Integrating Cultural Aspects Into Diabetes Education (INCLUDE)

August 10, 2026 updated by: NYU Langone Health

INCLUDE: INtegrating CuLtUral Aspects Into Diabetes Education

The goal of this study is to examine the efficacy of the video-based Diabetes Prevention Program (DPP) + Community-supported agriculture (CSA) (hereafter INCLUDE) intervention compared with a wait-list control group (hereafter CONTROL) on diabetes prevention among Chinese Americans at risk of developing T2D in NYC. Participants will be randomized with equal allocation to one of the two groups. The INCLUDE group will receive 2-3 culturally tailored DPP brief video/week for 12 weeks delivered via WeChat. They will also have access to a 10-week CSA program that Co-I Dr. Stella Yi has built in existing and ongoing community-partnered work in Brooklyn Chinatown. The CONTROL group will continue to receive their usual care and, at the end of the study, they will receive DPP videos and gift cards with a value equal to the 10-week CSA program. Measurements will occur at baseline, 3, and 6 months. This study will provide critical information on whether it is efficacious to use an existing social media platform plus CSA support to enhance access to DPP. If the intervention is proven efficacious, this project can provide important data for future scaling of this intervention. This study may serve as a transformative new model to enhance access to culturally tailored diabetes education and promote health equity for underserved limited English proficiency (LEP) immigrant and minority groups.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Chinese Americans are the second largest immigrant group in the U.S., who suffer disproportionately high type 2 diabetes (T2D) burden and have poor diabetes outcomes. The Diabetes Prevention Program (DPP) is an evidence-based intervention to prevent or delay T2D. However, many social determinants of health (SDOH) barriers limit the access of DPP to underserved Chinese Americans, including high rates of LEP, poverty, lack of health insurance, and poor access to care. Furthermore, there is a significant shortage of cultural- and linguistic-concordant providers to deliver DPP. Given the high T2D burden and rapid growth in the Chinese American population, there is an urgent need for research to make DPP accessible to this minority group. High social media use (e.g., WeChat) in Chinese Americans suggests a promising mechanism for enhancing access to DPP. Yet, this mobile health (mHealth) intervention alone is likely insufficient to address many SDOH barriers reported by low-income and LEP Chinese Americans, including food insecurity, and lack of access to fruits and vegetables. Community-supported agriculture (CSA) has been demonstrated to be an effective way to improve food security in White populations, and may help to address food access issues in LEP Chinese Americans. Guided by the NIMHD Research Framework, the investigators argue that a mHealth DPP intervention (individual level) that is supplemented with a culturally appropriate CSA (community level) with complementary nutrition/produce preparation education is a novel model for enhancing access to DPP and addressing SDOH barriers in LEP Chinese Americans. The investigators' pilot work demonstrates the feasibility, acceptability, and potential efficacy of WeChat-delivered educational videos targeting T2D management, and Co-I Dr. Stella Yi's pilot study has found high feasibility of the CSA model in LEP Chinese Americans. Building upon these pilot data, the investigators will adapt their current T2D management intervention to include video content relevant to DPP and combine it with a CSA model. The goal of this study is to examine the efficacy of the video-based DPP+CSA (hereafter INCLUDE) intervention compared with a wait-list control group (hereafter CONTROL) on diabetes prevention among Chinese Americans at risk of developing T2D in NYC. Participants will be randomized with equal allocation to one of the two groups. The INCLUDE group will receive 2-3 culturally tailored DPP brief video/week for 12 weeks delivered via WeChat. They will also have access to a 10-week CSA program that Co-I Dr. Stella Yi has built in existing and ongoing community-partnered work in Brooklyn Chinatown. The CONTROL group will continue to receive their usual care and, at the end of the study, they will receive DPP videos and gift cards with a value equal to the 10-week CSA program. Measurements will occur at baseline, 3, and 6 months. This study will provide critical information on whether it is efficacious to use an existing social media platform plus CSA support to enhance access to DPP. If the intervention is proven efficacious, this project can provide important data for future scaling of this intervention. This study may serve as a transformative new model to enhance access to culturally tailored diabetes education and promote health equity for underserved LEP immigrant and minority groups.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
150

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10016
        • NYU Langone Health

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

Participants must:

  1. self-identify as a Chinese immigrant or Chinese American;
  2. be between 18-70 years old,
  3. have a medical diagnosis of prediabetes or have a prediabetes risk test score of greater or equal to 5;
  4. Body Mass Index (BMI) >= 23 kg/m2,
  5. be willing to receive brief videos regarding diabetes prevention, and 6) possess a smartphone or, if they do not have one, be willing and able to use a study smartphone.

Exclusion Criteria:

Individuals will be excluded from participation if they meet any of the following:

