Dr. Kathryn Kanzler is applying for a Mentored Patient-Oriented Research Career Development Award (K23). This grant would provide intensive training and time to gain necessary skills and knowledge toward achieving her long-term goal of being an independent clinical investigator of scalable behavioral treatments to reduce health disparities and improve outcomes for patients with diabetes. Dr. Kanzler is a clinical health psychologist with experience as a clinician-educator in the US Air Force. Building on a strong foundation, additional training is sought in health disparities, clinical research and design, type 2 diabetes (T2DM), and dissemination and implementation science. Proposed training will be accomplished with guidance of multidisciplinary mentors and training advisors largely based at the University of Texas Health Science Center San Antonio. Activities include coursework, directed readings, seminars, workshops, and mentor meetings. The proposed study helps address an urgent need for more interventions for the Hispanic/Latino diabetes population. Despite continued biomedical advances, diabetes and related complications continue to take a higher toll in the Hispanic/Latino community, where there is 40% greater likelihood of death compared to non-Hispanic whites. Avoidance coping has emerged as a key factor in preventing optimal glycemic control, but interventions that address avoidance coping, such as Acceptance and Commitment Therapy (ACT), are limited by language and cultural barriers to care, as well as standard dissemination practices (e.g., ACT is usually provided by licensed providers in specialty settings). Community health workers (?Promotores?) serving on primary care teams could deliver key elements of ACT for diabetes, in addition to mitigating other barriers to self-management, such as limited resources, language differences, and low health literacy. This task-shifting paradigm allows for culturally-tailored and accessible care. Task-shifting core skills of ACT?Acceptance Based Coping (ABC) skills?to supervised Promotores could provide accessible and culturally appropriate treatment in the preferred language of patients. This study aims to develop an acceptable and feasible Promotores-delivered ABC intervention program for Hispanics/Latinos using REP pre-conditions and pre-implementation steps, in (a) qualitative and quantitative data from interviews and focus groups (Phase 1); and (b) repeated small-sample beta-tests (Phase 2).
The second aim, in preparation for a larger pragmatic trial, is to demonstrate feasibility in a pilot randomized trial through: evaluating recruitment and retention; establishing methods of assessing intervention fidelity and integrity; engaging multi-level stakeholders; and estimating the magnitude of potential impact on selected mechanisms and outcomes. This line of research has potential to improve glycemic control and quality of life for Hispanic/Latino patients with T2DM. This award will lay the foundation for a research program of scalable interventions that reduce health disparities through improved diabetes outcomes.
. Task-shifting core skills of Acceptance & Commitment Therapy to certified community health workers (Promotores) could bridge a critical care gap and provide access to evidence-based and culturally appropriate interventions in the preferred language of patients. The Acceptance Based Coping (ABC) skills intervention has potential to improve glycemic control and quality of life for Hispanic/Latino patients with T2DM. If funded, the K23 award will lay the foundation for a research program of scalable behavioral interventions that reduce health disparities and improve outcomes for patients with diabetes.