Diabetes Prevention for Hispanics Residing in Rural Communities: A Mobile Web-based Approach

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PROJECT SUMMARY/ABSTRACT Hispanics in the U.S. are disproportionately affected by Type 2 diabetes (T2D) risk, prevalence, and outcomes. More than half of Latinos will develop diabetes in their lifetime and are 50% more likely to die from it compared to non-Hispanic whites. Consumption of a high fat diet, insufficient physical activity, and being overweight/obese have all been linked to T2D. Consistent with this, Hispanics are more likely to engage in these risk behaviors and be overweight/obese. Fortunately, a relatively modest reduction in body weight can significantly reduce the risk of developing T2D. The landmark Diabetes Prevention Program (DPP) has clearly demonstrated this. Participants who received the DPP reduced their weight by 5-7%. Additionally, several adaptations have been shown to be successful in racial/ethnic populations. However, there remains a gap. Rural Hispanic adults experience even worse diabetes-related health disparities and are less likely to have access to diabetes self-management and support programs compared to their counterparts living in metropolitan counties. Furthermore, rural Hispanic face formidable access and resource barriers. Employing an in-person diabetes prevention program is not sufficient for this at-risk population. However, Latinos have high rates of ownership of smartphones and rural Hispanics utilize the internet from a mobile device at higher rates than both Caucasians and African Americans. Thus, utilizing a mobile, web-based approach is a laudable means of targeting a high-risk community. This will be the first mHealth diabetes prevention program that will simultaneously tailor the DPP for two priority populations: Hispanics and those living in rural communities. This evidence-based and theory driven intervention will provide rural Hispanics with the knowledge, skills, and self-efficacy to improve health behaviors and reduce diabetes risk. Users will explore content on healthy eating and physical activity through an array of videos, easy to understand diagrams, and simple navigation features. Users will also receive health text messages to their phones and can access to a live program coach for additional assistance and motivation. In Phase I, a prototype STEPS was developed, which was informed by formative research conducted with 53 rural Hispanic adults across the lifespan. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II we will complete development of the STEPS program for rural Hispanic adults. In partnership with Community Action Corporation of South Texas, we will examine the effectiveness of the STEPS intervention to reduce body weight by increasing physical activity and improving overall eating habits. Participants will be randomly assigned to either the intervention condition or to a control condition. Secondary measures will assess diabetes knowledge, diet, objective/self-report physical activity, self-efficacy, stress, and social support.