Understanding Barriers to Engagement in the Diabetes Prevention Program among Low-Income Latino Patients: Design and Implementation of an Intervention in Community Health Centers

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ABSTRACT: My long-term career goal is to be an independent investigator in minority health disparities research, working to improve outcomes for vulnerable and marginalized populations. My short-term (five-year) career goal is to gain quantitative skills in secondary data analysis, strengthen my expertise in causal inference, and learn to implement pragmatic community-based clinical trials that address structural barriers to health. Among US Latinos, the prevalence of type 2 diabetes (T2D) is alarmingly high, with approximately 1 in 2 at risk for developing T2D during their lifetime. The Diabetes Prevention Program (DPP) study demonstrated that a structured lifestyle change program to achieve 5-7% weight loss and/or use of metformin in overweight and obese individuals with prediabetes can prevent and/or delay the onset of T2D. California recently passed a law (SB 97) mandating that Medicaid (Medi-Cal) plans cover the DPP for interested and eligible Medi-Cal beneficiaries with prediabetes. However, Latinos and low-income patients face significant barriers to DPP participation. We need new, sustainable approaches to recruit, engage, and retain Latino and low- income populations in the DPP, including community-partnered approaches linking participants with low-cost resources that support lifestyle change and weight loss. My Specific Aims are as follows: 1. In a difference-in-difference analysis with data from two large California health systems, to determine the effect of SB 97 on 12-month weight change, achieving >5% weight loss (primary outcomes), systolic blood pressure, and T2D incidence (secondary outcomes) among Latino Medi-Cal patients with prediabetes compared with Latino patients of similar SES with prediabetes covered by the health insurance exchange. 2. Through a community-partnered approach and a community advisory board (CAB), to assess barriers and facilitators to recruitment, engagement, and retention at three health clinics that provide DPP programs serving LEP Latino patients, and develop an intervention that enhances recruitment and retention and improves existing Spanish-language DPP programs by addressing structural-level barriers. 3. To conduct a one-arm feasibility and acceptability pilot trial of a community-informed intervention (Aim 2) to recruit, engage, and retain Spanish-speaking patients who are eligible to participate in DPP classes at 3 FQHCs in South Los Angeles. Process outcomes include success with recruitment, ability to deliver the intervention in a clinical setting, and ability to measure study outcomes. Clinical outcomes include weight change, physical activity, and social determinants of health. This award will enable me to work with an experienced team of mentors to gain career development skills in community-based pragmatic clinical trials, best practices to engage minority populations in research, and interventions promoting health equity. The preliminary data collected will support a future R01 grant for a larger randomized trial of the community-partnered DPP intervention for Spanish-speaking Latinos with prediabetes.