<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04474496</url>
  </required_header>
  <id_info>
    <org_study_id>261131</org_study_id>
    <nct_id>NCT04474496</nct_id>
  </id_info>
  <brief_title>Impact of COVID-19 on Marshallese Communities in the U.S.</brief_title>
  <official_title>Impact of COVID-19 on Marshallese Communities in the U.S.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Arkansas</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Patient-Centered Outcomes Research Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Arkansas</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Marshallese adults in the U.S. will complete an online or telephone survey. This survey will&#xD;
      collect data describing the impact of COVID-19 on Marshallese communities. Data collected&#xD;
      will help describe: 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers&#xD;
      and facilitators to implementing preventative recommendations, 4) barriers and facilitators&#xD;
      to COVID-19 testing when appropriate, and 5) self-care behaviors during COVID-19. Participant&#xD;
      inclusion criteria: 1) Self-reported Marshallese; 2) 18 years of age or older; 3) Live in the&#xD;
      Continental U.S. or Hawaii.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Background and Rationale&#xD;
&#xD;
      While there is much we do not know about the differential effects of COVID-19, early data&#xD;
      shows that minority communities are disproportionally effected by the virus. There are many&#xD;
      factors that may increase the likelihood of contracting COVID-19 including: 1) community&#xD;
      spread because of lack of access to testing in low-income communities, 2) work environments&#xD;
      that may increase exposure, 3) more densely populated housing that reduces the ability to&#xD;
      social distance, 4) limited understanding of preventive measures due to literacy and language&#xD;
      barriers, 5) constrained financial resources to stay home and not work, and/or 6) lack of&#xD;
      trust in the health care system. The Marshallese are a Pacific Islander population&#xD;
      experiencing significant health disparities with some of the highest documented rates of type&#xD;
      2 diabetes mellitus (T2DM) of any population in the world. Estimated T2DM rates among&#xD;
      Marshallese in the U.S. range from 25%-50%, much higher than the general U.S. population.&#xD;
      People with T2DM are more likely to experience severe symptoms and complications when&#xD;
      infected with COVID-19; however, those that manage their T2DM well are less likely to become&#xD;
      extremely ill from the virus. In order to reduce the disparities caused by COVID-19 and&#xD;
      ultimately compare the effectiveness of prevention interventions among the low-income&#xD;
      minority communities most effected by COVID-19, it is critical to understand minority&#xD;
      populations': 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers and&#xD;
      facilitators to implementing preventative recommendations, 4) barriers and facilitators to&#xD;
      COVID-19 testing when appropriate, and self-care behaviors during COVID-19.&#xD;
&#xD;
      Specific Aims&#xD;
&#xD;
      Aim 1: Document COVID-19 risk exposure for Marshallese community members.&#xD;
&#xD;
      Aim 2: Document Marshallese community members' knowledge of preventive recommendations.&#xD;
&#xD;
      Aim 3: Document barriers and facilitators to implementing preventative recommendations.&#xD;
&#xD;
      Aim 4: Document Marshallese community members' barriers and facilitators to COVID-19 testing&#xD;
      when appropriate.&#xD;
&#xD;
      Aim 5: Document self-care behaviors during COVID-19.&#xD;
&#xD;
      Aim 6: Explore COVID-19 pandemic related barriers and facilitators to T2DM self-management&#xD;
      among Marshallese adults with T2DM.&#xD;
&#xD;
      Aim 7: Assess the effect of the COVID-19 pandemic on T2DM self-management activities among&#xD;
      Marshallese adults with T2DM.&#xD;
&#xD;
      Study Design and Procedures&#xD;
&#xD;
      Participants will complete an online or telephone survey. Up to 100 participants will also be&#xD;
      invited to complete an in-depth qualitative interview in addition to the survey (these&#xD;
      results are not presented here). Community-based recruitment for the online survey will be&#xD;
      conducted by posting an informational flyer on social media. The flyer will contain a link to&#xD;
      the study information sheet and survey documents. Study team members will also reach out to&#xD;
      study participants via phone or electronic mediums (e.g. email, text, or messenger). Study&#xD;
      staff will send potential participants a link to an electronic survey using REDcap. The&#xD;
      REDcap system will include electronic documentation of consent prior to completing the&#xD;
      survey. Access to study data will be limited to only those personnel who need it to complete&#xD;
      relevant job duties. All data, regardless of whether it is identifiable or not, will be&#xD;
      stored in a locked file cabinet in a locked room, or on a secure University of Arkansas for&#xD;
      Medical Sciences (UAMS) server that requires two-factor authentication.Each participant who&#xD;
      completes the survey will receive a $20 Walmart gift card as remuneration.&#xD;
&#xD;
      Measures/outcomes&#xD;
&#xD;
      Our survey will be based on CDC risk assessments and utilize the NIH funded COVID-19 items&#xD;
      that are part of the PhenX Toolkit, as well as other standardized survey items/scales. Those&#xD;
      participants with T2DM will be asked to complete questions pertaining to T2DM self-management&#xD;
      during COVID-19.&#xD;
&#xD;
      Data Analysis&#xD;
&#xD;
      Given the descriptive nature of the study aims, the analytic strategy will focus on&#xD;
      presenting results of item-level descriptive analyses, with an emphasis on frequencies and&#xD;
      proportions. There will be no attempt to impute missing responses for any items. For each&#xD;
      analysis, the number of included responses will be reported.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">July 27, 2020</start_date>
  <completion_date type="Actual">November 30, 2020</completion_date>
  <primary_completion_date type="Actual">November 30, 2020</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Other</observational_model>
    <time_perspective>Cross-Sectional</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked &quot;Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)&quot;</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to &quot;Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)&quot;.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on General Health Status</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked &quot;Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Access to Healthcare Services</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked &quot;In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)&quot;.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Dietary Habits</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked &quot;How do you think your eating habits have changed compared to before the COVID-19 outbreak?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise)</measure>
    <time_frame>Baseline</time_frame>
    <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise)</measure>
    <time_frame>Baseline</time_frame>
    <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Weight</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report changes in weight. Participants were asked &quot;Have you noticed your weight change since the COVID-19 outbreak?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on HbA1c (Glycated Hemoglobin)</measure>
    <time_frame>Baseline</time_frame>
    <description>After reporting their most recent HbA1c reading, participants were then asked &quot;How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Barriers to Type 2 Diabetes Management Due to COVID-19</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked &quot;Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>COVID-19 Screening</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked &quot;Were you screened for COVID-19? (Select all that apply)&quot;.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>COVID-19 Testing</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked &quot;Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>COVID-19 Vaccine Willingness/Hesitancy</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked &quot;If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Trusted Sources of COVID-19 Information</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked &quot;What resource do you trust most for reliable information about COVID-19?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Housing</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked how COVID-19 has impacted their housing situation. Participants were asked &quot;Please check all of the following that have happened to you since the COVID-19 outbreak&quot;.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Employment</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked how COVID-19 has impacted their employment. Participants were asked &quot;In what ways has the COVID-19 outbreak affected your work? (Select all that apply)&quot;.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Effects of COVID-19 on Income</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked how COVID-19 has impacted their income. Participants were asked &quot;As a result of COVID-19, has your family income changed?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sources of Stress During COVID-19</measure>
