Stories for Change (S4C): Digital Storytelling for Diabetes Self-Management among Hispanic Adults

PROJECT SUMMARY/ABSTRACT Hispanic adults are twice as likely to have type 2 diabetes mellitus (T2D) and 1.5 times more likely to die from the disease than non-Hispanic whites. These disparities are mediated, in part, by less healthful levels of physical activity, dietary quality, medication adherence, and self-monitoring of blood glucose than non-Hispanic whites. Given the complex sociocultural forces that influence these behaviors, a community-based participatory research (CBPR) approach is called for to address them. The Rochester Healthy Community Partnership is a robust CBPR partnership consisting of community-based organizations, health service organizations, and academics who are experienced at collectively deploying programming and outcomes assessment among immigrant populations. Over the past three years, RHCP partners from the Hispanic community have co- created a digital storytelling intervention for T2D self-management that has been piloted in primary care settings across multiple institutions. Digital storytelling interventions are narrative-based videos elicited through a CBPR approach to surface the authentic voices of participants overcoming obstacles to health promoting behaviors, in this case, behaviors related to diabetes self-management (physical activity, healthful diet, medication adherence, and blood glucose monitoring). These videos can shape health behaviors of viewers through influences on attitudes and beliefs. The aims are: 1) To evaluate the efficacy of a community- derived digital storytelling intervention among Hispanic adults with poorly controlled T2D, and 2) to explore the effect of the intervention on proposed theory-based mediators of change. Using a two-group design, 450 Hispanic adults with poorly controlled T2D will be randomly assigned to view the 12-minute digital storytelling intervention with usual care or receive usual clinical care only. Both groups will receive diabetes education materials and a resource guide for contacting their diabetes care team, consistent with existing standards of care. The primary outcome, measured up to six months after intervention delivery, will be glycemic control as measured by hemoglobin A1c. Secondary outcomes will include diabetes self-management behaviors, blood pressure, LDL-cholesterol, and body mass index. The impact of concomitant covariates, including sex, age, and socio-economic status, on the sensitivity of the intervention effect will also be explored. This work tests a scalable, low cost intervention targeting vulnerable populations implemented in primary care settings with the opportunity for rapid translation to practice. We will establish a disseminable framework for community participation in digital storytelling production for chronic disease management, providing a model that may be applied to other communities and health priorities.