Understanding Barriers to Engagement in the Diabetes Prevention Program among Low-Income Latino Patients: Design and Implementation of an Intervention in Community Health Centers

摘要： 我的长期职业目标是成为少数族裔健康差距研究的独立调查员，工作 以改善弱势和边缘化人口的结果。我的短期(五年)职业目标是 获得二次数据分析的量化技能，加强我的因果推理专业知识，并学习 实施务实的社区临床试验，解决影响健康的结构性障碍。在美国 在拉丁美洲人中，2型糖尿病(T2D)的患病率高得令人震惊，大约每2人中就有1人有患糖尿病的风险 在他们的一生中发展T2D。糖尿病预防计划(DPP)的研究表明， 有组织的生活方式改变计划，以实现5%-7%的体重减轻和/或在超重和/或 患有前驱糖尿病的肥胖患者可以预防和/或推迟T2D的发病。加利福尼亚州最近通过了一项法律 (SB 97)要求医疗补助(Medi-Cal)计划涵盖感兴趣和符合条件的Medi-Cal的DPP 糖尿病前期的受益者。然而，拉美裔和低收入患者在DPP方面面临着重大障碍 参与。我们需要新的、可持续的方法来招聘、吸引和留住拉美裔和低收入 民进党的收入人群，包括将参与者与 支持生活方式改变和减肥的低成本资源。我的具体目标如下： 1.在使用加州两个大型卫生系统的数据进行的差异分析中，以确定 SB 97对12个月体重变化、体重下降5%(主要结果)、收缩压血的影响 拉丁裔糖尿病前期患者的压力、T2D发生率(次要结果) 与健康保险交易所涵盖的患有前驱糖尿病的类似SES的拉丁裔患者相比。 2.通过社区合作办法和社区咨询委员会(CAB)，评估障碍和 在提供DPP计划的三家医疗诊所提供招聘、参与和留住服务的促进者 为LEP拉丁裔患者服务，并开发一种干预措施，以增强招募和留住 通过解决结构层面的障碍来改进现有的西班牙语DPP计划。 3.进行社区知情干预的单臂可行性和可接受性试点试验(目标2) 招募、聘用和留住3岁时有资格参加DPP课程的讲西班牙语的患者 南洛杉矶的FQHC。流程结果包括招聘成功、交付 临床环境中的干预，以及衡量研究结果的能力。临床结果包括体重 健康的变化、体力活动和社会决定因素。 这一奖项将使我能够与一个经验丰富的导师团队合作，在 以社区为基础的实用临床试验，让少数群体参与研究的最佳做法，以及 促进健康公平的干预措施。收集的初步数据将支持未来更大规模的R01赠款 社区合作的DPP对讲西班牙语的拉丁裔糖尿病前期患者进行干预的随机试验。

ABSTRACT: My long-term career goal is to be an independent investigator in minority health disparities research, working to improve outcomes for vulnerable and marginalized populations. My short-term (five-year) career goal is to gain quantitative skills in secondary data analysis, strengthen my expertise in causal inference, and learn to implement pragmatic community-based clinical trials that address structural barriers to health. Among US Latinos, the prevalence of type 2 diabetes (T2D) is alarmingly high, with approximately 1 in 2 at risk for developing T2D during their lifetime. The Diabetes Prevention Program (DPP) study demonstrated that a structured lifestyle change program to achieve 5-7% weight loss and/or use of metformin in overweight and obese individuals with prediabetes can prevent and/or delay the onset of T2D. California recently passed a law (SB 97) mandating that Medicaid (Medi-Cal) plans cover the DPP for interested and eligible Medi-Cal beneficiaries with prediabetes. However, Latinos and low-income patients face significant barriers to DPP participation. We need new, sustainable approaches to recruit, engage, and retain Latino and low- income populations in the DPP, including community-partnered approaches linking participants with low-cost resources that support lifestyle change and weight loss. My Specific Aims are as follows: 1. In a difference-in-difference analysis with data from two large California health systems, to determine the effect of SB 97 on 12-month weight change, achieving >5% weight loss (primary outcomes), systolic blood pressure, and T2D incidence (secondary outcomes) among Latino Medi-Cal patients with prediabetes compared with Latino patients of similar SES with prediabetes covered by the health insurance exchange. 2. Through a community-partnered approach and a community advisory board (CAB), to assess barriers and facilitators to recruitment, engagement, and retention at three health clinics that provide DPP programs serving LEP Latino patients, and develop an intervention that enhances recruitment and retention and improves existing Spanish-language DPP programs by addressing structural-level barriers. 3. To conduct a one-arm feasibility and acceptability pilot trial of a community-informed intervention (Aim 2) to recruit, engage, and retain Spanish-speaking patients who are eligible to participate in DPP classes at 3 FQHCs in South Los Angeles. Process outcomes include success with recruitment, ability to deliver the intervention in a clinical setting, and ability to measure study outcomes. Clinical outcomes include weight change, physical activity, and social determinants of health. This award will enable me to work with an experienced team of mentors to gain career development skills in community-based pragmatic clinical trials, best practices to engage minority populations in research, and interventions promoting health equity. The preliminary data collected will support a future R01 grant for a larger randomized trial of the community-partnered DPP intervention for Spanish-speaking Latinos with prediabetes.