Mobile Health App to Reduce Diabetes in Latina Women with Prior Gestational Diabetes

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Abstract Latino communities have been disproportionately impacted by the COVID-19 pandemic, being both at increased risk and experiencing more severe illness when infected. Latinos living in Puerto Rico have also been affected via access to healthy food. Even before the pandemic, access to healthy food had been threatened due to the unprecedented series of natural disasters, including Hurricane Maria in 2017. The onset of COVID-19 has further threatened access to healthy food. Relatedly, social distancing rules, which limit access to beaches, parks and public recreation areas to prevent unhealthy crowding in these spaces, may have a greater negative impact on low-income Puerto Ricans who rely on these spaces for physical activity. While public health recommendations for healthy shopping, healthy eating, and physical exercise during COVID-19 have emerged, these recommendations have not targeted to Latinos nor are they available in Spanish. Puerto Ricans would benefit from targeted healthy shopping and eating guidance due to the widespread food insecurity and poverty that already existed prior to COVID-19, and physical activity guidance due to the COVID-19 related constraints to outdoor physical activity. Digital technology, which is widely used by Puerto Rico residents, is a way to help families engage in healthy behaviors in the face of COVID-19, as it overcomes barriers by providing behavioral tools on healthy food shopping and food preparation, and providing ways to increase physical activity. Tailoring this information to Latinas, who typically manage shopping and food preparation in Latino families, would increase its impact. To our knowledge, no digital health intervention has been specifically targeted to, and co-designed with Latinas to promote healthy food shopping, healthy eating, and physical activity during COVID-19. While such an intervention has potential value for many Latino subgroups, Puerto Ricans represent a high-priority target because of pre-existing vulnerabilities brought about by several natural disasters that preceded COVID-19. The overall goal of this competitive supplement is to develop a culturally- and individually-tailored Spanish/ English digital health intervention to promote healthy food shopping and healthy eating, as well as physical activity, among Puerto Rican Latinas during the COVID-19 pandemic and its aftermath. This competitive revision expands the scope of our current SBIR Phase II parent grant (Hola Bebé), which is building and testing a digital health intervention with tools for healthy eating and physical activity for Latinas with a prior history of Gestational Diabetes Mellitus (GDM), as well as builds on our SBIR Phase I project (LISTA), which developed tools for healthy shopping and eating for Latinas. We are committed to the rapid dissemination of the mobile app during the pandemic and its aftermath, to Latina users of community health centers throughout Puerto Rico, as well as other sites where Latinas access food.