    <time_frame>Baseline</time_frame>
    <description>Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked &quot;What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)&quot;</description>
  </secondary_outcome>
  <number_of_groups>1</number_of_groups>
  <enrollment type="Actual">120</enrollment>
  <condition>COVID-19</condition>
  <arm_group>
    <arm_group_label>Marshallese adults in the U.S.</arm_group_label>
    <description>Marshallese persons 18 years of age or older currently residing in the United States</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Assessing the impact of COVID-19</intervention_name>
    <description>Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
    <arm_group_label>Marshallese adults in the U.S.</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Self-reported Marshallese persons 18 years of age or older who live in the continental&#xD;
        United States or Hawaii.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Self-reported Marshallese&#xD;
&#xD;
          -  18 years of age or older&#xD;
&#xD;
          -  Live in the Continental U.S. or Hawaii&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
        - Does not meet inclusion criteria&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
  </eligibility>
  <overall_official>
    <last_name>Pearl A McElfish, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Arkansas</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of Arkansas for Medical Sciences Northwest</name>
      <address>
        <city>Fayetteville</city>
        <state>Arkansas</state>
        <zip>72703</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>April 2021</verification_date>
  <study_first_submitted>July 10, 2020</study_first_submitted>
  <study_first_submitted_qc>July 15, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 16, 2020</study_first_posted>
  <results_first_submitted>February 28, 2021</results_first_submitted>
  <results_first_submitted_qc>April 1, 2021</results_first_submitted_qc>
  <results_first_posted type="Actual">April 5, 2021</results_first_posted>
  <last_update_submitted>April 1, 2021</last_update_submitted>
  <last_update_submitted_qc>April 1, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">April 5, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Marshallese</keyword>
  <keyword>Pacific Islanders</keyword>
  <keyword>Type 2 Diabetes</keyword>
  <keyword>COVID-19</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>COVID-19</mesh_term>
  </condition_browse>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>September 15, 2020</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/96/NCT04474496/Prot_SAP_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <recruitment_details>Recruitment was open from July 27, 2020 to November 30, 2020. The study was advertised by posting informational flyers on social media. Flyers contained a link to the study information sheet and survey.</recruitment_details>
      <group_list>
        <group group_id="P1">
          <title>Marshallese Adults in the U.S.</title>
          <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="120"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="120">120 individuals were deemed eligible based on inclusion criteria, completed at least 10 survey items, and were included in the final analytical sample</participants>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <population>120 eligible individuals completed at least 10 survey items and were included in the final analytical sample</population>
      <group_list>
        <group group_id="B1">
          <title>Marshallese Adults in the U.S.</title>
          <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="120"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="35.5" spread="8.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="77"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="43"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>American Indian or Alaska Native</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Asian</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Native Hawaiian or Other Pacific Islander</title>
                  <measurement_list>
                    <measurement group_id="B1" value="120"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Black or African American</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>White</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>More than one race</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Region of Enrollment</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>United States</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="120"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure</title>
        <description>Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked &quot;Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=117 due to missing data on this item for three participants.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure</title>
          <description>Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked &quot;Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)&quot;</description>
          <population>N=117 due to missing data on this item for three participants.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="117"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Hand washing for at least 20 seconds</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="114"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Avoiding touching your eyes, nose, and mouth with unwashed hands</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="112"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Use disinfectants to clean hands when soap and water not available for washing hands</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="114"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Staying home when you are sick or when you have a cold</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="109"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Asked family members or friends not to visit me</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="105"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Covering your mouth when you cough</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="113"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Wearing a face mask</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="115"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Physical distancing (keeping minimum 6 feet between you and others from outside your household)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="113"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Staying at home even if you do not feel sick</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="99"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Disinfecting surfaces</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="117"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="114"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure</title>
        <description>Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to &quot;Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)&quot;.</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure</title>
          <description>Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to &quot;Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)&quot;.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Required employees to work remotely or from home</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Suggested employees work remotely or from home</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="23"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Required employees to wear face masks</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="73"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Suggested employees wear face masks</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Provided employees with face masks</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="58"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Required social distancing at work</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="59"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Installed barriers / shields to reduce contact between employees and others</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="31"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Taken employee temperatures before entering workplace</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="61"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Asked COVID-19 screening questions of employees before entering workplace</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Was tested for COVID-19</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="47"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>None of these</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on General Health Status</title>
        <description>Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked &quot;Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on General Health Status</title>
          <description>Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked &quot;Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Better</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>About the same</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="74"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Worse</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="19"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Access to Healthcare Services</title>
