711-P: Measuring Social Determinants of Health (SDOH) Using Ecological Momentary Assessment (EMA) in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)

Background: While it is recognized that underserved YA with T1D experience SDOH that contribute to adverse outcomes, it is unknown how often and what SDOH are most frequently experienced, or whether they interfere with self-management, which limits potential for intervention. Using EMA methods, we explored relationships between daily experience of SDOH and diabetes self-management.

Methods: We recruited 61 underserved YA (18-30 yo) with T1D from the Bronx, New York. We prompted EMA surveys via smartphone 3 times daily over a 14-day period. We asked YA how SDOH interfered with self-management twice daily: “Since the last survey, which of the following life factors got in the way of your diabetes care today?”. Answer choices included money, food, housing, transportation, personal safety, mental health, and racial/ethnic or socioeconomic discrimination. Descriptive statistics were used to quantify and report frequency and variation of SDOH related care burden over the 14-day period.

Results: Overall, 51 YA completed 778 EMA surveys over the 14-day period (23±4 yo, 65% F, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean HbA1c 8.6%). Thirty-seven YA (73%) endorsed at least one daily SDOH related diabetes care burden, on an average of 22% of days. Mental health problems were reported most frequently (n=23 [62%], 11% of days), followed by transportation problems (n=17 [46%], 6% of days), and financial problems (n=15 (41%), 5% of days). The other SDOH choices accounted for less than 5% of responses.

Conclusion: Using EMA to study SDOH in a short timeframe identified significant daily SDOH related diabetes care burdens in underserved YA with T1D. Mental health, transportation, and financial barriers prominently and frequently interfered, while others were described more sporadically albeit still present. SDOH need to be measured in new ways to better understand how and when to intervene to improve outcomes in underserved populations.