Implementing an effective Diabetes intervEntion Among Low-income immigrants (IDEAL Study)

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PROJECT SUMMARY This proposed R18 is in response to the RFA-HS-23-002 Dissemination and Implementation of Equity-Focused Evidence-Based Interventions in Healthcare Delivery Systems. Chinese immigrants are the second largest immigrant group in the U.S., who suffer a disproportionately high type 2 diabetes (T2D) burden and have poor diabetes outcomes. Diabetes Self-Management Education and Support (DSMES) programs are evidence- based interventions that provide patients with important counseling and support to navigate diabetes self- management at home. However, numerous social determinants of health (SDOH) barriers limit the dissemination of DSMES programs to Chinese immigrants, including high rates of poverty, limited English proficiency (LEP), and lack of access to care and insurance. Given the high T2D burden and rapid population growth in Chinese immigrants, there is an urgent need for research to disseminate and implement DSMES in this minority population. The overarching goal for our proposed R18 IDEAL study (Implementing an effective Diabetes intervEntion Among Low-income immigrants) is to test the effectiveness and implementation process of an innovative multi-level care model for delivering a culturally tailored diabetes intervention to low-income Chinese immigrants with diabetes. Building upon our strong pilot data and established partnerships with clinical and community partners in Chinese immigrant communities, we propose to conduct a type 1 hybrid study to examine the effectiveness and implementation process of the IDEAL intervention for glycemic control among 270 Chinese immigrants with uncontrolled T2D in NYC. Participants will be randomized with equal allocation to one of the two groups. The IDEAL group will receive 1 culturally and linguistically tailored DSMES brief video/week for 24 weeks delivered via text message links plus bi-weekly support calls from a CHW for 24 weeks. The CHW will assess participants’ SDOH barriers to T2D care and link them to available resources in the community. The wait-list control (hereafter CONTROL) group will continue to receive usual care and at the end of the study, they will receive DSMES videos. The primary outcome is HbA1c at 6 months and secondary outcomes include HbA1c at 12 months and psychosocial factors at 6 and 12 months. This study addresses the urgent need to disseminate and implement evidence-based diabetes interventions in underserved populations to reduce health disparities. Study findings will provide important evidence on potential scalable strategies to foster the dissemination of effective implementation, replication, and sustainability of evidence-based interventions for use in healthcare and community settings. It can also serve as a program model for other high risk LEP immigrant populations such as Hispanic immigrants who also bear a high T2D burden, face similar SDOH barriers to accessing DSMES programs, and frequently use text messages.