582-P: Process Evaluation of Dulce Digital–Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes

Diabetes self-management education and support improves clinical outcomes in populations disproportionately impacted by type 2 diabetes, including ethnic/racial minorities and individuals of low socioeconomic status. Mobile health (mHealth) interventions have been shown to reduce barriers to accessing these services. The Dulce Digital-Me study sought to integrate adaptive mHealth technologies into diabetes management to enhance self-management support and reduce inequities. This process evaluation uses the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population, with no differences in baseline clinical characteristics (HbA1c, systolic blood pressure, or LDL cholesterol) between eligible participants who did not (N=261) versus did (N=310) enroll in the study (ps>0.15) . A key informant interview revealed that the medical assistant health coach (MA) found the adoption of the study to be successful in positively impacting patients’ diabetes self-management. Participants across study arms had no significant differences in delivery of mHealth content (ps>0.07) , demonstrating that the intervention was implemented with fidelity. Participants who received Dulce Digital-Me with additional support from an MA were most engaged in responses to ecological momentary assessment prompts (p<0.02) , suggesting utility and acceptability of integrating medical assistants with mHealth interventions. Perceptions of implementation among study participants were positive—with 93% of all participants reporting that the intervention was helpful in managing their diabetes—and were consistent across study arms (p=0.7) . Further studies are warranted to evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and patient populations.