        <description>Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked &quot;In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)&quot;.</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Access to Healthcare Services</title>
          <description>Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked &quot;In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)&quot;.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I did not go to healthcare appointments because of concern about entering my provider's office</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>My healthcare provider canceled appointment</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="14"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>My healthcare provider changed to phone or online visits</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>My healthcare provider told me to self-isolate or quarantine</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="21"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>None of these apply</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="53"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Dietary Habits</title>
        <description>Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked &quot;How do you think your eating habits have changed compared to before the COVID-19 outbreak?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Dietary Habits</title>
          <description>Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked &quot;How do you think your eating habits have changed compared to before the COVID-19 outbreak?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I feel that I am eating more healthy now than before the COVID-19 outbreak</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="25"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I am eating about the same as before the COVID-19 outbreak</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I feel that I am eating less healthy now than before the COVID-19 outbreak</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="30"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I have not noticed</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="18"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise)</title>
        <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise)</title>
          <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>More</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>About the same</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="52"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Less</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="35"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise)</title>
        <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise)</title>
          <description>After reporting how many times per week they engaged &quot;in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)&quot;, participants were then asked &quot;Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>More</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>About the same</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="56"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Less</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="37"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Weight</title>
        <description>Participants were asked to report changes in weight. Participants were asked &quot;Have you noticed your weight change since the COVID-19 outbreak?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Weight</title>
          <description>Participants were asked to report changes in weight. Participants were asked &quot;Have you noticed your weight change since the COVID-19 outbreak?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I have lost weight</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="30"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I think I weigh about the same</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I have gained weight</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I have not noticed</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on HbA1c (Glycated Hemoglobin)</title>
        <description>After reporting their most recent HbA1c reading, participants were then asked &quot;How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>Using survey skip logic, only those participants who selected &quot;yes&quot; to being previously diagnosed with type 2 diabetes were asked this question (n=13).</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on HbA1c (Glycated Hemoglobin)</title>
          <description>After reporting their most recent HbA1c reading, participants were then asked &quot;How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?&quot;</description>
          <population>Using survey skip logic, only those participants who selected &quot;yes&quot; to being previously diagnosed with type 2 diabetes were asked this question (n=13).</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="13"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Higher</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>About the same</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Lower</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Barriers to Type 2 Diabetes Management Due to COVID-19</title>
        <description>Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked &quot;Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>Using survey skip logic, only those participants who selected &quot;yes&quot; to being previously diagnosed with type 2 diabetes were asked this question (n=13).</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Barriers to Type 2 Diabetes Management Due to COVID-19</title>
          <description>Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked &quot;Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)&quot;</description>
          <population>Using survey skip logic, only those participants who selected &quot;yes&quot; to being previously diagnosed with type 2 diabetes were asked this question (n=13).</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="13"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Insulin</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Needles</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Blood glucose meters</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Testing strips</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Other diabetes medication</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>No issues to report</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>COVID-19 Screening</title>
        <description>Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked &quot;Were you screened for COVID-19? (Select all that apply)&quot;.</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>COVID-19 Screening</title>
          <description>Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked &quot;Were you screened for COVID-19? (Select all that apply)&quot;.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Yes, by phone</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, online</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, at a drive-through screening</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, at a healthcare clinic or hospital</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="32"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, at work</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>No</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="28"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>COVID-19 Testing</title>
        <description>Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked &quot;Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)&quot;</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>COVID-19 Testing</title>
          <description>Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked &quot;Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)&quot;</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>No, I never tried to get tested</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>No, I tried to get tested but was not able to</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, and I am waiting for the results</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, and I tested negative</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="54"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, and I tested positive</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="33"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>COVID-19 Vaccine Willingness/Hesitancy</title>
        <description>Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked &quot;If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=113 due to missing data on this item for seven participants.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>COVID-19 Vaccine Willingness/Hesitancy</title>
          <description>Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked &quot;If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?&quot;</description>
          <population>N=113 due to missing data on this item for seven participants.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="113"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Extremely likely</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="39"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Somewhat likely</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="25"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Unlikely</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Very unlikely</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="32"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Trusted Sources of COVID-19 Information</title>
