Research Profile

This project focuses on diabetes prevention among Hispanic/Latino adults in Utah. Research has found that lifestyle intervention focused on improving nutrition and increasing physical activity successfully prevents or delays type 2 diabetes for many adults at risk. Unfortunately, lifestyle intervention delivered in community and health care settings has demonstrated low recruitment and completion among Hispanic participants. This is especially problematic given that Hispanic adults have the highest rate of type 2 diabetes of all racial/ethnic groups in the United States. The purpose of the proposed work is to develop and evaluate a family-based lifestyle intervention that meets the needs and preferences of Hispanic adults in Utah who are at high risk for type 2 diabetes. The research team previously found that including close others in lifestyle intervention improved recruitment and completion, but that many Hispanic participants lacked time to participate in the intervention. The innovative intervention the team develops will incorporate family members, be culturally appropriate, and be less burdensome for participants. To increase the likelihood this intervention will fulfill current and future community needs, it will be delivered by Community Health Workers. Including family members and lessening the burden of the program has the potential to build on the modest success of culturally-adapted lifestyle intervention in Hispanic adults, by improving recruitment and completion, and therefore improving lifestyle to prevent or delay type 2 diabetes.

We hope this project will increase the success of lifestyle interventions in engaging participants and facilitating lifestyle change. We know that type 2 diabetes is more common among those with a family history of the disease. As an individual with type 2 diabetes, your children are more likely to develop it. Further, individuals within a family are likely to have similar lifestyles (e.g., eating habits, activity levels) by virtue of the shared home environment. Thus, we aim to develop a diabetes prevention intervention focused on health behavior change at the family level. We believe this project will help us identify how family members can best provide support for those at risk for type 2 diabetes, improving intervention engagement and outcomes. Further, given that family members of those at risk for type 2 diabetes are likely to be at heightened risk themselves, it is possible that the intervention will reach family members who would otherwise not learn about or engage in the intervention.

My interest in how relationships can be leveraged to facilitate health behavior change among individuals at risk for type 2 diabetes grew out of my experiences during my Clinical Psychology PhD. In my predoctoral clinical internship at the University of California, San Diego and the San Diego VA, half of my time was devoted to conducting couple and family therapy with Veterans and their family members. In addition to the expected focus on relationship problems, which had been the focus of my research since I was an undergraduate student, I became keenly aware of the need to focus on individual family members' physical and mental health that impacted - and was impacted by - relationship functioning. Over the past 4 years, with support from an NIDDK career development award (K23) and internal grants at the University of Utah, I have devoted my research efforts to adapting the CDC's PreventT2 curriculum of the National Diabetes Prevention Program to be delivered to romantic couples, and to be more broadly applicable across a range of communities and cultures. The project funded by this award represents a critical next step. Lifestyle intervention in community and health care settings has demonstrated particularly low recruitment and completion among Hispanic/Latino participants. This is especially problematic given that Hispanic adults have the highest rate of type 2 diabetes of all racial/ethnic groups in the United States. This community-based participatory research project focuses on meeting the specific needs of the Hispanic community in Utah, and extends the intervention focus to a broader family context. The project was designed and will be carried out together with partners at a local community-based organization, Alliance Community Services (Ms. Sara Carbajal-Salisbury, Ms. Jeannette Villalta). Alliance serves approximately 1,000 Hispanic families in Utah each year. My expertise in diabetes prevention in a relationship context is complemented by the expertise of these community partners and other colleagues who have expertise in culturally adapting behavioral interventions for, and health disparities in, the Hispanic community in Utah (Dr. Ana Sanchez-Birkhead, Dr. Anu Asnaani).

I believe future diabetes research will more consistently include key stakeholders and more directly address social determinants of health. Recent work in journals published by the American Diabetes Association has demonstrated the profound impact of social determinants of health on diabetes disparities among marginalized groups (e.g., Hill-Briggs et al., 2021; Ogunwole & Golden, 2021). As social determinants of health are substantial barriers to enrollment, engagement, and health behavior change among participants in diabetes prevention interventions, it is critical that these factors be addressed, and they are best addressed using community-based methods designed to reduce health disparities.