Monday, March 20, 2023 3/20/2023

Addressing Marshallese Immigrant Barriers to Diabetes Self-Management through Family DSMES

Award Number: R01MD013852
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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ABSTRACT Marshallese are a subpopulation of Pacific Islanders that are experiencing significant health disparities, with some of the highest documented rates of type 2 diabetes mellitus (T2DM) in the world.1-6 Estimates of T2DM in the Marshallese range from 20% to 50%, compared to 8.3% for the US population.1-6 Pilot data (n = 401) documented that Marshallese immigrants in Arkansas have extremely high rates of T2DM (38.4%), and pre- diabetes (32.6%), and only 10% engage in self-management behaviors. The Marshallese immigrant population has increased rapidly in United States (US). Marshallese immigrants experience unique barriers to self- management of T2DM, as well as unique cultural assets that can be leveraged to help mitigate these barriers. The research team worked with the Marshallese community to develop a culturally-adapted family model of DSMES (Family-DSMES). The intervention uses an asset-based approach predicated upon Marshallese’s collectivist culture and leverages the influence of family to help Marshallese immigrants engage in self- management behaviors. The initial implementation and evaluation of Family-DSMES was taught to one family at a time in patients’ homes. While the Family-DSMES was successful at improving patient outcomes, there are challenges and expenses for delivery in a home setting to one family at a time that make the intervention unsustainable. The proposed study will test the intervention in faith-based organizations (FBOs) (as opposed to patients’ homes) with groups of families (as opposed to one family at a time). With these significant changes, we hypothesize that the Family-DSME will be effective and sustainable. Our specific aims are: 1) Test the effectiveness of Family-DSMES to improve diabetes-related outcomes among Marshallese patients; 2) Evaluate the effect of Family-DSMES on family members; and 3) Conduct a cost-effectiveness analysis to understand intervention costs in relationship to outcomes. We will conduct a fully-powered cluster RCT that includes 288 Marshallese patients with T2DM and 288 of their family members. A wait-list control arm that includes patients and family members will serve as an untreated comparison group during the study. The RCT will be conducted at 24 Marshallese FBOs, and it will be taught by Marshallese community health workers. Data will be collected from patients and their family members in both arms of the study at baseline, immediately post-intervention, six months, and 12 months post-intervention. We will also obtain a medical records release to abstract participants’ biometric outcomes at 18 and 24 months post-intervention. In addition to our primary analyses, we will examine the potential mediation effect perceived social (family) support has on patients’ outcomes. We will also evaluate potential heterogeneity of treatment effects according to sex, nativity, and level of acculturation. While the Marshallese are a small population, this immigrant community is underrepresented in research, and they are experiencing a health crisis that must be addressed. Testing group delivery in FBOs is imperative to expanding the reach and long-term sustainability of the Family-DSMES.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $871,421 )
2023	2023	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	004	5	2/19/2023	NON-COMPETING CONTINUATION	$871,421
2023	2022	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	002	4	1/5/2023	SUPPLEMENT FOR EXPANSION	$0
2023	2022	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	003	4	1/5/2023	SUPPLEMENT FOR EXPANSION	$0
2023	2021	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	001	3	12/2/2022	SUPPLEMENT FOR EXPANSION	$0
2023	2021	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	000	3	11/30/2022	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2022 ( Subtotal = $1,630,855 )
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	010	4	8/4/2022	SUPPLEMENT FOR EXPANSION	$0
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	003	4	2/14/2022	NON-COMPETING CONTINUATION	$668,677
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	006	4	2/28/2022	SUPPLEMENT FOR EXPANSION	$570,000
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	011	4	8/8/2022	SUPPLEMENT FOR EXPANSION	$0
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	008	4	4/27/2022	NON-COMPETING CONTINUATION	$74,299
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	005	4	2/24/2022	SUPPLEMENT FOR EXPANSION	$317,879
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	009	3	8/4/2022	SUPPLEMENT FOR EXPANSION	$0
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	004	3	2/24/2022	SUPPLEMENT FOR EXPANSION	$0
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	002	3	12/28/2021	SUPPLEMENT FOR EXPANSION	$0
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	007	3	3/3/2022	SUPPLEMENT FOR EXPANSION	$0
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	001	3	12/28/2021	SUPPLEMENT FOR EXPANSION	$0
2022	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	000	2	12/28/2021	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2021 ( Subtotal = $2,860,041 )
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	000	2	11/12/2020	SUPPLEMENT FOR EXPANSION	$715,920
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	005	3	3/12/2021	NON-COMPETING CONTINUATION	-$48,563
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	004	3	2/12/2021	SUPPLEMENT FOR EXPANSION	$942,418
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	003	3	2/2/2021	NON-COMPETING CONTINUATION	$680,266
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	002	2	1/20/2021	SUPPLEMENT FOR EXPANSION	$0
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	006	3	6/11/2021	SUPPLEMENT FOR EXPANSION	$0
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	007	2	7/21/2021	SUPPLEMENT FOR EXPANSION	$0
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	008	3	8/14/2021	SUPPLEMENT FOR EXPANSION	$570,000
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Trans-NIH Research Support	001	2	1/13/2021	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2020 ( Subtotal = $1,132,520 )
2020	2020	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	000	2	2/6/2020	NON-COMPETING CONTINUATION	$755,020
2020	2020	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	001	2	6/29/2020	SUPPLEMENT FOR EXPANSION	$377,500


Issue Date FY: 2019 ( Subtotal = $754,414 )
2019	2019	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Minority Health and Health Disparities Research	000	1	7/29/2019	NEW	$754,414


Grand Total All Awards = $7,249,251

Sum of Action Amount is $7,249,251;

Grand Total = $7,249,251

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Addressing Marshallese Immigrant Barriers to Diabetes Self-Management through Family DSMES

Award Number: R01MD013852

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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