This proposed research is consistent with the Notice of Special Interest NOT-OD-22-032. In this administrative supplement, we will build on the infrastructure of our ongoing R01 parent grant [ ] – the focused on increasing physical activity among the general population [1]. Per the specific areas of research listed in the Notice of Special Interest, we will use “methodological and strategic innovations to improve the recruitment and retention of sexual and gender minority (SGM) individuals in any research activity.” NCT03903874 Deep South Interactive Voice Response (IVR)-supported Active Lifestyle (DIAL) intervention - that is This research is important because studies have shown that rates of inactivity-related chronic conditions are even higher among SGM populations compared to their heterosexual counterparts. Contributing to this disparity are SGM-specific barriers to physical activity (e.g., fear of discriminatory interaction in locker rooms) in addition to barriers experience by the general population (e.g., limited time, commitment). These barriers are further exacerbated by pervasive stigma and discrimination experienced by SGM communities in the Deep South. The state of Alabama continues to have discriminatory laws (e.g., HIV/AIDS criminalization, lack of LGBTQ topics in schools, exclusions of LGBTQ parents in adoption and foster placement) which contribute to massive mental and physical health burdens among SGM adults. Given the potential to address a range of critical health outcomes by increasing physical activity, new dynamic approaches are urgently needed, and we therefore propose building on the current parent award to: Phase 1 (6 months) - Conduct phone interviews with 20 SGM adults living in the rural Black Belt counties of Alabama to determine what aspects of the current recruitment and retention strategies, as well as intervention content, should be adapted. Phase 2 (6 months) - Finalize the DIAL intervention in collaboration with our community partners, academic experts, and IVR The insights from the interviews will be presented to our stakeholders in a virtual workshop to receive feedback and further inform the adaptation of intervention procedures and content. Following the workshop, ur IVR developer from the parent grant will work with his programming team to mock-up the developer and programming team for implementation. o beta version of adapted intervention content for review and feedback at a subsequent workshop. Feedback will be used to finalize intervention content changes for implementation. Upon completion of the 12-month administrative supplement, we will be positioned for an R34 application to conduct final usability testing and a pilot trial of the newly adapted physical activity intervention to address health disparities amongst rural SGM populations in Deep South.

Sexual and gender minority adults living in the rural, Deep South experience pervasive stigma and discrimination which further exacerbate a range of health disparities that are driven by physical inactivity. New dynamic approaches are urgently needed, and we therefore propose building on our current study to identify if and how retention and recruitment strategies, as well as intervention content, of an Interactive Voice Response-supported study can be adapted to meet the unique and pressing needs of sexual and gender minority people.