Health Without Barriers: Community-Engaged Adaptation of a Whole Family-Inclusive Intensive Health Behavior and...

Area of Science:

• Public Health and Preventive Medicine
• Health Behavior Interventions
• Rural Health Equity

Background:

• Type 2 diabetes (T2D) and cardiovascular diseases (CVD) risk factors emerge in adolescence, with rural youth disproportionately affected.
• Standard intensive health behavior and lifestyle treatment (IHBLT) interventions face access and efficacy challenges in rural settings due to unique barriers.
• Tailoring IHBLT to rural contexts, considering structural inequities, is crucial for effective prevention and treatment.

Purpose of the Study:

• To demonstrate a systematic, participatory co-creation process for adapting IHBLT to local rural contexts.
• To evaluate the feasibility and acceptability of an adapted IHBLT program, 'Health Without Barriers,' for rural families.
• To prioritize access for low-income families, Spanish-speaking caregivers, and historically marginalized racial/ethnic groups.

Main Methods:

• Co-creation of an adapted IHBLT program using the Practical, Robust Implementation and Sustainability Model with an equity focus.
• Extensive initial information gathering followed by iterative adaptation and further data collection.
• Feasibility and acceptability assessment via self-report surveys, program attendance, and focus groups with rural families (n=29 adolescents, n=22 caregivers).

Main Results:

• The participatory co-creation process successfully yielded culturally and locally relevant adaptations to the IHBLT program.
• The adapted 'Health Without Barriers' program demonstrated feasibility and acceptability among diverse rural families.
• Findings highlight the potential for tailored interventions to improve T2D and CVD risk factor management in underserved rural populations.

Conclusions:

• Systematic participatory co-creation is effective for adapting health interventions to specific rural community needs and contexts.
• The adapted IHBLT program shows promise for increasing access and efficacy in preventing T2D and CVD among rural adolescents.
• This approach offers a replicable model for researchers and practitioners aiming to enhance health equity in rural settings.