Developing and Piloting FUERTE: Federally qUalified health centers Engaging Hispanic men at Risk of DiabeTEs

PROJECT SUMMARY/ABSTRACT Diabetes and diabetes-related complications are disproportionately more prevalent among Hispanic men. The Diabetes Prevention Program (DPP) is an intensive lifestyle intervention that effectively reduces the risk of diabetes; however, Hispanic men are relatively underrepresented in the program and less likely to remain engaged in it, which decreases the likelihood of reaching the program’s 5% weight loss goal. Federally Qualified Health Centers (FQHCs) serve many Hispanic adults but have been understudied as settings to test implementation strategies to potentially address these inequities. The proposed K23 career development award will equip Dr. Christopher J. Gonzalez with scholarly training and practical experience as he becomes an independent clinician-investigator conducting implementation trials that reduce racial and ethnic inequities in diabetes. It will enable him to develop, implement, and evaluate FUERTE (Federally qUalified health centers Engaging Hispanic men at Risk for diabeTEs), a multi-component implementation strategy for FQHCs to facilitate referrals of Hispanic men to the DPP and to support their continued engagement in the program. FUERTE is anticipated to include i) information sessions for providers, ii) direct outreach to DPP-eligible Hispanic men, and iii) tailored content, delivered through WhatsApp, meant to increase the DPP’s relevance and acceptability to Hispanic men enrolled in the program, while encouraging additional peer support. First, (Aim 1) qualitative interviews with 30 stakeholders at FQHCs will identify barriers to referring and supporting Hispanic men at FQHCs to the DPP, informing the development of a theory-driven implementation strategy that facilitates DPP referrals and supports engagement of Hispanic men in the DPP. Second, (Aim 2) incorporating stakeholder feedback, focus groups with DPP-eligible Hispanic men at an FQHC will facilitate user-centered content development for the multi-component implementation strategy. Third, (Aim 3) the multi- component implementation strategy will be piloted in a real-world hybrid implementation trial among 40 DPP- referred Hispanic men at an FQHC and assessed for feasibility using the evaluative components of the RE- AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. DPP participation, weight change, and A1C change will be assessed. Through formal didactics and training from a team of experienced mentors and multidisciplinary advisors, Dr. Gonzalez will acquire knowledge and skills in implementation theory, stakeholder-engaged intervention design, cultural adaptation, user-centered design, real-world trials, and implementation evaluation. His environment at Weill Cornell Medical College, including the Cornell Center for Health Equity, and Settlement Health, an FQHC where Dr. Gonzalez practices internal medicine and with whom he has partnered for this research, is ideal to support his training, complete the proposed aims, and achieve his goal of becoming an independent clinician-investigator and apply for an R01 testing the implementation strategy developed and piloted in this award in a future large-scale multi-site trial.