T1D-PATCHY (Type 1 Diabetes-Promoting Access to diabetes Technology with Community Health Workers for Youth) - Abstract Youth with type 1 diabetes (T1D) from low-income families or on public insurance are more likely to have adverse health outcomes and are less likely to use diabetes devices compared with their peers. Diabetes technology can serve as an intervention target to improve health outcomes for all youth with T1D. There is an urgent need to develop an intervention that addresses the multi-level barriers, such as social needs and inadequate school support, that underserved youth with T1D and their caregivers face regarding diabetes device use. Deployment of community health workers (CHWs) is an evidence-based intervention that can address the root causes of diabetes device barriers. As trusted community members, CHWs can integrate social and medical care and bridge communities, families, and youth. Aided by qualitative stakeholder data, Dr. Chen developed a specialty T1D-CHW care model, “T1D-PATCHY” (T1D-Promoting Access to diabetes Technology with Community Health Workers for Youth), to address challenges faced by youth with T1D and their caregivers. Yet, there remains a need to develop effective implementation strategies to use T1D-PATCHY in diabetes clinics and schools. This proposal aims to implement and evaluate T1D-PATCHY using the novel implementation planning framework, Implementation Mapping. The study rationale is that a multi-level T1D- CHW specialty care model can influence diabetes device adoption and use, leading to improved health outcomes for underserved youth with T1D. The study aims are to: 1) identify barriers associated with implementing T1D-PATCHY at schools; 2) develop a multifaceted implementation strategy for T1D-PATCHY; and 3) evaluate T1D-PATCHY in a pilot randomized controlled trial (RCT) with the primary outcome of feasibility. Exploratory outcomes include diabetes device uptake, overcoming social needs, implementation outcomes, hemoglobin A1c, psychosocial outcomes and durability of device use at 3 months post-intervention. Results will inform a fully powered RCT for a future R01 application. This 5-year K23 award aims to provide Dr. Chen with career development to become an independent investigator and leader in pediatric T1D health services research, implementation science, and school-based interventions. This proposal includes four main training objectives: 1) to increase competencies in community-based participatory research, 2) to build skills in rapid qualitative analysis, 3) to develop proficiency in implementation science, and 4) to gain clinical trial expertise. Dr. Chen has a mentorship team of experts in T1D health services research (Dr. Shivani Agarwal, co-primary mentor), school-based research (Dr. Marina Reznik, co-primary mentor), pediatric T1D (Dr. Lori Laffel, co- mentor), implementation science (Dr. Kevin Fiori, co-mentor), qualitative methodology (Dr. Molly Tanenbaum, co-mentor), and applied statistical methods (Dr. Mimi Kim, co-mentor). This award will support Dr. Chen's transition to independence by helping her develop the skills to implement and evaluate community-based interventions to improve health outcomes for youth with T1D.
