) Community engagement strategies, provide tangible benefits, organize a Citizen Advisory Committee |
|
|
|
PI: C. Jenkins |
Longitudinal case study of 2 counties’ efforts to decrease disparities
54
|
Expanded Chronic Care Model for interventions
55
|
Improve diabetes and foot care by 3% annually for African Americans with diabetes across 5 health systems |
African Americans with diagnosed diabetes (and significant others) living in 2 counties |
Community‐driven educational activities & creation of healthy learning environments where people live, work, worship, play, & seek healthcare
56
|
County‐wide reduction of diabetes‐related amputations by 44%
57
|
REACH Charleston and Georgetown Diabetes Coalition: Reducing Diabetes‐Related Amputations |
|
CBPR for methods |
Decrease disparities in amputations in African Americans by 3% annually in 2 county areas |
(n≥ 45,000 participants) |
Evidence‐based health systems changes using CQI teams
57
|
Improved diabetes care for African Americans receiving care in 5 health systems
54
|
Funded by CDC |
|
|
|
Healthcare providers in 2 county area (n= 39 physicians, >250 RNs, 5 pharmacists, 6 podiatrists) |
Coalition interventions focused on collaboration, trust, sound business planning for systems, community & policy changes |
|
|
|
|
|
Coalition members including community members and leaders, people with diabetes, and healthcare professionals |
|
|