Purpose: The purpose of this study was to describe adaptations and participant characteristics and engagement in family-focused diabetes self-management education (DSME) before and during a large-scale disruption in health care access and research participation, which prompted a pivot to virtual DSME. Methods: The study was conducted at a federally qualified health center (FQHC) serving a predominantly low-socioeconomic status Hispanic community. Two hundred twenty-two adults with type 2 diabetes (85% Hispanic) receiving care from the FQHC enrolled with a support person (SP); dyads were randomized to community health worker (CHW)-led dyad-focused Family Support for Diabetes Health Action (FAM-ACT) or patient-focused DSME. Survey, health record, and session data were compared between those enrolled before (n = 77) versus during the disruption (n = 145). Results: In hybrid (virtual+in person) DSME, CHWs prioritized group discussion and shorter sessions emphasizing participants’ personal health goals and social-emotional concerns. Enrollment was lower after versus before switching to hybrid (23% vs 30% recruited). Those with less complex diabetes and preferring Spanish enrolled at higher rates during hybrid offerings. Overall, patient DSME attendance slightly decreased during versus before hybrid implementation (mean –0.3 sessions/6) but increased in FAM-ACT patients (mean +0.3 sessions/6) and SPs (mean +0.5 sessions/6). During hybrid programs, patients choosing virtual attendance were more often female, living with children, have food insecurity and difficulty prioritizing diabetes over other demands. Conclusions: Group DSME delivered via hybrid sessions maintained participant engagement during a large-scale disruption in health care access by addressing language, health and social needs, life demands, and technological barriers. Trial registry: The underlying trial was registered with www.clinicaltrials.gov (NCT03812614, 01/18/2019).
Deverts et al. (Thu,) studied this question.