LINK-IT: Leveraging vIdeos and commuNity health worKers to address socIal determinants of health in immigranTs

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PROJECT SUMMARY This proposed R01 is in response to the PAR-21-081 Addressing Health Disparities among Immigrant Populations through Effective Interventions. 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 access 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 make DSMES accessible to this minority population. High text message use among Chinese immigrants suggests a promising mechanism for enhancing access to DSMES. Yet, this mobile health (mhealth) intervention alone is insufficient to address many SDOH barriers reported by LEP Chinese immigrants (e.g., lack of insurance, financial barriers). Community health worker (CHW) has been shown as an effective model to address SDOH barriers in health disparity populations. Guided by the NIMHD Research Framework, we argue that a mHealth intervention that is supplemented with CHW support is a novel model for enhancing access to DSMES in Chinese immigrants. Our pilot work demonstrates the feasibility, acceptability, and potential efficacy of a text message-delivered video-based DSMES intervention. The goal of this R01 is to examine the efficacy of the video-based DSMES (hereafter VIDEO) or the video-based DSMES+CHW (hereafter VIDEO+CHW) intervention compared with the wait-list control group (hereafter CONTROL) to improve glycemic control among Chinese immigrants with uncontrolled T2D in NYC. Participants will be randomized with equal allocation to one of the 3 groups. The VIDEO group will receive 1 DSMES brief video via text messages per week for 24 weeks. The VIDEO+CHW group will receive the same DSMES videos 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 CONTROL group will continue to receive their usual care and at the end of the study, they will receive DSMES videos. The primary outcome is HbA1c at 6 months. This study will provide critical information on whether it is efficacious to use an existing text messaging platform or text message plus CHW support to enhance access to DSMES. If either of the intervention is proven effective, this project can provide important data for future projects to explore how we can implement this scalable intervention in real-world settings. This study may serve as a program model for chronic care in other high-risk immigrants such as LEP Hispanic immigrants who also bear a high T2D burden, face similar barriers to accessing DMSES programs, and frequently use text messages.