The current prevalence of Type 2 diabetes mellitus (T2DM) has reached unprecedented levels in the U.S. and worldwide. The public health implications of this widespread phenomenon are overwhelming, as it poses risks to overall population health and financial burden on both patients and the U.S. health care system with a total estimated cost of $245 billion in 2017. For the rural U.S. population, diabetes rates are particularly high in nonmetropolitan regions, where health care resources are often more limited than large urban areas. With optimal control of patients’ glycemic levels, T2DM is mostly a preventable chronic disease. Technology-enabled diabetes self-management education and support (DSME/S) programs offer a novel approach to assist patients with T2DM to improve their health outcomes by self-monitoring diet, physical activity, weight, and blood glucose level, using mobile and connected technology tools to provide more coordinated and patient-centered care. The long-term goal for this pilot study is to present an evidence-based strategy to increase the availability of technology-based DSME/S in rural regions that have been identified as Medically Underserved Areas (MUA). The objective is to test the feasibility and acceptability of the proposed intervention that will be tailored to meet community health needs.
This research study will pursue the following specific aims: (1) to evaluate the acceptability and feasibility of a technology-enabled DSME/S program delivered by a CHW for patients with T2DM in a designated rural South Texas region, and (2) to assess the effect of eHealth literacy on self-monitoring health behavior outcomes before and after the intervention. For the first aim, we plan to collaborate with our community partner – South Texas Area Health Education Center/Promotora/Community Health Worker Institute to adapt the evidence-based behavioral lifestyle intervention enhanced by mobile and wearable technology to support the behavioral intervention for the DSME/S educational content and coordinate with community health workers to reach the rural residents in a designated MUA. Focus-group interviews and surveys will be administered to gain an understanding of study participants’ experience with this proposed intervention. For the second aim, patient-generated self-monitoring data from a mobile application and wearable activity trackers will be collected and analyzed with respect to their eHealth literacy competency. We will also evaluate whether participant’s adherence to self-monitoring is affected by their level of eHealth literacy at the end of study. Our project aims to deliver preliminary findings to address the needs of technology-enabled DSME/S programs in rural areas and provide a partnership approach with the community collaborators that promises greater feasibility to implement patient centered health programs.