ADAPTING AND ASSESSING THE FEASIBILITY OF A TELEHEALTH DIABETES PREVENTIONPROGRAM FOR HISPANIC ADOLESCENTS

项目摘要 西班牙裔青少年不成比例地承受着2型糖尿病(T2D)和健康的社会决定因素的负担 (SDoH)，这可能成为改变行为和参与疾病预防努力的障碍。 远程医疗是在弱势人群中提供疾病预防计划的一种潜在有效方法 社区，因为它减轻了一些SDoH的负担，如交通、育儿需求和父母工作 日程表。然而，目前还没有针对西班牙裔的基于理论或证据的远程医疗T2D预防计划 青春年华。这个职业发展奖的目标是帮助Erica Soltero博士实现她的长期目标，即成为 在高危儿童中设计和实施T2D预防干预的独立调查者 受SDoH影响的种群。索尔特罗博士的短期目标包括获得使用混合药物的专业知识。 方法、自我决定理论(SDT)和基于技术的干预措施的发展。在……里面 与她的多学科指导团队合作，她制定了一项培训计划，以实现这些目标 通过课程作业、研讨会、科学会议和有指导的研究。本研究的目的是适应 每一小步都很重要(ELSC)，这是一个基于证据、以文化为基础的T2D预防计划，即将交付 通过远程健康，并测试适应远程健康干预的可行性和可接受性。而远程医疗是 更适合远程提供营养教育，需要其他基于技术的工具来远程 促进身体活动(PA)。因此，我们将调整和集成我们之前测试的干预，该干预使用 活动跟踪器(即Fitbit)和文本消息植根于SDT，以促进PA进入远程医疗计划。 为了确保所有基于技术的组件都是可行的，并考虑到SDOH，我们将使用混合的- 方法通过三个迭代阶段接触西班牙裔青少年(14-16岁；N=24)及其 父母(N=24)在适应过程中。一旦ELSC-远程医疗计划被开发出来，一个新的样本 患有肥胖(BMI%≥95)的西班牙裔青少年(14-16岁；N=40)将从社区诊所招募 并随机分为ELSC-远程健康干预组和常规护理对照组。可行性和 将使用先验的可行性标准(例如，招聘、数据收集、忠诚度)和退出来评估可接受性 采访。我们将检查干预对PA和T2D风险结局(空腹)的初步效果 血糖、胰岛素、胰岛素抵抗和糖化血红蛋白)。这项建议是在调查小组先前工作的基础上提出的 在T2D预防方面，使用活动跟踪器和文本消息来开发远程医疗提供的T2D预防 具有接触和吸引拉美裔青年的巨大潜力的计划。这项研究将推动科学的发展。 远程保健作为受SDoH影响的高危青年的疾病预防工具。完成拟议的 培训和研究将为索尔特罗博士提供技能、研究经验、专业发展和 学术产品需要申请R01资金，并过渡到成功的独立科学家。

Project Summary Hispanic adolescents are disproportionately burdened by type 2 diabetes (T2D) and social determinants of health (SDoH), which can serve as barriers to behavior change and participation in disease prevention efforts. Telehealth is a potentially effective approach for delivering disease prevention programs in vulnerable communities as it reduces the burden of some SDoH like transportation, childcare needs, and parent work schedules. However, there are no theory- or evidence-based telehealth T2D prevention programs for Hispanic youth. The goal of this career development award is to assist Dr. Erica Soltero in her long-term goal of becoming an independent investigator designing and implementing T2D prevention interventions among high-risk pediatric populations impacted by SDoH. Dr. Soltero’s short-term goals include gaining expertise in the use of mixed- methods, the Self-Determination Theory (SDT), and development of technology-based interventions. In collaboration with her multidisciplinary mentorship team, she has developed a training plan to reach these goals via coursework, workshops, scientific meetings, and mentored research. The purpose of this study is to adapt Everly Little Step Counts (ELSC), an evidence-based, culturally grounded T2D prevention program, for delivery via telehealth and test the feasibility and acceptability of the adapted telehealth intervention. While telehealth is more suited for remotely delivering nutrition education, other technology-based tools are needed to remotely promote physical activity (PA). Thus, we will adapt and integrate our previously tested intervention that uses activity trackers (i.e. Fitbit) and text-messages grounded in the SDT to promote PA into the telehealth program. To ensure that all technology-based components are feasible and considerate of SDoH, we will use a mixed- methods approach across three iterative phases to engage Hispanic adolescents (14-16 years; N=24) and their parents (N=24) in the adaptation process. Once the ELSC-telehealth program is developed, a new sample of Hispanic adolescents (14-16 years; N=40) with obesity (BMI%≥95th) will be recruited from community clinics and randomized to the 12-week ELSC-telehealth intervention or usual care control group. Feasibility and acceptability will be assessed using a priori feasibility criteria (e.g. recruitment, data collection, fidelity) and exit interviews. We will examine the preliminary efficacy of the intervention on PA and T2D risk outcomes (fasting glucose, insulin, insulin resistance and HbA1c). This proposal builds on the investigative team’s previous work in T2D prevention, activity trackers, and text messaging to develop a telehealth delivered T2D prevention program with great potential for reaching and engaging Hispanic youth. This study will advance the science on telehealth as a disease-prevention tool among high-risk youth impacted by SDoH. Completion of the proposed training and research will provide Dr. Soltero with the skills, research experience, professional development, and scholarly products needed to apply for R01 funding and transition to a successful, independent scientist.