Depression and physical inactivity are leading contributors to cardiometabolic diseases such as obesity, diabetes, and cardiovascular disease. Low-wage workers, who comprise one-third of all workers in the U.S. and are essential to many industries, are more likely to be physically inactive and to have cardiometabolic conditions and depression, yet they are half as likely as higher wage workers to utilize preventive care. Targeted workplace initiatives have been successful in improving employee health, but low-wage workers are difficult to engage, in part due to a high burden of social disadvantage (e.g., food and housing insecurity, time and financial constraints). Currently, to our knowledge, there are no workplace interventions for depression that specifically target low-wage workers and their unique social risk factors. This study was conceptualized using a planned adaptation approach that involves low-wage workers in the design of the intervention to increase engagement and feasibility in this population. The proposed study will adapt an evidence-based 8-session telephone-delivered depression intervention for working adults, Be Well at Work, and add critical enhancements for low-wage workers: assessment and referrals for social determinants of health, physical activity promotion, and personalized text message behavioral support via ecological momentary assessment and intervention. The adapted intervention, Be Well at Work-PLUS, will be developed and tested in three phases: (1) qualitative interviews with low-wage workers to understand social determinants of health, barriers and facilitators of engagement, and intervention preferences (Aim 1); (2) a single-arm pilot (N=10) with exit interviews to refine the intervention content and delivery (Aim 2); (3) a pilot randomized controlled trial comparing Be Well at Work-PLUS to a waitlist condition (N=60; Aim 3). This iterative process will yield results on feasibility, acceptability, and preliminary clinical outcomes of Be Well at Work-PLUS and provide data to apply for an R01 efficacy trial. To compliment these research aims, Dr. McCurley has designed a training plan to gain expertise in (1) implementation science, including planned adaptation of evidence-based interventions and participatory design methods for improving reach and engagement in low-income groups, (2) mobile health, specifically, text messaging for increased intervention feasibility and uptake; and (3) randomized controlled trial design. The career development plan involves regular mentorship with experts in implementation science, mobile health, randomized behavioral intervention trials, as well as didactic courses and workshops in these topics, dissemination of results through presentations and publications, and support for grant writing and additional skill development to advance Dr. McCurley’s career as an independent behavioral scientist. This K23 proposal will position Dr. McCurley to become an independent investigator developing interventions that fuse technology and behavioral science to address depression, health behavior, social determinants of health, and cardiometabolic diseases in low-income populations.

PROJECT NARRATIVE Low wage workers comprise one third of all workers in the U.S. and have a high prevalence of cardiometabolic risk factors, including depression and physical inactivity. The proposed project develops and tests a dynamic workplace-based depression intervention that is tailored to the specific social and behavioral needs of low- wage workers and enhanced with text message support for mood and physical activity. If found to be feasible and acceptable, this intervention could provide a scalable workplace program to reduce the adverse economic and health impacts of depression for low-wage workers and their employers.