Developing and Pilot Testing Community and Family-Based Strategies to improve Type 1 Diabetes Management in African American and Latino School-Aged Children

Butler, Ashley

Abstract

AND ABSTRACT Studies have increasingly showed that African American and Latino children with type 1 diabetes (T1D) have poorer health outcomes than Non-Hispanic white children. Strong shared involvement between parents and children in diabetes management behaviors is essential to optimize glycemic control in youth, and protect against rapid deterioration of glycemic control during adolescence and poor outcomes in young adulthood. African American and Latino families are less likely to engage in shared involvement in diabetes management, but no studies have identified the obstacles faced by minority families. This gap in the literature severely limits the development of interventions that target shared involvement in order to improve glycemic control and prevent glycemic control deterioration during adolescence among minority families. Another major limitation of the literature for preventing this deterioration is that lack of published intervention trials of adapted interventions that improve diabetes outcomes during school-age years (5-9 years) before family health routines are solidified and challenging to modify. Studies in pediatric asthma suggest that community-based interventions delivered by trained parent peers may also be an effective approach for improving health outcomes in school-age children with T1D. The purpose of this project is to create and test a parent peer- delivered, community-based family intervention based on Family Teamwork, an effective clinic-based face to face intervention for pre- and early- adolescent youth with T1D and their parents, focusing on families of school-age youth (ages 5-9 years) who are African American or Latino. The intervention, which we have named Family Teamwork-Peer Delivery (FT-P), has the potential to prevent the rapid deterioration of glycemic control in adolescence by targeting family health routines before they are firmly established. We will integrate adapted Family Teamwork curriculum materials originally developed for adolescents with a successful intervention program delivered by parent peers our team has implemented focused on improving quality parenting among minority families with limited resources and high chronic life stressors. We will apply, for each racial/ethnic group separately, participatory approaches involving community stakeholders to adapt the evidence-based Family Teamwork components and integrate them with the parent peer delivery format. The study will occur in the diverse city of Houston, where approximately 30% of children with T1D diabetes are African American or Latino. We will test the feasibility, stakeholder satisfaction, and preliminary outcomes of the refined, adapted, and integrated FT-P intervention with African American and Latino families, obtain qualitative data on family acceptability and usefulness of the intervention, and further refine the intervention for each racial/ethnic group separately to prepare for a larger randomized controlled trial.

Public Health Relevance

The research will provide new information on the ease and acceptability of a community-based, peer-delivered family intervention that aims to promote parental involvement in diabetes management to improve treatment adherence and optimal glycemic control among African American and Latino school-aged children (5-9 years) with type 1 diabetes (T1). Study findings will be used to inform a full-scale randomized controlled trial to examine the efficacy of the intervention among African American and Latino families.