Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marcella Nuñez-Smith

Abstract

Hispanic Americans are at a high risk for diabetes, prompting a need for targeted interventions. Community-engaged research (CEnR) methods are recommended in efforts to address health disparities in minority populations. However, it is unclear to what extent researchers in this area use CEnR framework to guide their work. In this exploratory evaluation, we seek to assess the relevant published literature for the outcomes of diabetes prevention programs among at-risk Hispanic Americans and the presence of CEnR components in these programs. We further explore whether the number of CEnR components is associated with intervention outcomes including weight change, intervention participant engagement, and study retention. We searched MEDLINE, EMBASE, CINAHL, and LILACS for relevant articles from 2002 to 2016 in English language. Two members of the research team screened all articles. Seven studies (5 RCTs, 2 prospective trials) met eligibility criteria. Significant improvements were reported for several measures of body composition including weight, BMI, and waist circumference. Small or insignificant changes were reported for measures of glucose control. Mixed results were found for psychosocial and behavioral outcomes. The CEnR elements most often utilized were implementation in a community setting (100%), and collaborating with community members in partnerships and advisory committees (86%), in cultural intervention tailoring (86%) and in program delivery (71%). Studies were generally limited in several key areas of CEnR including data analysis (14%), dissemination of results (14%), choosing a research focus (14%), and data collection (0%). However, we found no statistical relationship between our CeNR composite variable and weight change (R2=0.0), insufficient data to report on CeNR and study participation, and a moderate negative relationship between CeNR and retention (R2=-0.53). However, further research is needed to confirm these results. This paper demonstrates the variability of both the use and description of CEnR components within the literature. These findings support the need for consensus guidelines on best practices for reporting of CEnR components. Once established, further research can investigate the association between CEnR and research process and outcome measures.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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