PROJECT SUMMARY Poor health literacy, medication non-adherence, and lack of interventions easily delivered by healthcare providers negatively impact health outcomes in Hispanic patients with type 2 diabetes (T2D). Hispanics use smartphones, download apps, and search online for health-related information more often than other groups in the U.S.; however, health information found online and in existing digital apps can be misleading, difficult to interpret, and is seldom individually tailored. A digital health app with individually tailored educational content which is useable, engaging, and culturally adapted would likely improve comprehensive medication management (CMM) delivery to older Hispanics with T2D by improving their understanding of the disease and medications, and ultimately improve their health outcomes. The proposed project’s goal is therefore to create a digital health app that will empower older Hispanics with T2D to manage their disease. Through previous funding, we developed a computer-delivered, individually-tailored, and culturally adapted prototype health intervention consisting of three modules which target health literacy and aim to improve adherence in older Hispanics with T2D. During preliminary testing, patients agreed that the modules were easy to use, culturally appropriate, and relevant to their needs, while pharmacists agreed that the intervention could streamline patient counseling and offered a tailored approach to provide CMM. In this proposal, we will transform the prototype content into a modernized digital health app aimed at maximizing CMM in this patient population by improving health literacy and medication adherence. Based on the preliminary testing, we hypothesize that this digital health app will be useable and accepted by both the patients and their pharmacists, and will improve medication adherence, hemoglobin A1c, and fasting glucose levels. Our proposal consists of two Specific Aims: 1) to refine and modernize previously developed health intervention content and develop a digital health app for older Hispanic patients with T2D and their pharmacists that is usable and accepted; and 2) to assess health outcomes by pilot testing the app in 40 Hispanic adults 50 years or older with T2D. The long-term goal is to create a digital health app to educate patients by providing critical, individually tailored information in a secure format that is easy to use, cost-effective and which will enable pharmacists to provide patient-tailored CMM. Following completion of the proposed project, the refined digital health app will be ready for wider dissemination and testing in a larger-scale study. Our team will also be prepared to conduct a large scale, robust, and pragmatic trial of the integration of the digital health app into pharmacist patient care services to improve T2D medication use and health outcomes. The results of this project will not only lead to a sustained, powerful influence on managing T2D, but will also provide a foundational framework for ubiquitous application to different diseases, languages, and cultures that can be leveraged by various healthcare providers to provide CMM in a systematic and efficient manner.

PROJECT NARRATIVE Currently, 41% of Hispanics (34.2 million persons) have below basic health literacy (HL) levels, and, when combined with multiple burdens of chronic diseases such as type 2 diabetes (T2D), this negatively impacts adherence to treatment. The goal of the proposed project is to create a culturally adapted digital health app that will empower older Hispanics with T2D to improve medication adherence and manage their illness by providing tailored, accurate information on T2D, self-management options, and knowledge on prescribed medications while directly involving pharmacists providing them comprehensive medication management. The results of this project will not only lead to a sustained, powerful influence on T2D management, but will also provide a foundational framework for ubiquitous application to different diseases, languages, and cultures that can be leveraged by various healthcare providers to provide comprehensive medication management in a systematic and efficient manner.