REACH-Es: Adapting a digital health tool to improve diabetes medication adherence among Latino adults

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PROJECT SUMMARY Background: Latino adults have a disproportionate burden of type 2 diabetes and diabetes-related complications. Diabetes medication non-adherence is an important modifiable contributor to suboptimal glycemic management among Latino adults, who are nearly twice as likely to report non-adherence to diabetes medications as non-Hispanic White individuals. Besides language barriers, additional commonly reported barriers that contribute to non-adherence in this population include negative perceptions about insulin use and misunderstanding ongoing need for diabetes medications once HbA1c has improved. Mobile health (mHealth) technology can reduce medication adherence barriers and improve adherence behavior, but mHealth tools that address commonly reported barriers to diabetes medication adherence among Latino adults are lacking. Candidate: I am an endocrinologist born and raised in Latin America; my long-term career goal is to develop scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes. Training: I have received outstanding research training in epidemiology but to achieve my long-term career goal I require additional training in: 1) adaptation of evidence-based interventions, 2) mixed methods, and 3) conduct of clinical trials in mHealth. Mentors: My training and research plans will be overseen by Primary Mentor Dr. Deborah Wexler (type 2 diabetes clinical trials/intervention adaptation) and Co-Mentor Dr. Lindsay Mayberry (mixed methodologist/mHealth clinical trials). Drs. Margarita Alegria (behavioral intervention adaptation to a Latino population), Enrique Caballero (cultural tailoring of diabetes interventions to a Latino population), J. Jaime Miranda (mHealth intervention development/testing in Latino populations), and Tanayott Thaweethai (biostatistics) will provide additional focused expertise. Research: I will adapt REACH, a text message-based mHealth platform with content tailored to address self-reported barriers to diabetes medication adherence (developed by Dr. Mayberry), to a Latino population (REACH-Español) with type 2 diabetes through two specific aims. Aim 1: Adapt and develop REACH-Es content on barriers to diabetes medication adherence with engagement of a diverse group of stakeholders (n=8), qualitative input from Latino adults with type 2 diabetes (n=20-30), and beta testing for intervention refinement with stakeholder input. Aim 2: Conduct a pilot RCT (n=70) to assess feasibility, acceptability, and usability of REACH-Es, as well as intervention targets (diabetes medication adherence and barriers to adherence) comparing REACH-Es to control; secondary outcomes are HbA1c and diabetes self- efficacy. The project will generate preliminary data for an R01 hybrid-effectiveness implementation trial of REACH-Es. The completion of these training and scientific aims will facilitate my transition to becoming an independent physician-investigator focused on developing scalable, patient-centered interventions that address gaps in diabetes self-care to improve outcomes among Latino adults with type 2 diabetes.