        <description>Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked &quot;What resource do you trust most for reliable information about COVID-19?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=117 due to missing data on this item for three participants.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Trusted Sources of COVID-19 Information</title>
          <description>Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked &quot;What resource do you trust most for reliable information about COVID-19?&quot;</description>
          <population>N=117 due to missing data on this item for three participants.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="117"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>University of Arkansas for Medical Sciences</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Community Clinic</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Another healthcare organization</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Dr. Sheldon Riklon's radio show or Facebook Live videos</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="14"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>News outlets</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>US Dept of Health (CDC, NIH, and other federal health agencies)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Your state Dept of Health</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Marshallese Consulate/RMI Ministry of Health</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Your pastor</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Other</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>None</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Housing</title>
        <description>Participants were asked how COVID-19 has impacted their housing situation. Participants were asked &quot;Please check all of the following that have happened to you since the COVID-19 outbreak&quot;.</description>
        <time_frame>Baseline</time_frame>
        <population>N=118 due to missing data on this item for two participants.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Housing</title>
          <description>Participants were asked how COVID-19 has impacted their housing situation. Participants were asked &quot;Please check all of the following that have happened to you since the COVID-19 outbreak&quot;.</description>
          <population>N=118 due to missing data on this item for two participants.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="118"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I have moved into a friend or family member's household</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>A friend or family member(s) have moved into my household</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I became homeless (e.g., lived in a shelter, outside, or in a car)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>None of these</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="98"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Employment</title>
        <description>Participants were asked how COVID-19 has impacted their employment. Participants were asked &quot;In what ways has the COVID-19 outbreak affected your work? (Select all that apply)&quot;.</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Employment</title>
          <description>Participants were asked how COVID-19 has impacted their employment. Participants were asked &quot;In what ways has the COVID-19 outbreak affected your work? (Select all that apply)&quot;.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I lost my job permanently</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I lost my job temporarily</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I got a new job</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I reduced my work hours</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I increased my work hours</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>My job put me at increased risk of getting COVID-19</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="23"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I laid off employees</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>None of these apply</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Effects of COVID-19 on Income</title>
        <description>Participants were asked how COVID-19 has impacted their income. Participants were asked &quot;As a result of COVID-19, has your family income changed?&quot;</description>
        <time_frame>Baseline</time_frame>
        <population>N=119 due to missing data on this item for one participant.</population>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Effects of COVID-19 on Income</title>
          <description>Participants were asked how COVID-19 has impacted their income. Participants were asked &quot;As a result of COVID-19, has your family income changed?&quot;</description>
          <population>N=119 due to missing data on this item for one participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="119"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Yes, it increased our income</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Yes, it decreased our income</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="66"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>No</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="43"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sources of Stress During COVID-19</title>
        <description>Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked &quot;What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)&quot;</description>
        <time_frame>Baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Marshallese Adults in the U.S.</title>
            <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
          </group>
        </group_list>
        <measure>
          <title>Sources of Stress During COVID-19</title>
          <description>Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked &quot;What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)&quot;</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="120"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Health concerns</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Financial concerns</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="90"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Impact on work</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Impact on your child</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Impact on your community</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="61"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Impact on family members</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Access to food</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="59"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Access to baby supplies (e.g., formula, diapers, wipes)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="24"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Access to personal care products or household supplies</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="43"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Access to medical care, including mental health care</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="32"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Access to medical supplies (e.g., prescriptions, testing supplies, etc.)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Social distancing or being quarantined</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="47"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Other</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I am not stressed about the COVID-19 outbreak</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Don't know/Not sure</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>Day of survey</time_frame>
      <desc>This was a one-time cross-sectional survey, so there was no contact with participants prior to, or after the completion of, the survey.</desc>
      <group_list>
        <group group_id="E1">
          <title>Marshallese Adults in the U.S.</title>
          <description>Marshallese persons 18 years of age or older currently residing in the United States&#xD;
Assessing the impact of COVID-19: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="120"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="120"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="120"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <point_of_contact>
      <name_or_title>Dr. Pearl A. McElfish</name_or_title>
      <organization>University of Arkansas for Medical Sciences</organization>
      <phone>479-713-8680</phone>
      <email>pamcelfish@uams.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04474496
org study id: 261131
nct id: NCT04474496
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Marshallese adults in the U.S. will complete an online or telephone survey. This survey will
      collect data describing the impact of COVID-19 on Marshallese communities. Data collected
      will help describe: 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers
      and facilitators to implementing preventative recommendations, 4) barriers and facilitators
      to COVID-19 testing when appropriate, and 5) self-care behaviors during COVID-19. Participant
      inclusion criteria: 1) Self-reported Marshallese; 2) 18 years of age or older; 3) Live in the
      Continental U.S. or Hawaii.
Background and Rationale

