T1DTechCHW: Enhancing the Community Health Worker Model to Promote Diabetes Technology Use in Young Adults From Underrepresented Minority Groups

Albert Einstein College of Medicine119 enrolled

Overview

The objective of this study is to test the early effects and implementation of an enhanced community health worker (CHW) model (T1D-CATCH) that encourages and supports diabetes technology use in young adults from underrepresented minority groups (YA-URMs) with type 1 diabetes (T1D). The investigators will conduct a 9-month randomized controlled trial in which YA-URMs will be randomized to T1D-CATCH or usual care. The investigators will recruit from adult and pediatric endocrinology and primary care practices in a large safety-net health system in the Bronx, New York. Our specific aims are to 1) evaluate T1D-CATCH effects on technology initiation and continued use over 6 months and 2) evaluate T1D-CATCH implementation using Proctor's Taxonomy of Implementation Outcomes: feasibility, adoption, fidelity, and cost.

The study will involve a 9-month randomized control trial of usual care versus T1D-CATCH, an intervention that enhances core community health worker (CHW) service roles to support increased use of T1D technology in young adults (underrepresented minorities) (YA-URM's). Participants will be recruited from primary and specialty care practices at Montefiore Medical Center in the Bronx, New York, which is a large safety-net hospital system in one of the poorest counties in the U.S. Two young adult-aged CHWs from the Montefiore CHW program will be trained extensively per our Supporting Emerging Adults with Diabetes (SEAD) program manuals. For YA-URMs, CHWs will conduct hands-on diabetes technology education, goal-setting, peer support, and social service linkage. CHWs will also help shift insurance approval tasks away from busy providers and better align patient-provider priorities through close communication between the YA-URM and provider. Group sessions will be optional and will follow the YA-centric education curriculum developed in Dr. Agarwal's Supporting Emerging Adults with Diabetes (SEAD) program.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Interventions

T1D-CATCHBEHAVIORAL

As defined by the Centers for Disease Control and Prevention (CDC), a CHW is "a frontline public health worker who is a trusted member of a community or who has a thorough understanding of the community being served, and leverages this unique position to link health systems, social services, and communities". CHWs engender trust with patients by having direct community and lived experience, offering specific support and empathy that may be difficult for other diabetes care professionals to provide. In addition, CHWs have firsthand understanding of cultural barriers to traditional western healthcare and can promote patient-centered culturally-relevant care. They enhance team-based care by helping providers with extra outreach, social needs management, time-consuming tasks, and aligning patient-provider priorities. CHWs in this project will provide social needs assessment and management, introduction to diabetes technologies, and support for onboarding to technology.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 35 Years

Medical Language ↔ Plain English

Inclusion Criteria: * T1D duration ≥6 months * 18-35 years old * Self-identified URM status: non-Hispanic Black or Hispanic * English- or Spanish-speaking * Not currently on a connected diabetes technology system (includes never offered, prescribed but not started within 3 months of receiving the device, discontinued, or previously refused technology) Exclusion Criteria: * Developmental or sensory disability interfering with study participation * Current pregnancy * Participation in another behavioral or diabetes technology intervention study in the past 6 months.

Outcomes

Primary Outcomes

Technology Initiation

Technology use will be tracked using EMR prescriptions, self-reporting, CHW records, and device platforms and will be measured and reported as a binary variable (yes/no). Technology will include any combination of continuous glucose monitor (CGM), pump, or CGM and pump. Technology initiation will be defined as at least 1 week of first use in the 6-month period. Variables will be described using summary statistics with counts/percentages.

Time frame: 6 months following intervention

Secondary Outcomes

Technology Initiation

Technology use will be tracked using EMR prescriptions, self-reporting, CHW records, and device platforms and will be measured and reported as a binary variable (yes/no). Technology will include any combination of continuous glucose monitor (CGM), pump, or CGM and pump. Technology use will be defined as at least 1 week of first use in the 3-month period. Variables will be described using summary statistics with counts/percentages.

Time frame: 3 months following intervention

Continued Technology Use - Percent Use

Continued technology use by study end will be determined from device platform metrics detailing days/percent time used, in addition to self-report. Per standard diabetes technology clinical trial guidelines, CGM use is defined as pump use \>90% time. The percentage of time used (% used) will be summarized by study arm using basic descriptive statistics. A target of at least 90% CGM wear-time is associated with the best outcomes for glycemic control.

Time frame: 9 months following intervention

Continued Technology Use - Days of wear

Continued technology use by study end will be determined from device platform metrics detailing days/percent time used, in addition to self-report. Per standard diabetes technology clinical trial guidelines, CGM use is defined as ≥ 5/7 days wear over the 9 month period. Days of wear will be summarized study arm using basic descriptive statistics. A target of at least 5/7 days of CGM wear-time is associated with the best outcomes for glycemic control.