Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless.

Introduction: People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods: We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c_7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results: Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion: We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration: https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.

Professional Development, Shifting Perspectives, and Instructional Change among Community College Anatomy and Physiology Instructors.

This paper presents community college (CC) instructors' responses to the Community College Anatomy and Physiology Educational Research (CAPER) project, a professional development program focused on active learning and educational research. We engage with conceptual change theory to better understand why and how CC instructors shifted their perspectives toward active learning. Qualitative data indicate that the participating CC instructors experienced pedagogical discontentment, leading to increased positive beliefs about active learning and educational research. In addition, we find that CC instructors have continued their pursuit of pedagogical change and educational research through communities of practice, which provide positive learning environments.

Teaching Interrupted: How COVID-19 Turned Thoughts into Practice.

The Community College Anatomy and Physiology Education Research (CAPER) project is a 2-year grant that provides a variety of professional development opportunities to community college instructors of Anatomy and Physiology in the United States. Instructors who participate in the CAPER project also take part in a larger research study that uses both qualitative and quantitative methods to track the instructors' progress with adapting new teaching methods into their classrooms. When the COVID-19 pandemic caused global disruption to daily life, there were two cohorts of community college instructors participating in the CAPER project. While the immediate impact of the pandemic on community college instructors was not the subject of the original research project, the data from 12 in-depth interviews conducted in the midst of the pandemic revealed rich insights into teacher beliefs and attitudes, adaptation methods, and online learning as an opportunity for change during a global pandemic. This subset of the data also speaks to the importance of the CAPER project for professional development, as community college instructors in the CAPER program used their new skills to integrate active learning techniques in the online learning environment. In this article, we analyze community college instructors' adaptations to online learning through the lens of conceptual change theory.