Mobile Health App to Reduce Diabetes in Latina Women with Prior Gestational Diabe

描述(由申请人提供)：西班牙裔女性患2型糖尿病(T2 DM)的终身风险最高。对于妊娠合并妊娠期糖尿病(GDM)的妇女来说，存在预防T2 DM的机会之窗。既往患有妊娠期糖尿病的妇女患T2 DM的风险增加。西班牙裔女性患妊娠期糖尿病的风险更高，那些患有GDM的女性患T2 DM的相对风险比患有GDM的非西班牙裔白人女性更高。NIH资助的糖尿病预防计划(DPP)记录了改变生活方式对预防T2 DM的有效性。将民进党的研究转化为以社区为基础的环境一直是具有挑战性的。移动技术的最新发展为将从实验环境中获得的知识应用于社区护理提供了有希望的解决方案。拟议的SBIR建立在该团队基于CDC资助的互联网、GDM修改的DPP的基础上，将是第一个开发和测试互动的、文化上和个人定制的、简单语言的西班牙语/英语移动健康干预(m-Interaction)，以降低最近患有GDM的西班牙裔妇女患T2 DM的风险。移动干预利用了手机在西班牙裔育龄妇女中的广泛应用，并提供了克服身体障碍(全天候无障碍)、知识障碍(简单西班牙语/英语的教育/技能发展)、基础设施障碍(不使用手机)、经济障碍(负担得起)和文化障碍(文化上可接受)的机会。在患有妊娠期糖尿病的西班牙裔妇女中，使用移动电话预防T2 DM解决了RFA的目标……“现有技术已根据特定健康差距人群的需求进行了重新设计。”拟议的系统在技术上是创新的，使用参与者为自己和其他人生成的短信。西班牙语/英语移动应用程序的功能：针对行为变化的文化/个人定制教育/激励文本；a)参与者生成的基于算法的个性化定制文本；b)基于参与者先前定义的时间表自动生成的文本；c)基于参与者关于当前活动的实时输入的即时文本；以及体重跟踪。我们的长期目标是在这一高危人群中预防T2 DM。形成性评估测试文本的文化可接受性和应用程序的可用性。一项试点随机试验探索了APP在改变健康饮食自我效能(主要结果)、体重减轻(次要结果)、糖化血红蛋白(HbA1c)、T2 DM的感知风险和修正感知风险(探索性)方面的有效性。第一阶段结果将提供数据，以确定制定/提交m干预措施第二阶段随机对照试验的样本量，以促进健康的生活方式，从而在最近患有妊娠期糖尿病的西班牙裔妇女中实现减肥。M-干预为缩小健康差距和改善最近患有妊娠期糖尿病的西班牙裔妇女的健康结果提供了一种可扩展和具有成本效益的方法的潜力，这是一个高风险但服务不足的群体。鉴于医疗保健服务的变化，拟议中的应用具有广泛的商业潜力。

DESCRIPTION (provided by applicant): Hispanic women have the highest lifetime risk for type 2 diabetes (T2DM). A window of opportunity for preventing T2DM exists for women with pregnancies complicated by gestational diabetes mellitus (GDM). Women with prior GDM face increased risk of T2DM. Hispanic women are at increased risk of GDM, and those with GDM have higher relative risks for developing T2DM than non-Hispanic white women with GDM. The NIH-funded Diabetes Prevention Program (DPP) documented the effectiveness of lifestyle modification to prevent T2DM. Translating DPP research into community-based settings has been challenging. Recent development of mobile technologies offers promising solutions to taking knowledge obtained from experimental settings into community-based care. The proposed SBIR, building on the team's CDC-funded internet-based, GDM-modified DPP, would be the first to develop and test an interactive, culturally and individually-tailored, plain languae Spanish/English mobile health intervention (m-intervention) to reduce risk of T2DM for Hispanic women with recent GDM. The m-intervention leverages the widespread adoption of mobile phones in Hispanic women of reproductive age, and affords the opportunity to overcome physical barriers (accessible 24/7), knowledge barriers (education/skills development in plain Spanish/English), infrastructure barriers (not present using mobile phones), economic barriers (affordable), and cultural barriers (culturally acceptable). Using mobile phones to prevent T2DM in Hispanic women with prior GDM addresses the RFA's goal for..."existing technologies that have been redesigned based on the needs of a specific health disparity population." The proposed system is technologically innovative using participant-generated text messages for themselves as well as others. The Spanish/English mobile app features: culturally/individually tailored educational/motivational texts for behavioral change; algorithm-derived, individually tailored texts that are a) participant generated; b) automated, based on prior participant-defined schedule, and c) just in-time, based on real time participant input about current activities; and weight tracking. Our long-term goal is the prevention of T2DM in this at-risk population. Formative evaluations test the cultural acceptability of the texts and the usability of the app. A pilot randomized trial explores effectiveness of the app in changes in self-efficacy for healthy eating (primary outcome), weight loss (secondary outcome), and HBA1C, perceived risk for T2DM, and modified perceived risk (exploratory). Phase I results will provide data to determine sample size for the development/submission of a Phase II RCT of the m-intervention to promote healthy lifestyle to achieve weight loss among Hispanic women with recent GDM. The m-intervention offers potential of a scalable and cost-effective approach to decreasing health disparities and to improving health outcomes in Hispanic women with recent GDM, a high-risk, yet underserved group. The proposed application has broad commercialization potential given changes in health care delivery.