Faculty Mentor: Katherine Baucom (Psychology, University of Utah)

Diabetes is the 6th leading cause of death by disease and the 7th leading cause of death overall in the U.S. (CDC, 2024), which makes it crucial to create programs that are targeted at diabetes prevention. Hispanics have the highest prevalence of type 2 diabetes of all racial/ethnic groups (22%; Cheng, 2019), while being the largest and fastest-growing minority group in the USA (Census, 2020). Lifestyle intervention has been shown to lower the incidence of type 2 diabetes (DPPRG, 2002). Unfortunately, real-world translations have not been as effective in the Hispanic community. Lifestyle coaches working primarily with Hispanic participants have identified that a lack of family support makes lifestyle intervention less effective as they are less willing to participate (Aguirre, 2021). With all this taken into account, there needs to be a better, more effective method for diabetes prevention that is specifically tailored to the needs of the Hispanic community and their culture.

The CDC National Diabetes Prevention Program (National DPP) is a year-long lifestyle intervention that aims to facilitate 5-7% weight loss through increased physical activity and nutrition change (CDC, 2024). This program has been delivered in English and Spanish to target Hispanic communities with higher type 2 diabetes prevalence rates. Part of the reason the CDC curriculum is less effective for the Hispanic participants is low enrollment and retention rates in the Hispanic community (Ely et al., 2017). Thus, the National DPP does not appear to meet the needs of Hispanic communities. Familism, a social pattern in which the family assumes a position of ascendance over individual interests (Merriam-Webster), is a commonly held value in the Hispanic community. Familism is positively correlated with physical health for example, those with higher levels of familism have been found to have increased/better mental and physical health due to the increase in support (Corona, 2019). Due to this, implementing an adapted family-based lifestyle intervention curriculum designed to engage the Hispanic community effectively is extremely valuable.

The HEART lab and a community-based organization (Alliance Community Services) developed the ADIOS T2D project, which aims to adapt the National DPP curriculum to be more culturally relevant to the Hispanic/Latinx community. Aim 1 was previously implemented to inform the creation of an adaptation of the program that would best meet the needs of the Hispanic community with community partner feedback. This aim included Community Health Workers (CHW) delivery of the National DPP curriculum in Spanish (PrevengaT2). Participants were Hispanic adults at high risk for type 2 diabetes, along with an adult family member.

Participant feedback was collected through weekly focus group meetings and questionnaires before and after the program. CHWs also gave feedback to the team following each class. Based on this feedback, a new curriculum (PrevenganT2) was created to better meet the needs of Hispanic communities in Utah.

I (JC) have been involved with Aim 2 of the ADIOS T2D project, which evaluates the PrevenganT2 adaptation. PrevenganT2 is currently being implemented in both Salt Lake and Davis counties with each of them having 10-12 participants in each class. Based on Aim 1 participant feedback, the program includes 1-hour classes each week for 14 weeks. In addition to the name change, the PrevenganT2 curriculum also has more inclusive pictures and culturally-relevant food choices and activity examples (e.g., dancing)These adaptations aim to create a larger sense of identification within the program for participants making it easier to be able to feel represented. Our team in the HEART Lab will examine the effects of the full PrevenganT2 curriculum when the Aim 2 data collection is completed at the end of October 2024.

Acknowledgement

We want to acknowledge the following individuals for their contributions to the HEART Lab summer 2024 SPUR experience and the ADIOS T2D project: Brooke Franklin, Elizabeth Beaulieu, Yiqing Cao, Manuel Gutierrez Chavez, Madelyn Whitaker, Sara Carbajal-Salisbury, Jeannette Villalta, Nelamaria Flores, Virginia Fuentes, Maria Hernandez, Diana Parry-Alba, Carmen Rodriguez, Yolanda Rodriguez, Veronica Selene Zavala, Anu Asnaani, Ana Sanchez-Birkhead, and faculty and staff in the Office of Undergraduate Research at the University of Utah.

Bibliography

Aguirre M.C., Diaz Y., Bauman T., et al. Emotional, Social, and Structural Barriers Among Latinx Participants in the National Diabetes Prevention Program. Poster presented at: Association for Behavioral and Cognitive Therapies Annual Convention; November 2021;Virtual

Centers for Disease Control and Prevention. (2024, May 2). FASTSTATS – leading causes of death. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Cheng Y.J., Kanaya A.M., Araneta M.R.G., et al. Prevalence of Diabetes by race and ethnicity in the United States, 2011-2016. JAMA. 2019;322(24):2389-2398. doi:10.1001/jama.2019.19365

Corona K., Campos B., Rook K.S., Biegler K., Sorkin D.H. (2019). Do cultural values have a role in health equity? A study of Latina mothers and daughters. Culture Divers Ethnic Minor Psychol 25(1):65-72. doi: 10.1037/cdp0000262. PMID: 30714768; PMCID: PMC6499474

The Diabetes Prevention Program Research Group. (2002). Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 346(6):393-403. doi:10.1056/NEJMoa012512

Ely E.K., Gruss S.M., Luman E.T., et al. A national effort to prevent type 2 diabetes:Participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care. 2017;40(10):1331-1341. doi:10.2337/dc16-2099

Joachim-Célestin M., Gamboa-Maldonado T., Dos Santos H., & Montgomery S.B. (2020) A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High? J Prim Care Community Health. doi:10.1177/2150132720945423

Merriam-Webster. (n.d.). Familism definition & meaning. Merriam-Webster. https://www.merriam-webster.com/dictionary/familism

Mhpmarketing. (2024, April 1). Familismo & Fatalismo: How Cultural Beliefs Affect Health Care. MHP Salud. https://mhpsalud.org/familismo/#:~:text=In%20Hispanic%2FLatino%20culture%2C%20a,concept%20known%20as%20%E2%80%9CFamilisimo%E2%80%9D.

U.S. Census Bureau (2021). Race and Ethnicity in the United States: 2010 and 2020 Census. https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-the-united-state-2010-and-2020-census.html