In this K01 training module, I plan to acquire necessary training to pursue a career in primary and secondary prevention of type II diabetes in primary care settings through behavioral interventions, with a focus on underserved populations. For the past two years, I have received foundational training and research experience in epidemiology, and have used existing datasets to study the associations between health behaviors and chronic diseases, including cardiovascular disease and diabetes. I have also observed the design, adaptation, and implementation of physical activity interventions in healthy adults. I recently directed a small demonstration trial (N=10) of a physical activity intervention adapted for Latino men, which showed significant increases in activity after 12 weeks. In the K01 training period, I plan to gain further experience in designing and implementing randomized controlled trials of physical activity interventions for specific populations in primary care settigs, and to gain thorough training in the pathophysiology, relevant biomarkers, and treatment of type II diabetes. Furthermore, I plan to build a basic skillset in assessments of cost and cost- effectiveness of primary care-based interventions. I will accomplish these goals through a combination of coursework, training seminars, clinic observation, and meetings and one-on-one training exercises with mentors. These training goals will be overseen and supported by an extremely qualified mentoring team with extensive experience in physical activity interventions, diabetes epidemiology and clinical treatment, and cost- effectiveness, in addition to thorough experience mentoring fellows, residents, and junior faculty. This training will give me the skills necessary to design and implement cost-effective behavioral interventions in primary care for diabetes, an area I feel is critical to public health. The goal of the research plan is to implemen a culturally and linguistically adapted web-based physical activity intervention designed specifically for Latinas with type II diabetes in a primary care setting. Latinas are projected to experience the largest increases in diabetes prevalence in the coming decades, with projected prevalence rates exceeding 50% for Latinas born in this century, yet few interventions have been designed specifically for this high-risk group which reports a number of cultural, linguistic, and socioeconomic barriers to participating in self-management interventions. The proposed intervention will be based on a web-delivered intervention developed for Latinas by the primary mentor, which is based on the Transtheoretical Model and Social Cognitive Theory. Past trials have shown efficacy of the intervention in non-diabetic populations, yet it has never been tested with clinical populations or in a primary care setting. In the current proposal, this intervention ill be modified for a diabetic population and, in collaboration with the UCSD Family Medicine Clinic, will be implemented in a primary care setting as a diabetes management program. Conducting a small randomized controlled trial (N=80), we will accomplish four specific aims: 1) to test the efficacy of the culturally adapted web-based individually tailored physical activity intervention in increasing weekly minutes of moderate-to-vigorous physical activity, 2) to test the effect of the intervention on clinical markers of diabetes, such as glucose and HbA1c, in addition to medication use, 3) to assess the cost of the intervention in increasing physical activity in order to provide preliminary cost-effectiveness analyses in using the intervention as a diabetes management program, and 4) to assess maintenance of behavior change and change in clinical markers. The proposed intervention incorporates features shown in past diabetes management trials to effectively increase physical activity behavior, including goal setting, self-monitoring, individually tailored feedback, and community support, and also addresses barriers commonly cited by Latinas, such as lack of transportation, linguistic barriers, and lack of support, thus it has great potential to increase physical activity in diabetic Latinas. Furthermore, the web-based format reduces staff and participant burden and increases participant engagement, and is appropriate given the large increases in Internet use among Latinos in recent years. Finally, the web-based format could allow for widespread dissemination in primary care, making it a potentially low cost, high reach approach for promoting an important disease management behavior in an at-risk population.
Latinas in the United States report especially high rates of type II diabetes, yet have less access to self- management programs due to linguistic, cultural, and socioeconomic barriers. As current projections estimate prevalence of diabetes will exceed 50% in Latinas born in this century, there is a great need for the development of low cost interventions to promote diabetes management behaviors, such as physical activity, designed specifically for Latinas. Through a small randomized controlled trial (N=80), the current project will test the efficacy of a web-based, culturally adapted, individually tailored physical activity intervention delivered through primary care for Latinas with type II diabetes, and will also assess effects of the intervention on clinical markers of diabetes and the cost-effectiveness of deliverin such an intervention in a primary care setting.