We propose to develop and test a targeted telephone-based health information technology (health IT) intervention for diabetes prevention among ethnic minority women in the San Francisco Bay area with recent prior gestational diabetes (pGDM). This group of women comprises the single most identifiable risk group for subsequent rapid onset of type-2 diabetes (DM), yet little is know about them, their diabetes knowledge or risk perceptions, behaviors, health literacy, or about their preferences related to tailored telephone-based counseling interventions to prevent DM. Ethnic minority women, particularly Latinas and Asians and women born outside the US, have disproportionately higher rates of GDM and DM, than white or African American women. Diabetes prevention studies indicate that the long-term risk for developing DM can be reduced significantly (up to 50%) through diet and exercise. Adapting these intensive interventions specifically to low income and ethnic minority pGDM women who have recently had a baby and may face barriers in accessing health care and adopting preventive behaviors is the goal of this project. In the proposed research we will study factors crucial to the adaptation of an existing effective evidence-based health IT tool to the prevention of DM in low-income ethnic minority pGDM women. We have determined in comparative effectiveness studies, that our Automated Telephone Self-Management Support (ATSM) program is efficacious in improving health outcomes for low-income ethnic minority patients with diabetes. In this CHARM Center study, we will use a participatory design to co-develop the ATSM intervention for DM prevention with key stakeholders, so that it is relevant to low income ethnic minority pGDM women and re-name it Support via Telephone Advice and Resources (STAR-Moms). We will then conduct a pilot randomized clinical trial in English and Spanish of STAR Moms beginning in the end of pregnancy and lasting 9 months post-partum among a sample of primarily Latina and Asian pGDM women receiving care at San Francisco General Hospital, a large public hospital where GDM women in the SF county safety net clinics receive care. Study outcomes include: weight loss (kg), exercise and diet changes, knowledge, and use of preventive services.

Public Health Relevance

We propose to develop and test an intervention to prevent diabetes among women with recent gestational diabetes (GDM), focusing on Latina and Asian women who have the highest rates of GDM. Women with recent GDM comprise the single most identifiable risk group for subsequent rapid onset of type-2 diabetes, yet little is know about them. Our research has the potential to delay diabetes onset past childbearing age;and reduce population diabetes incidence in this high risk and under-studied population.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1-RN)
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University of California San Francisco
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