Mobile pop-up units for diabetes prevention among Hispanics in rural Indiana

ABSTRACT Type 2 diabetes disproportionately affects rural Hispanic populations in the US. Although the prevalence of diabetes is higher in rural Hispanics than in non-Hispanic Whites, rural Hispanics have limited access to evidence-based diabetes preventive services. Hispanics are less likely to receive diabetes preventive screening, advice and referrals recommended by the US Preventive Service Task Force than any other group. Aside from socioeconomic and language barriers, a main problem is reaching this vulnerable population with culturally appropriate preventive interventions. Mobile health units could help better reach rural Hispanics; they have been found to increase healthcare access for minoritized populations, serve as links between community and clinical settings, and contribute to the initiation of preventive interventions. However, mobile health units face challenges related to the cost of motor vehicles, lack of community participation, and lack of relevance to rural Hispanics. To address these limitations, we propose to use implementation research and community- engagement to co-design and pilot-test a health unit that provides guideline-recommended diabetes preventive services (i.e., screening, counseling, and referrals) for Hispanics living in rural Indiana. The study will be guided by the Exploration, Preparation, Implementation and Sustainment Framework to complete the following specific aims: 1) Prototype a health unit model to deliver diabetes preventive services through a process of co- creation, community feedback, and iterative design, and 2) Determine the reach, feasibility, and implementation of the health units among Hispanics in rural Indiana. A structured participatory process following human centered design methods will be used to engage community stakeholders in the design of the health units and the implementation plan, which will increase the likelihood of success and potential for scale. By bringing evidence-based diabetes preventive services to the places where minoritized communities live, our health unit model has the potential to ameliorate the access disparities rural Hispanics face. This application aligns with NIDDK’s research priorities and strategic mission to address diabetes disparities and will provide data to inform intervention content, sampling and measurement for a subsequent study to test the effectiveness and implementation the health unit model.