Although Chinese American immigrants demonstrate significant health disparities, services tailored to their cultural concerns are few, perhaps because of a 'model minority' stereotype that mischaracterizes Asian Americans as free from health and social problems. The proposed project aims to improve diabetes management in immigrant Chinese patients by partnering with the community to develop an efficacious diabetes behavioral intervention that incorporates cultural concerns.

The epidemic of type 2 diabetes mellitus (T2DM) in the U.S. is particularly acute in ethnic minority groups. Disproportionately high rates of diabetes, 1.6 to 3 times those observed in European Americans, are found in Chinese Americans, the largest group of Asian Americans and one of the most rapidly growing immigrant groups. Chinese Americans have cultural concerns about family obligation and well- being that are challenged by health prescriptions that assume a Western individualistic orientation. Few culturally appropriate interventions for immigrant Chinese with T2DM are available and none address the family context of disease management. The proposed project is a part of a research program to improve management of T2DM through a community-academic partnership. Specific aims are to:

1. Strengthen a community-academic partnership with the immigrant Chinese community in San Francisco to improve diabetes management;

2. Adapt and test a behavioral diabetes intervention, Coping Skills Training, to address family and cultural issues in immigrant Chinese patients with T2DM; and

3. Disseminate findings about the adapted Coping Skills Training intervention via the community-academic partnership to the immigrant Chinese American community through service programs, ethnic media, and professional scientific publications.

A mixed-methods community based participatory research approach (CBPR) will be used to adapt and test a behavioral intervention, Coping Skills Training, to be culturally appropriate. A repeated measures design will be used to test the efficacy of the adapted intervention protocol. In a previous collaboration, two historically significant social service and health agencies serving immigrant Chinese in San Francisco have partnered with this nurse-led interdisciplinary research team to describe Chinese family processes of care of T2DM. This project will enable the same partners to co-develop an intervention that strengthens patient skills for coping with personal and family dilemmas in their disease management. Formative research processes are proposed, including strengthening interagency linkages, partnering with patient and community advisors to adapt the intervention, and testing the intervention using culturally respectful approaches. Thirty patients will be recruited to adapt the intervention, and 150 to test the efficacy of the adapted intervention. This application addresses the NINR program areas of health disparities and self management in illness through an intervention designed to} enhance health seeking and health maintenance behaviors (by incorporating) cultural norms and values of communities and their members.} Significance: Although Chinese American immigrants demonstrate significant health disparities, services tailored to their cultural concerns are few, perhaps because of a `model minority' stereotype that mischaracterizes Asian Americans as free from health and social problems. The proposed project aims to improve diabetes management in immigrant Chinese patients by partnering with the community to develop an efficacious diabetes behavioral intervention that incorporates cultural concerns.