Diversity Supplement for Courtney Ortz: Older Adults Using Social Support to Improve Self-Care (OASIS): Adaption, Implementation, and Feasibility of Peer Support for Older Adults with T2DM in Appalachia

Specific Aims Using a mixed methods approach, this proposal expands upon the parent R01 by proposing to identify social needs and risks that influence rural-dwelling older adults’ T2D self-care behaviors. Social needs that influence older adults’ abilities to manage their health care include food, housing, utilities, unexpected expenses, transportation, and medical supplies/medications,1 Social risks include living alone, living with individuals who cannot provide necessary support, insufficient personal hygiene, low income and associated high cost of treatment, and limited access to health care and resources.2 Nevertheless, to develop interventions for rural- dwelling older adults in Appalachia with T2D, we first need to determine the specific set of social needs and risks relevant to their self-care. To address this gap in knowledge, we will assess older adults’ views of their social risks and social needs as well as the views of community leaders on resources that are available to these individuals.?This socioecological approach which suggests multiple levels of influence, including intrapersonal, interpersonal, institutional, community, and policy levels,3 will ensure multiple perspectives which will allow for an understanding of multiple levels of influence. Our long-term goal is to develop an intervention for rural-dwelling older adults living with T2D that directly addresses contextual factors that may influence self-care. The goal of the proposed study is to better understand social risks and needs of older Appalachian adults with T2D and how they influence hemoglobin A1C (HbA1C) levels and psychosocial outcomes. Our central hypothesis is that there is a positive association between the number of self-reported social risk/needs, self-care behaviors, and HbA1C level. The rationale for this project is that a determination of how social risk and needs influence self-care for rural-dwelling older adults with T2D will aid in developing a comprehensive intervention. To achieve our goal, we propose the following study aims: Aim 1: Examine the relationship between social risk, social needs, and HbA1C in older adults in Appalachian Kentucky. We will use a mixed method approach wherein we will identify social risk/needs with quantitative data with validated questionnaires. Qualitative data will also be collected to obtain a better understanding of the social risks/needs identified with the validated questionnaires. Specifically, participants will participate in an 8-week photovoice data collection activity where they will be asked to take at least one picture per week of things that represent facilitators or barriers to managing their T2D.4 Semi-structured interviews will allow participants to verbalize the facilitators or barriers in managing their T2D and allow for a deeper understanding of the older adults’ social risks and needs in their T2D care. Aim 2: Explore organizational and community influences of social risk and needs of older adults in Appalachian Kentucky. We will conduct focus groups with community partners, such as community organization leaders, social workers, and case workers, to get community and organizational perspectives on the resources available to older adults and why older adults may or may not use available resources. Using a socioecological approach, focus group questions will be framed at intrapersonal, interpersonal, institutional, community, and policy levels to understand the resources available and/or needed and whether they are being used. Aim 3: Create a resource guide for older adults with T2D in rural Appalachia Kentucky. Building on the findings from aims 1 and 2, we will assemble a community advisory group, comprised of older adults, social workers, case managers, and community leaders, to develop a resource guide that will aid rural older adults in addressing unmet social needs and mitigating social risks that challenge their ability to manage their T2D. Focus groups will be conducted to aid in the creation of this resource guide, and questions asked in the focus group will concentrate on combining the resources aimed at targeting social risks and needs using a socio-ecological approach. We will also identify the best modality to share the resource guide with the target population. IMPACT: Findings from this diversity supplement in conjunction with the parent award will (1) provide additional information regarding social risk and needs specific to older adults diagnosed with T2D in Appalachian communities to inform future intervention development, and (2) provide Dr. Courtney Ortz with the opportunity to leverage her experience as a gerontologist and social worker to pursue her long-term goal of transitioning to a postdoctoral position and into an independent researcher at the University of Kentucky. Key Words: Type 2 Diabetes, Appalachia, older adults, social needs, social risks