Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention in Low-income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial (Preprint)
Authors: Hu Lu , Islam Nadia , Zhang Yiyang , Shi Yun , Li Huilin , Wang Chan , Sevick Mary Ann 
Published: September 2022

BACKGROUND

Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the U.S. health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit the access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media-based diabetes intervention may be feasible to reach this community.

OBJECTIVE

The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media-based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial.

METHODS

CARE was a pilot randomized controlled trial (RCT, n=60) of a 3-month intervention. Participants were randomized to one of the two arms (n=30 each): wait-list control, or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from study community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. HbA1c, self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes.

RESULTS

This pilot RCT study was approved by the Institute of Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021 and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022 with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale R01 study.

CONCLUSIONS

This study will serve as an important first step to exploring scalable interventions to increase access to evidence-based diabetes interventions in underserved low-income immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (e.g., WhatsApp).

CLINICALTRIAL

Clinicaltrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697