654-P: Insights on Inclusion—Tailoring a Health Insurance Toolkit to Diverse Emerging Adults with Type 1 Diabetes
Authors: SHANNON CHANTEL S. , KANCHIBHATLA ANUHYA K. , JANE ROCHE MARY , RIEKE JORDEN , LEWIS CLAUDIA , WILLIAMS DIONNE A. , LUNDGRIN ERIKA L. , HATIPOGLU BETUL , LITCHMAN MICHELLE L. , ALLEN NANCY A. , BLANCHETTE JULIA E. 
Published: June 2024

Introduction: Emerging adults (EA) ages 18-30 with type 1 diabetes (T1D) experience unique challenges navigating the healthcare system and health insurance. Financial stress and health insurance literacy (HIL) are lower among racially/ethnically diverse EA and contribute to less optimal self-management outcomes and quality of life. The purpose of this study is to understand how to tailor a financial and HIL toolkit to racially/ethnically diverse EA with T1D.
Methods: A community advisory board (CAB) engaged in five 60-minute focus groups. Transcripts were de-identified and coded by three team members for a deductive thematic analysis using a priori codes. An independent investigator cross-checked codes and resolved discrepancies to minimize bias. Member-checking was performed using a structured guide to validate findings.
Results: The CAB had 100% retention and was comprised of six EAs with T1D (50% female, 66.6% racially/ethnically diverse, 50% Medicaid, mean age 26.6 ± 7.26 years) and four financial/insurance/diabetes experts (mean age 50.75 ± 7.04 years). The following key themes to tailor the toolkit to racially/ethnically diverse EA with T1D emerged: 1) addressing clinician bias (ableism, technology/therapy recommendation bias), 2) community and support systems, 3) self-advocacy (empowerment, mental health impacts of T1D), 4) acknowledging health disparities (navigating financial and insurance stress, geographic area, health and insurance literacy) and 4) representation (culture and family dynamics, healthcare providers with T1D, racial/ethnic media representation).
Conclusion: The CAB emphasized addressing clinician bias, community/support systems, self-advocacy, health disparities and representation to tailor the toolkit to racially/ethnically diverse EA with T1D. A 13-part mixed-media toolkit has been developed incorporating the key themes identified by the CAB and will be tested for efficacy in a randomized controlled trial.

Disclosure
C.S. Shannon: None. A.K. Kanchibhatla: None. M. Roche: None. J. Rieke: None. C. Lewis: None. D.A. Williams: None. E.L. Lundgrin: None. B. Hatipoglu: Research Support; Tandem Diabetes Care, Inc. M.L. Litchman: Research Support; American Diabetes Association, Association of Diabetes Care & Education Specialists, Dexcom, Inc. Other Relationship; Association of Diabetes Care & Education Specialists. Research Support; National Institutes of Health. N.A. Allen: Research Support; Dexcom, Inc. Consultant; Diathrive Health. J.E. Blanchette: Speaker's Bureau; Insulet Corporation. Board Member; Juvenile Diabetes Research Foundation (JDRF). Research Support; American Heart Association, Association of Diabetes Care & Education Specialists, National Institute of Diabetes and Digestive and Kidney Diseases, Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; LifeScan Diabetes Institute. Consultant; WellDoc. Advisory Panel; Cardinal Health/Edgepark.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (G-2305-05992)