(1125) Beliefs, Mistrust, and Race-congruent Peer Support in Black Adults with Diabetes: A Mixed Methods Pilot Feasibility Trial

Objectives: Black adults disproportionately have poor glycemic control and medication non-adherence compared to other racial and ethnic subgroups. Current diabetes self-management programs have a limited focus on addressing Black adults’ health beliefs, provider mistrust and sociocultural barriers to taking diabetes medications. Thus, we developed an intervention, incorporating culturally tailored educational sessions on beliefs about diabetes and mistrust, and race-congruent peer support into an evidence-based diabetes program. Using a mixed methods design to examine the feasibility and acceptability of a pilot trial is optimal to address key feasibility questions before conducting a larger powered effectiveness trial.

Methods: This was a pilot randomized clinical trial comparing an 8-week intervention including phone-based race congruent peer support versus the 6-week standard diabetes program. Four feasibility intervention domains were evaluated, including capability for (a) recruitment, (b) randomization, (c) intervention adherence and acceptability and (d) retention. Data were collected through self-reported questionnaires, field notes, semi-structured interviews and focus groups. Descriptive statistics in the study were performed using SPSS version 28.0. Qualitative content analysis was used to inductively explore participants’ experience and feedback on the program as well as the barriers they encountered during the program and potential strategies to overcome the challenges. Mixed methods integration was implemented using a side-by-side joint display to compare, synthesize and interconnect the quantitative and qualitative results across the four domains.

Results: Confirmed by quantitative and qualitative data, community outreach was a feasible way to reach potential participants (49/48, 102%). Participants preferred interactive community engagement and word of mouth from prior participants for recruitment. Regarding enrollment and randomization acceptability, having an adapted motivational interviewing approach and using health literacy principles in orientation was feasible. Explaining the study and discussing the pros and cons related to trial participation may have enhanced enrollment rates (14/15, 93%), time of enrollment of 13 days (47 days faster than the anticipated 60 days) and reduced drop-out after randomization (0/14, 0%). Consistent with quantitative data, participants supported the explanation of trial expectations and appreciated the explicit clarification of the differences between trial arms. Average group session attendance was 80% with a mean completion rate of 5.6 (SD = 2.5) for 7 intervention phone calls. Themes showed high satisfaction with group sessions and participants’ appreciated practicing techniques related to communicating with healthcare providers, planning healthy meals and setting goals for self-management. There were suggestions to add goals related to medication-taking. The retention rate was 93% (13/14) for participants and 67% (2/3) for Ambassadors. The reasons of dropping out were conflicts with schedule and medical issues.

Conclusions: A culturally tailored diabetes management program targeting beliefs, provider mistrust and including race-congruent peer support may be feasible and acceptable. Explaining the rationale of randomization before enrollment may enhance trial enrollment. Future studies should consider a more interactive approach to recruitment, tailoring the program to address goals for medication-taking and recruiting healthcare professionals who share similar backgrounds with the participants to enhance intervention adherence.