Testing an Adapted Diabetes Self-Management Education and Support (DSMES) Digital Health Intervention among Mexican Origin Hispanics to Increase Access and Participation

ABSTRACT Diabetes is among the top ten leading causes of death among adults 18 years of age and older. Hispanics are disproportionately represented, having greater than 50% chance of developing type 2 diabetes mellitus (T2DM) at an earlier age, higher rates of diabetes-related kidney failure, and higher rates of diabetes-related vision loss than non-Hispanic whites. The cost associated with diabetes in the United States, in 2022, was reported to be over $412.9 billion dollars with $306.6 billion related to direct cost of the disease (e.g., insulin and diabetic supplies) and over $160.3 billion associated with indirect cost (e.g., lost work and wages). An effective way of reducing the risk of diabetes complications, hospitalization, and mortality, is through Diabetes Self- Management Education and Support (DSMES) interventions; however, these programs are extremely underutilized and not convenient or accessible to most patients with T2DM. The On the Road to Living Well with Diabetes (OTR) DSMES program was developed to increase self-management of diabetes. The OTR- DSMES program is currently offered in-person and is led by community health workers (CHWs). The proposed project will adapt the in-person bilingual OTR-DSMES intervention into an online digital health version of the OTR DSMES. We propose three specific aims. Aim 1: Identify barriers and facilitators toward participating in DSMES interventions among Mexican origin Hispanics (MoHs) who have T2DM and healthcare providers (HCPs) to inform the adaptation of a digital health intervention (DHI) for diabetes self-management. Aim 2: Enhance and adapt the On the Road (OTR) to Living Well with Diabetes in-person intervention into a digital health intervention (DHI). Aim 3: Conduct a three-group randomized study testing the in-person OTR DSMES intervention against the DHI version of the OTR DSMES and a control group. Our hypothesis is that a DHI version of the OTR DSMES intervention is as effective as the in-person DSMES and more effective than a control at increasing diabetes knowledge, intentions and self-efficacy to engage in diabetes self-management behaviors, and decreasing perceived diabetes stress and HbA1C levels. Upon establishing that the DHI version of the OTR DSMES intervention is equivalent to in-person delivery, the DHI version could be widely disseminated to reach broader audiences, including rural populations and home-bound people, thus addressing sustainability and improving self-efficacy to manage diabetes and subsequently reducing complications and hospitalizations.