DP24-004, PRC Core: Center for Health Promotion and Disease Prevention

Univ Of North Carolina Chapel Hill, Chapel Hill NC

Investigators

Abstract

ABSTRACT Diabetes affects over 37 million people in the US with the disease burden disproportionately borne by American Indian, African American, Hispanic/Latino, and rural subgroups (our priority populations). Despite progress in diabetes treatment, glycemic and cardiometabolic (e.g., blood pressure) outcomes are not improving. Healthy eating, physical activity, medication adherence, and self-monitoring of blood glucose are essential self-care practices. While Diabetes Self-Management Education and Support (DSMES) programs are effective at improving these self-care practices, they are significantly under-utilized nationwide, with only 5% of newly diagnosed Medicare beneficiaries and 6.8% with private insurance accessing DSMES within one year of diagnosis. Innovative implementation strategies are needed to bridge the gap between research and practice. Prevention Research Centers (PRC) are well positioned to lead this effort. We propose building on our long experience in the PRC Network to: 1) continue growing our prevention research capacity; 2) support a core research project to identify more effective strategies for implementing, scaling, and sustaining DSMES, with a focus on eliminating health disparities/inequities; and 3) contribute to and learn from PRC Network partners to improve public health service delivery in partnership with state and local health departments; community and tribal organizations; and national organizations. Together, we will put feasible evidence-based interventions into national practice, addressing health equity as the highest priority. Our core research project will focus on understanding how to implement DSMES more equitably in those at highest risk by examining contextual factors and key drivers of DSMES utilization, such as reimbursements, referral policies/practices, and willingness of persons with diabetes (PWD) to participate. We propose a 3- phase study to address implementation challenges for rural residents in NC with high diabetes prevalence. Phase I: Understand complex determinants of uptake and sustained DSMES use in priority populations to adapt program delivery. Use systems and implementation science to understand barriers and facilitators of DSMES uptake, prioritize key leverage points for change, assess organizational readiness for DSMES implementation, and identify cultural adaptations for DSMES materials. Phase II: Test the effects of adapted DSMES program implementation. Use a hybrid trial Type 3 effectiveness-implementation design (12 sites: 6 health departments + 6 Federally Qualified Health Centers/similar primary care clinics and 240 PWD [20 participants per site]). Phase III: Disseminate and translate research products to state and national audiences through established partnerships and stakeholder support. With program staff and PWD, conduct a final review of the adapted DSMES to anticipate and address potential implementation, dissemination, and translation challenges and develop a DSMES Toolkit companion guide and marketing plan for widespread dissemination.