An astonishing 86 million adults have prediabetes and are at high risk for joining the 29.1 million Americans who already have type 2 diabetes without appropriate intervention. These Americans who are at high risk will add to the staggering $245 billion in annual health care costs currently being spent on diabetes in the U.S. [1]. Efforts to translate evidence-based interventions to prevent or treat chronic disease have been identified; however, reach to high-risk populations has been limited. Reviews of dissemination and implementation studies have suggested the need for additional translational strategies and cultural adaptations are needed ?to increase program relevance, satisfaction, and participation? among high-risk populations. Historically black colleges and universities (HBCU) are typically situated within, educate, employ, and serve populations that are at high risk for chronic disease, and may be an important partner for disseminating interventions in high-risk communities. The proposed R21 project will evaluate the capacity for D&I of EBIs for chronic disease prevention and treatment in low-income, high-risk populations through HBCUs by addressing the following aims: 1. Conduct formative assessment to identify facilitators for and barriers to D&I of EBIs in low-income, high-risk communities through HBCUs; 2. Adapt, pilot test, and evaluate a curriculum for training HBCU students to facilitate EBIs in low-income, high-risk communities; and 3. Explore the feasibility for expanding our D&I model to other HBCUs and chronic disease outcomes. The proposed research will be implemented with representatives from Winston-Salem State University (WSSU; an HBCU), Wake Forest School of Medicine, and residents from the surrounding low-income community. We will use the Diabetes Prevention Program (DPP) curriculum as an exemplar model for training because diabetes is prevalent in the community and our team already has experience with, and a curriculum for, training DPP facilitators. The facilitator curriculum will be adapted to be delivered as a college-level course with input from relevant HBCU and community stakeholders. The course will include general group leader training and experiential learning opportunities to practice curriculum delivery. We will adapt and pilot test the course with ~6 students in year 1. During year 2, we will conduct a larger evaluation of curriculum as a for- credit course with 30 students. Outcomes of interest, informed by the RE-AIM framework, are focused on process measures and program fidelity and include reach, implementation, effectiveness, adoption, and maintenance of the course into the WSSU curriculum. The proposed R21 will be used to plan for a larger randomized, controlled pragmatic trial to test whether the HBCU model is successful for preventing or delaying type 2 diabetes onset by achieving DPP goals in underserved groups.
The proposed project is relevant given the high burden of chronic disease in low-income and racial/ethnic minority communities, and limited engagement of high-risk communities in research and programs designed to disseminate evidence-based interventions. Partnership with historically black colleges and universities to deliver programs in high risk communities may be a successful strategy for increasing participation, given HBCUs existing roles within high risk communities.
