This is an application for a K23 award for Dr. Elizabeth Burner, an emergency physician and patient- oriented clinical researcher at the University of Southern California. She is developing a research agenda examining novel communication technologies to improve patient self-management of diabetes. This K23 award will provide Dr. Burner with support to (1) become an expert in mixed-methods research strategies (2) conduct clinical investigations of a mobile phone based behavioral intervention for urban Latino patients with diabetes that incorporates an augmented social module (3) conduct sophisticated statistical analysis to examine patient characteristics that impact the intervention’s efficacy (4) develop an independent clinical research career. Dr. Burner has established a mentoring team lead by Dr. Thomas Buchanan with expertise in diabetes and interventions among low-income Latinos and two co-mentors: 1) Dr. Anne Peters, with expertise in clinical trials with patients with diabetes, and 2) Dr. Shinyi Wu, with expertise in health systems, mobile health interventions and non-English speaking patients. She will also have key advisors in 1) Dr. Sanjay Arora, with expertise in mobile health with emergency department patients 2) Dr. Lourdes Baezconde-Garbanati with expertise in qualitative methods and culturally sensitive interventions for Latinos and 3) Dr. Wendy Mack, with expertise design and statistical analysis of non-cancer clinical trials. Dr. Burner will be taking formal coursework, participating in several research seminars at the University of Southern California and will conduct a mentored research project. Diabetes has disproportionately affected the Latino population. TExT-MED (Trial to Examine Text Message for Emergency Department Patients with Diabetes) is a locally designed, successful mobile health (mHealth) intervention for low income Latinos with diabetes. Social support interventions have likewise been successful at improving patient self-efficacy and disease management but are limited in scale due to two key obstacles: 1) requirements of in-person training of family and friends to be supporters and 2) the need to coordinate schedules and physical location between the patient and their supporter. mHealth can overcome these obstacles by allowing supporters to be trained remotely via a mobile platform and by allowing communication between a patient and supporter to occur at any time or place. The proposed intervention leverages the success of TExT-MED by augmenting the program with a social supporter that each patient can select from his or her own social support system (Family And friend Network Supporters (FANS)), creating TExT-MED+FANS. Aim 1 refines and lengthens the preliminary TExT-MED+FANS intervention through focus groups and individual interviews with cognitive interview techniques. Aim 2 conducts a 12 month, randomized pilot study of this intervention. Preliminary data will be collected on change in glycemic control measured by Hemoglobin A1c and change in healthy behavior choices measured by multiple validated scales to support a future fully- powered trial. Lastly, Aim 3 evaluates the user experience with TExT-MED+FANS, and the impact of TExT- MED+FANS on patient motivation, self-efficacy and behaviors through a qualitative analysis of semi-structured individual interviews. This research will form the basis for a fully powered study of this mHealth intervention to improve diabetes behaviors and outcomes for a bilingual population.

This study will be a comprehensive evaluation of a highly scalable and low-cost social support intervention for patients with diabetes delivered entirely via mobile phones. It will provide key insights and novel directions for future mHealth interventions for chronic diseases, particularly in low-income, Spanish speaking populations.