The burden of diabetes is greater for racial/ethnic minorities, including African Americans. Overweight andobesity are risk factors for the development of diabetes and are also more prevalent in racial/ethnic minorities.The Diabetes Prevention Program and subsequent translation studies demonstrated the efficacy of a lifestyleintervention on reducing weight and risk of type 2 diabetes. Increasing evidence supports efforts to engageCHWs to help extend our reach to reduce obesity and diabetes risk in underserved communities. Research isneeded to identify standard, effective, and scalable CHW training models to equip them to help extend ourreach in racial/ethnic minority communities, especially at-risk African Americans. Internet-based immersive 3-dimensional (3-D) virtual world environments offer the opportunity to reach populations with standardized andtailored approaches that can overcome common barriers to participation and allow for engaging andexperiential educational opportunities. Building on our prior work and experience, we will tailor/adapt,implement, and evaluate an internet-based 3-D virtual world model to remotely deliver a CHW training program(CDC ?Road to Health?; RTH) to support CHWs' efforts to educate at-risk African American communities aboutlifestyle changes to reduce obesity and diabetes risk. We will use a sequential mixed-methods design toaddress these specific aims:
Aim 1. Use community-based participatory research methods to guide the overallstudy and inform tailoring and adaptation of our virtual world model to deliver the CHW training program;
Aim2. Conduct a randomized pilot study (N=40 CHWs) to compare change in primary outcomes (0, 12 weeks)after the in-person versus virtual world delivery of the training program. Participants will be experienced AfricanAmerican female CHWs who share characteristics of the at-risk population they serve. Primary CHW outcomesinclude program content knowledge and delivery skill, self-efficacy, adherence, and change in lifestylebehaviors;
and Aim 3. Conduct summative focus groups to refine the CHW virtual world training program andstudy methodology to guide subsequent development of an RO1. If our virtual world CHW training modelshows promise in this study and subsequent effectiveness in an RCT, it could be tailored/adapted for diversegroups and scaled for broad remote dissemination.
/Significance:The burden of diabetes is greater for racial/ethnic minorities; including African Americans. Overweight andobesity are risk factors for the development of diabetes and are also more prevalent in racial/ethnic minorities.The Diabetes Prevention Program demonstrated the efficacy of a lifestyle intervention on reducing weight andrisk of type 2 diabetes. Increasing evidence supports efforts to engage community health workers (CHWs) tohelp extend diabetes prevention efforts in underserved at-risk racial/ethnic minority communities. Standard;effective; and scalable training models are needed to help equip CHWs in their community-based diabetesprevention efforts. This study will tailor/adapt; implement; and evaluate an innovative internet-based virtualworld model to remotely deliver a best practice CHW diabetes prevention training program to African AmericanCHWs; with a long term goal of reducing obesity and diabetes risk in underserved African Americancommunities.
