This proposal addresses the need for translation of the results of clinical trials for the prevention and treatment of type 2 diabetes to the community level. We propose to work with families that include at least one family member with type 2 diabetes. The intervention is designed to help all family members learn how they can adopt healthy lifestyles that are known to reduce risk for diabetes or its complications and better utilize existing community resources, including the health care system. A family visit program previously tested in families of second graders in the San Luis Valley (SLV), will be adapted to address the prevention continuum (primary prevention of diabetes in family members without diabetes, secondary prevention identifying family members with previously undiagnosed diabetes, and tertiary prevention of diabetes complications). This will be done in a two-arm randomized design, with 250 families randomized to a family visit program, and 250 families to usual care. The family visit program includes a 6 month tailored, hands-on, activity-based family visit program to address primary and tertiary prevention (increased physical activity and fruit and vegetable consumption, maintenance of healthy body weight) and to improve support systems so that family members with diabetes can more successfully follow their doctors' recommendations. Activity-based group sessions will be conducted on a monthly basis during the 6 months of family visits and for 6 months after family visits are completed bringing families together to reinforce and advance the target behaviors. We will collaborate with health care providers to address the self-management and community resources components of the chronic care model for health care quality improvement. The study will be conducted in the San Luis Valley (SLV), a medically underserved area with 48% of the population being Hispanic; one of the lowest per capita income levels of any region in Colorado; and where epidemiologic investigations over the last 18 years have documented this to be a high risk population for diabetes, obesity, poor nutrition and physical inactivity. Program effectiveness will be evaluated with intent-to-treat comparisons, mediational analysis, and dose response in the intervention group. Process data will be used to describe intervention delivery and how it was received by participants. Costs and other information needed to evaluate the family visit program as a reimbursable treatment and preventive service will also be collected and analyzed.
