Diabetes Homelessness Medication Support Program in Spanish

Not Applicable

Completed

Interventions: Behavioral: Diabetes Homelessness Medication Support Program in Spanish

Brief Summary: This single-arm trial of the Diabetes Homeless Medication Support intervention for Spanish-speaking people (n=12) will test the perception and feasibility of anticipated study procedures.

Detailed Description: This study has an overall goal to modify and pilot test a previously developed collaborative care intervention using motivational interviewing and behavioral activation alongside education and psychosocial support to improve medication adherence tailored to the experiences of people experiencing homelessness and diabetes (DH). The intervention was developed in English. This study is intended to test the modified intervention for DH who speak Spanish (DH-SH). The study team's central hypothesis is that medication adherence and diabetes self-care (and eventual glycemic control, health care use/cost) will improve with an intervention tailored to the unique context of DH-SH.

This protocol tests patient perceptions of the feasibility and acceptability of study procedures and refines the D-Homes treatment manual through test cases (n=12). The study team hypothesizes that the D-Homes manual and study procedures will be feasible and acceptable to DH-SH as measured by self-report and post-treatment interview.

Recruitment & Eligibility

Inclusion Criteria

Age 18 yrs or older
Spanish-speaking
Recent homelessness by federal definition (HEARTH ACT)
1. Any housing instability in the last 12 mo. (includes supported housing or worry about paying rent)
2. Significant housing instability in the last 24 mos. (includes any stay in shelter, outside, or places not meant for human habitation)
Self-reported diagnosis of type 2 diabetes, later verified in medical record
Plan to stay in local area or be reachable by phone for the next 16 weeks
Willingness to work on medication adherence and diabetes self-care

Exclusion Criteria

Inability to provide informed consent (e.g. presence of a legal guardian, prisoners)
Active psychosis or intoxication precluding ability to give informed consent
Pregnant or lactating females
Patients who choose to opt out of research

Arm && Interventions

Group	Intervention	Description
DH-Spanish Intervention	Diabetes Homelessness Medication Support Program in Spanish	Behavioral treatment by a diabetes wellness coach.

Primary Outcome Measures

Name	Time	Method
Acceptability of Intervention	at 16 weeks	Client Satisfaction Questionnaire, 8-item version, with a score range from 8-32, higher score indicating higher satisfaction.

Secondary Outcome Measures

Name	Time	Method
Change in Glycemic Control	Baseline and 16 weeks	We will measure glycemic control using hemoglobin A1c. This will be done on a consistent, validated point-of-care machine using blood samples collected via venipuncture. We will compare glycemic control from baseline to 16 weeks.
Health-related Quality of Life	Baseline and 16 weeks	As measured by the 12 Item Short Form Survey (SF-12), a 12-question questionnaire. The SF-12 is analyzed for two summary scores - the physical component score (PCS-12) and the mental component score (MCS-12). The average score of each component is 50 for people in the United States, with a standard deviation of 10 points. Scores above 50 indicate higher than average health-related quality of life while scores below 50 indicate lower than average health-related quality of life.
Diabetes Medication Adherence	Baseline and 16 weeks	As measured by the Adherence to Refills and Medications Scales-Diabetes (ARMS-D), Total scores range from 12-48, with higher values indicating worse outcomes. We will compare ARMS-D scores from baseline to 16 weeks.