      While there is much we do not know about the differential effects of COVID-19, early data
      shows that minority communities are disproportionally effected by the virus. There are many
      factors that may increase the likelihood of contracting COVID-19 including: 1) community
      spread because of lack of access to testing in low-income communities, 2) work environments
      that may increase exposure, 3) more densely populated housing that reduces the ability to
      social distance, 4) limited understanding of preventive measures due to literacy and language
      barriers, 5) constrained financial resources to stay home and not work, and/or 6) lack of
      trust in the health care system. The Marshallese are a Pacific Islander population
      experiencing significant health disparities with some of the highest documented rates of type
      2 diabetes mellitus (T2DM) of any population in the world. Estimated T2DM rates among
      Marshallese in the U.S. range from 25%-50%, much higher than the general U.S. population.
      People with T2DM are more likely to experience severe symptoms and complications when
      infected with COVID-19; however, those that manage their T2DM well are less likely to become
      extremely ill from the virus. In order to reduce the disparities caused by COVID-19 and
      ultimately compare the effectiveness of prevention interventions among the low-income
      minority communities most effected by COVID-19, it is critical to understand minority
      populations': 1) risk exposure, 2) knowledge of preventive recommendations, 3) barriers and
      facilitators to implementing preventative recommendations, 4) barriers and facilitators to
      COVID-19 testing when appropriate, and self-care behaviors during COVID-19.

