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

项目总结/摘要 美国的西班牙裔人受到2型糖尿病（T2 D）风险，患病率和 结果。超过一半的拉丁美洲人将在他们的一生中患上糖尿病，并且死于糖尿病的可能性增加了50%。 与非西班牙裔白人相比。高脂肪饮食，体力活动不足， 超重/肥胖都与2型糖尿病有关。与此相一致的是，西班牙裔更有可能参与 这些危险行为和超重/肥胖。幸运的是，相对适度的体重减轻可以 显著降低患T2 D的风险。具有里程碑意义的糖尿病预防计划（DPP）显然已经 证明了这一点。接受DPP的参与者体重减轻了5- 7%。此外，若干 适应已被证明是成功的种族/民族人口。 然而，仍然存在差距。农村西班牙裔成年人的糖尿病相关健康状况更差 差异，与糖尿病自我管理和支持计划相比， 居住在大都市的人。此外，农村西班牙裔面临着巨大的机会， 资源壁垒。采用面对面的糖尿病预防计划是不够的， 人口然而，拉美裔人拥有智能手机的比例很高，而农村的拉美裔人则使用智能手机。 从移动终端上网的比率高于白人和非洲裔美国人。因此，利用 移动的、基于网络的方法是针对高风险社区的一种值得称赞的手段。 这将是第一个mHealth糖尿病预防计划，将同时为两个人量身定制DPP 优先人群：西班牙裔和生活在农村社区的人。这种基于证据和理论的 干预将为农村拉美裔人提供知识，技能和自我效能，以改善健康 行为，降低糖尿病风险。用户将通过以下方式探索有关健康饮食和体育活动的内容： 一系列视频、易于理解的图表和简单的导航功能。用户还将获得健康 短信到他们的手机，并可以访问一个现场节目教练额外的帮助和动机。 在第一阶段，开发了STEPS原型，该原型是根据与 53个西班牙裔农村成年人的生命周期。第一阶段的结果有力地支持了 干预措施的有效性，远远超过第一阶段建议中确定的基准。 在第二阶段，我们将完成为农村西班牙裔成年人制定的STEPS计划。在 与南得克萨斯州社区行动公司的伙伴关系，我们将审查的有效性， STEPS干预通过增加体力活动和改善整体饮食习惯来减轻体重。 参与者将被随机分配到干预条件或对照条件。二次 测量将评估糖尿病知识、饮食、客观/自我报告的身体活动、自我效能、压力， 社会抚养费

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.