628 - Perceptions of the utility of community health workers in addressing barriers to diabetes technology device use in black children with type 1 diabetes

Poster Number: 628
Publication Number: 628.2883

Background: Disparities persist in both the uptake and continued use of diabetes technologies such as continuous glucose monitors and automated insulin devices by non-Hispanic Black youth with type 1 diabetes (T1D). Previous focus groups with Black patients with T1D identified CHWs as a potential way to decrease disparities in diabetes technology use.

Objective: To assess barriers to technology use, perceived utility of a community health worker (CHW) serving on a clinical team as a diabetes technology coach, and recommendations to increase acceptability of a CHW intervention, from the perspectives of Black young adults and parents.

Design/Methods: Applying the Health Information Technology Acceptance Framework for Chronic Diseases’ Management, from January to June 2023 we conducted pre-implementation telephone interviews (n=17) followed by Zoom focus groups (n=4) with Black young adults and parents of Black children with T1D, all of whom had current or previous experience with a diabetes device. Sessions were audio-recorded, transcribed, and analyzed using content analysis to identify themes related to framework domains. Findings were shared with the intervention team after each round of data collection to iteratively refine the features of the CHW component of a broader intervention.

Results: Participants identified barriers consistent with prior literature, most commonly citing challenges with device malfunction and maintenance and consistent device use. Parents and young adults saw the potential for the CHW to share knowledge, advice, and resources; act as a source of motivation to stay on track, and provide hands-on help with device challenges. Parents and young adults expressed that the CHW should be knowledgeable; supportive, a good listener, and have shared experience (i.e same race, community, have personal experience with diabetes). Beyond diabetes technology they envisioned CHWs assisting with insurance issues, nutrition, and other community resources. The majority (n=12) expressed preference for virtual visit. Young adults expressed a gap in peer support and a desire to build a relationship with the CHW. In follow-up focus groups, participants indicated openness to meeting in a neutral, community location over home visits and the benefit of CHWs especially in the early months of device use.

Conclusion(s): Black young adults and parents of children with T1D saw CHWs as useful supports to assist between clinical visits and would be more open to visits conducted virtually or in a neutral location.