      Specific Aims

      Aim 1: Document COVID-19 risk exposure for Marshallese community members.

      Aim 2: Document Marshallese community members' knowledge of preventive recommendations.

      Aim 3: Document barriers and facilitators to implementing preventative recommendations.

      Aim 4: Document Marshallese community members' barriers and facilitators to COVID-19 testing
      when appropriate.

      Aim 5: Document self-care behaviors during COVID-19.

      Aim 6: Explore COVID-19 pandemic related barriers and facilitators to T2DM self-management
      among Marshallese adults with T2DM.

      Aim 7: Assess the effect of the COVID-19 pandemic on T2DM self-management activities among
      Marshallese adults with T2DM.

      Study Design and Procedures

      Participants will complete an online or telephone survey. Up to 100 participants will also be
      invited to complete an in-depth qualitative interview in addition to the survey (these
      results are not presented here). Community-based recruitment for the online survey will be
      conducted by posting an informational flyer on social media. The flyer will contain a link to
      the study information sheet and survey documents. Study team members will also reach out to
      study participants via phone or electronic mediums (e.g. email, text, or messenger). Study
      staff will send potential participants a link to an electronic survey using REDcap. The
      REDcap system will include electronic documentation of consent prior to completing the
      survey. Access to study data will be limited to only those personnel who need it to complete
      relevant job duties. All data, regardless of whether it is identifiable or not, will be
      stored in a locked file cabinet in a locked room, or on a secure University of Arkansas for
      Medical Sciences (UAMS) server that requires two-factor authentication.Each participant who
      completes the survey will receive a $20 Walmart gift card as remuneration.

      Measures/outcomes

      Our survey will be based on CDC risk assessments and utilize the NIH funded COVID-19 items
      that are part of the PhenX Toolkit, as well as other standardized survey items/scales. Those
      participants with T2DM will be asked to complete questions pertaining to T2DM self-management
      during COVID-19.

