title: Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.
abstract: One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework.
  
  
  
  STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design.
  
  
  
  STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations.
  
  
  
  ClinicalTrials.gov NCT02240420.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA. margaret.handley@ucsf.edu.|Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA. margaret.handley@ucsf.edu.|UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA. margaret.handley@ucsf.edu.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Handley
authors.affiliation: Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA.|Zuckerberg San Francisco General Hospital, San Francisco, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harleman
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA.|Vista Family Health Center, Santa Rosa, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gonzalez-Mendez
authors.affiliation: Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA.|Zuckerberg San Francisco General Hospital, San Francisco, USA.
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Stotland
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.|UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Althavale
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fisher
authors.affiliation: Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA.|UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Martinez
authors.affiliation: University of California San Francisco, San Francisco, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Ko
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.|UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sausjord
authors.affiliation: Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA.|UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Rios
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000534:rehabilitation*; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods*; D006630:Hispanic or Latino; D006801:Humans; D008490:Medical Informatics / Q000379:methods*; D009042:Motivation; D049590:Postpartum Period; D011203:Poverty; D011247:Pregnancy; D017216:Telemedicine / Q000379:methods*
keywords: Behavior change theory; COM-B model; Diabetes Prevention Program; Diabetes prevention; Health disparities