Preventing type 2 diabetes is a high priority for health care systems. Particular focus is needed on racial and ethnic minority populations who suffer disproportionately from diabetes and its complications. Success depends not only on patient access to lifestyle programs to reduce risk, but on patient engagement in such programs. Yet evidence-based strategies to increase engagement in clinical settings are lacking. This K01 career development award will provide Susan D. Brown, PhD with the expertise needed to achieve her long- term goal of reducing health disparities in diabetes by engaging diverse at-risk patients, such as overweight and obese women with a history of gestational diabetes, in preventive programs in health care settings. This proposal examines whether two theory-driven outreach strategies, tailored diabetes risk information and self- affirmation, impact three initial and sustained patient engagement outcomes: patient responses to outreach materials, and participation and retention in a lifestyle program. The central hypothesis is that diabetes risk information individually tailored to women's race/ethnicity and diabetes risk factors derived from electronic medical records may increase patient engagement. Yet tailored risk information can be psychologically threatening;thus its effects will be enhanced, and the threat mitigated, when individuals can affirm a sense of self-worth by actively reflecting on values that are important to them. Among overweight/obese women with a history of gestational diabetes, the Specific Aims are as follows.
Aim 1 : Develop novel, interactive outreach materials to be used in the clinical setting containing tailored diabetes risk information and self-affirmation, in collaboration with patients and health system stakeholders.
Aim 2 : Experimentally pre-test the impact of the developed outreach materials on patient responses in a 2 (tailored vs. non-tailored) x 2 (self-affirmation vs. no self-affirmation) design.
Aim 3 : Experimentally pilot test the impact of interactive outreach materials on patient engagement in a health system lifestyle program, as compared to standard outreach;I will also explore effects on weight loss. This theory-based research in a real-world clinical setting will expand our limited knowledge base regarding patient engagement for diabetes prevention. Dr. Brown will benefit from the primary mentorship of Assiamira Ferrara, MD, PhD, Senior Research Scientist and Section Chief for Women's and Children's Health at the Kaiser Permanente Northern California Division of Research. Complementing Dr. Brown's strengths in clinical psychology and obesity treatment, this K01 award will provide systematic training overseen by experts in diabetes and diabetes prevention (Dr. Ferrara), implementation science (Constance Weisner, DrPH, MSW and Julie Schmittdiel, PhD), health disparities (Alyce Adams, PhD), and biostatistics (Charles Quesenberry, PhD) to ensure Dr. Brown's success as an independent diabetes prevention investigator.

Public Health Relevance

Type 2 diabetes is a serious but preventable disease that disproportionately affects racial and ethnic minorities. This proposal evaluates novel outreach strategies to increase patient engagement in lifestyle programs for diabetes prevention, focusing on women in a health system who are at high risk. Expanding our knowledge of evidence-based patient engagement strategies is greatly needed to improve the health of patients at high risk for diabetes and reduce diabetes health disparities.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
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Kaiser Foundation Research Institute
United States
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Hedderson, Monique M; Brown, Susan D; Ehrlich, Samantha F et al. (2018) A Tailored Letter Based on Electronic Health Record Data Improves Gestational Weight Gain Among Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster-Randomized Controlled Trial. Diabetes Care 41:1370-1377
Gadgil, Meghana D; Ehrlich, Samantha F; Zhu, Yeyi et al. (2018) Dietary Quality and Glycemic Control Among Women with Gestational Diabetes Mellitus. J Womens Health (Larchmt) :
Brown, Susan D; Grijalva, Christina S; Ferrara, Assiamira (2017) Leveraging EHRs for patient engagement: perspectives on tailored program outreach. Am J Manag Care 23:e223-e230
Schmittdiel, Julie A; Adams, Sara R; Goler, Nancy et al. (2017) The impact of telephonic wellness coaching on weight loss: A ""Natural Experiments for Translation in Diabetes (NEXT-D)"" study. Obesity (Silver Spring) 25:352-356
Boccio, Mindy; Sanna, Rashel S; Adams, Sara R et al. (2017) Telephone-Based Coaching. Am J Health Promot 31:136-142
Ehrlich, S F; Hedderson, M M; Brown, S D et al. (2017) Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes. Diabetes Metab 43:416-423
Kubo, Ai; Ferrara, Assiamira; Brown, Susan D et al. (2017) Perceived psychosocial stress and gestational weight gain among women with gestational diabetes. PLoS One 12:e0174290
Brown, Susan D; Ehrlich, Samantha F; Kubo, Ai et al. (2016) Lifestyle behaviors and ethnic identity among diverse women at high risk for type 2 diabetes. Soc Sci Med 160:87-93
Ferrara, Assiamira; Hedderson, Monique M; Brown, Susan D et al. (2016) The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial. Diabetes Care 39:65-74
Ehrlich, Samantha F; Sternfeld, Barbara; Krefman, Amy E et al. (2016) Moderate and Vigorous Intensity Exercise During Pregnancy and Gestational Weight Gain in Women with Gestational Diabetes. Matern Child Health J 20:1247-57

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