      Data Analysis

      Given the descriptive nature of the study aims, the analytic strategy will focus on
      presenting results of item-level descriptive analyses, with an emphasis on frequencies and
      proportions. There will be no attempt to impute missing responses for any items. For each
      analysis, the number of included responses will be reported.
observational model: Other
time perspective: Cross-Sectional
measure: Personal Preventative Behaviors to Decrease Risk of COVID-19 Exposure
time frame: Baseline
description: Participants will report behaviors they regularly engage in to lessen their risk of contracting COVID-19 (e.g., social distancing, wearing a mask, etc.). Participants were asked "Which of the following measures have you taken to prevent infection from COVID-19? (Select all that apply)"
measure: Workplace Preventative Actions to Decrease Risk of COVID-19 Exposure
time frame: Baseline
description: Participants will report specific steps taken by their employers to reduce risk of contracting COVID-19 (e.g., requiring remote work, mask mandates, etc.). Participants were asked to "Please check all of the following your workplace has done since the COVID-19 outbreak (Select all that apply)".
measure: Effects of COVID-19 on General Health Status
time frame: Baseline
description: Participants will be asked to rate their general health status compared with before the COVID-19 outbreak. Participants were asked "Compared to the time before the COVID-19 outbreak, is your physical health status better, worse, or about the same?"
measure: Effects of COVID-19 on Access to Healthcare Services
time frame: Baseline
description: Participants will be asked to report ways in which the COVID-19 pandemic has disrupted access to healthcare (e.g., seeking routine care, getting necessary medications, etc.). Participants were asked "In what ways has the COVID-19 outbreak affected your overall healthcare? (Select all that apply)".
measure: Effects of COVID-19 on Dietary Habits
time frame: Baseline
description: Participants will be asked to compare their current dietary behaviors with before the COVID-19 outbreak. Participants were asked "How do you think your eating habits have changed compared to before the COVID-19 outbreak?"
measure: Effects of COVID-19 on Physical Activity Behaviors (Not Specifically for Exercise)
time frame: Baseline
description: After reporting how many times per week they engaged "in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of physical activity that was not specifically for exercise (total minutes of continuous activity, including walking, yard work, construction work, etc.) in a typical week before the COVID-19 outbreak?"
measure: Effects of COVID-19 on Physical Activity Behaviors (Specifically for Exercise)
time frame: Baseline
description: After reporting how many times per week they engaged "in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking, etc.)", participants were then asked "Is this more, less or about the same as the number of days you participated in at least 30 minutes of a specific exercise session (such as swimming, walking specifically for exercise, biking etc.) in a typical week before the COVID-19 outbreak?"
measure: Effects of COVID-19 on Weight
time frame: Baseline
description: Participants were asked to report changes in weight. Participants were asked "Have you noticed your weight change since the COVID-19 outbreak?"
measure: Effects of COVID-19 on HbA1c (Glycated Hemoglobin)
time frame: Baseline
description: After reporting their most recent HbA1c reading, participants were then asked "How different was this HbA1c reading from your average HbA1c reading before the COVID-19 outbreak?"
measure: Barriers to Type 2 Diabetes Management Due to COVID-19
time frame: Baseline
description: Participants with type 2 diabetes were asked to report how the COVID-19 outbreak affected their access to type 2 diabetes supplies (insulin, needles, etc.). Participants were asked "Has the COVID-19 outbreak affected your level of access to the following? (Select all that apply)"
measure: COVID-19 Screening
time frame: Baseline
description: Participants were asked to report whether they have been screened for COVID-19 and by what method (by phone, online, at work, etc.). Participants were asked "Were you screened for COVID-19? (Select all that apply)".
measure: COVID-19 Testing
time frame: Baseline
description: Participants were asked to report whether they have been tested for COVID-19 and the results of the test. Participants were asked "Have you had the nose swab test for the virus that causes COVID-19? (Mark all that apply)"
measure: COVID-19 Vaccine Willingness/Hesitancy
time frame: Baseline
description: Participants were asked to report whether they would accept a COVID-19 vaccine. Participants were asked "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?"
measure: Trusted Sources of COVID-19 Information
time frame: Baseline
description: Participants were asked to report which sources of information they trust the most to stay informed about COVID-19. Participants were asked "What resource do you trust most for reliable information about COVID-19?"
measure: Effects of COVID-19 on Housing
time frame: Baseline
description: Participants were asked how COVID-19 has impacted their housing situation. Participants were asked "Please check all of the following that have happened to you since the COVID-19 outbreak".
measure: Effects of COVID-19 on Employment
time frame: Baseline
description: Participants were asked how COVID-19 has impacted their employment. Participants were asked "In what ways has the COVID-19 outbreak affected your work? (Select all that apply)".
measure: Effects of COVID-19 on Income
time frame: Baseline
description: Participants were asked how COVID-19 has impacted their income. Participants were asked "As a result of COVID-19, has your family income changed?"
measure: Sources of Stress During COVID-19
time frame: Baseline
description: Participants were asked to report their greatest sources of stress from the COVID-19 outbreak (e.g., health concerns, financial concerns, etc.). Participants were asked "What have been your greatest sources of stress from the COVID-19 outbreak? (Select all that apply)"
arm group label: Marshallese adults in the U.S.
description: Marshallese persons 18 years of age or older currently residing in the United States
intervention type: Other
intervention name: Assessing the impact of COVID-19
description: Surveying Marshallese adults in the U.S. to determine the impact of COVID-19
arm group label: Marshallese adults in the U.S.
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
last name: Pearl A McElfish, PhD
role: Principal Investigator
affiliation: University of Arkansas
facility: 
country: United States
responsible party type: Sponsor
mesh term: COVID-19
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
point of contact: 