Audible diabetesRx: An audio-based digital tool to address health literacy barriers to medication adherence in type 2 diabetes

About This Grant

PROJECT SUMMARY Background: Latino adults in the U.S. have higher prevalence of type 2 diabetes (T2D) and mean HbA1c and are nearly twice as likely to report suboptimal adherence to diabetes medications as non-Hispanic White individuals. Low heath literacy (prevalent among ~40% of U.S. Latino adults) is an important modifiable contributor to suboptimal diabetes medication adherence in this population. Audio-based interventions can improve medication adherence and HbA1c among individuals with low health literacy. However, audio-based interventions have lacked scalability (i.e. rely on person-delivered education) and may not provide on-demand information needed to support sustained adherence. Digital diabetes technology can provide on-demand medication information and support medication adherence, but such tools have generally been limited to written content, which can pose additional challenges for people with low health literacy. Preliminary data: In the parent K23 study, the PI (Dr. Seiglie) adapted an English-language, text message platform (REACH) to an adult Latino population with T2D (REACH-Español). REACH delivers personalized, written content that addresses patient-reported barriers to diabetes medication adherence. At enrollment in the REACH-Español pilot RCT, 84% of participants identified a health literacy barrier to diabetes medication adherence as a primary barrier; the barrier “I have trouble reading medication labels” was selected by a majority of participants with baseline HbA1c >9%. Trouble reading medication labels, which could be contributing to poor glycemic control in this population, cannot be solely addressed through language-concordant written information. An audio- based alternative providing on-demand diabetes medication information in Spanish could overcome written information barriers and improve HbA1c. Research: This proposal aims to develop Audible diabetesRx, an audio-based, text message tool that will provide on-demand diabetes medication information tailored for Latino adults with T2D and low health literacy. Aim 1a will develop an Audible diabetesRx prototype by implementing the user-centered sprint methodology with engagement of Latino adults with T2D (n=12) who selected “I have trouble reading medication labels” in the parent K23, as well as expert stakeholders (user design, health IT, and community pharmacists). Aim 1b will conduct beta and usability testing of Audible diabetesRx among Latino adults with T2D and low health literacy (n=18-24). Aim 2 will assess feasibility and acceptability of Audible diabetesRx in a 3-month pre-post study among Latino adults with T2D and low health literacy (n=30). Impact: This R03 proposal has the potential to develop a novel line of research focused on audio-based, digital tools to address health literacy barriers to medication adherence in T2D. The proposal will focus on U.S. Latino adults with T2D, but study findings could have relevance in other chronic conditions and/or English- speaking populations with low health literacy. Findings resulting from this R03 will serve as the basis for a future R01 application to assess efficacy of Audible diabetesRx and will support Dr. Seiglie’s K-to-R transition.