  1. unable or unwilling to provide informed consent;
  2. unable to participate meaningfully in the intervention (e.g., uncorrected sight and hearing impairment);
  3. unwilling to accept randomization assignment;
  4. are pregnant, plan to become pregnant in the next 6 months, or become pregnant during the study, or
  5. are breastfeeding (e.g., they may have potential dietary restrictions).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
No Intervention: CONTROL
Participants will receive the standard of usual care.
Experimental: INCLUDE
Participants will receive 2-3 Diabetes Prevention Program (DPP) videos per week for 12 weeks. Additionally, community health workers (CHWs) will call participants every other week to review key video content, help with goal setting and problem solving, and assess and address social determinants of health (SDOH) barriers. Participants will also receive fresh produce from the 10-week community-supported agriculture (CSA) program.
Behavioral: Diabetes Prevention Program (DPP)
Video-based intervention to prevent or delay Type 2 Diabetes. Includes both educational and social cognitive theory (SCT)-based behavioral content. Each video lasts about 5 minutes in duration.
Behavioral: Community-Supported Agriculture (CSA)
Provides weekly and culturally appropriate fresh produce for 10 weeks.
Behavioral: Community Health Worker support (CHW)
CHWs will call participants every other week to review key video content, help with goal setting and problem solving, and assess and address SDOH barriers.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Percentage Change in Body Weight
Time Frame: Baseline, Month 3
Weight measured in pounds (lbs) via a standardized weight scale.
Baseline, Month 3
Percentage Change in Body Weight
Time Frame: Month 3, Month 6
Weight measured in pounds (lbs) via a standardized weight scale.
Month 3, Month 6

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in Weight Efficacy Lifestyle Questionnaire (WEL) Score
Time Frame: Baseline, Month 3
20-item participant self-report of confidence level in resisting desire to eat. Assessed via 10-point Likert scale ranging from 0 (not confident) to 9 (very confident). Scores range from 0-180; higher scores indicate higher confidence level in resisting desire to eat. An increase in scores indicates confidence levels in resisting desire to eat increased during the observation period.
Baseline, Month 3
Change in Weight Efficacy Lifestyle Questionnaire (WEL) Score
Time Frame: Month 3, Month 6
20-item participant self-report of confidence level in resisting desire to eat. Assessed via 10-point Likert scale ranging from 0 (not confident) to 9 (very confident). Scores range from 0-180; higher scores indicate higher confidence level in resisting desire to eat. An increase in scores indicates confidence levels in resisting desire to eat increased during the observation period.
Month 3, Month 6
Change in Starting the Conversation (STC) Diet Scale Score
Time Frame: Baseline, Month 3
8-item self-report questionnaire measuring dietary behaviors. Scores range from 0 to 16; lower scores indicate more healthful dietary behaviors. A decrease in scores indicates healthful dietary behaviors increased during the observation period.
Baseline, Month 3
Change in Starting the Conversation (STC) Diet Scale Score
Time Frame: Month 3, Month 6
8-item self-report questionnaire measuring dietary behaviors. Scores range from 0 to 16; lower scores indicate more healthful dietary behaviors. A decrease in scores indicates healthful dietary behaviors increased during the observation period.
Month 3, Month 6
Change in International Physical Activity Questionnaire (IPAQ) Short-Version Score
Time Frame: Baseline, Month 3

7-item self-assessment providing an estimate of the number of minutes per week participants engage in three categories of physical activity: vigorous activity, moderate activity, and walking activity.

Scores are expressed in metabolic equivalent (MET) minutes per week. MET minutes represent the amount of energy expended carrying out physical activity. Higher scores indicate higher weekly levels of physical activity. An increase in scores indicates weekly levels of physical activity increased during the observation period.
Baseline, Month 3
Change in International Physical Activity Questionnaire (IPAQ) Short-Version Score
Time Frame: Month 3, Month 6

7-item self-assessment providing an estimate of the number of minutes per week participants engage in three categories of physical activity: vigorous activity, moderate activity, and walking activity.

Scores are expressed in metabolic equivalent (MET) minutes per week. MET minutes represent the amount of energy expended carrying out physical activity. Higher scores indicate higher weekly levels of physical activity. An increase in scores indicates weekly levels of physical activity increased during the observation period.
Month 3, Month 6
Change in San Francisco Chinese Food Security Module Score
Time Frame: Baseline, Month 3

18-item self-assessment measuring food access and insecurity among Chinese immigrants. Responses of "yes," "often," "sometimes," "almost every month," and "some months but not every month" are coded as affirmative. Food Security Status Levels are assigned based on the total number of affirmative responses.

Households with children: 0-2 affirmative responses = "Food Secure"; 3-7 = "Food Insecure without Hunger"; 8-12 = "Food Insecure with Hunger, Moderate"; 13-18 = "Food Insecure with Hunger, Severe."

Households without children: 0-2 affirmative responses = "Food Secure"; 3-5 = "Food Insecure without Hunger"; 6-8 = "Food Insecure with Hunger, Moderate"; 9-10 = "Food Insecure with Hunger, Severe."

A decrease in the number of affirmative responses indicates food security status improved during the observation period.
Baseline, Month 3
Change in San Francisco Chinese Food Security Module Score
Time Frame: Month 3, Month 6

18-item self-assessment measuring food access and insecurity among Chinese immigrants. Responses of "yes," "often," "sometimes," "almost every month," and "some months but not every month" are coded as affirmative. Food Security Status Levels are assigned based on the total number of affirmative responses.

Households with children: 0-2 affirmative responses = "Food Secure"; 3-7 = "Food Insecure without Hunger"; 8-12 = "Food Insecure with Hunger, Moderate"; 13-18 = "Food Insecure with Hunger, Severe."

Households without children: 0-2 affirmative responses = "Food Secure"; 3-5 = "Food Insecure without Hunger"; 6-8 = "Food Insecure with Hunger, Moderate"; 9-10 = "Food Insecure with Hunger, Severe."

A decrease in the number of affirmative responses indicates food security status improved during the observation period.
Month 3, Month 6
Change in SDOH Score
Time Frame: Baseline, Month 3
The 14-item SDOH questionnaire assessed core health-related social needs and barriers across five domains: economic stability (e.g., food access and housing stability), education access and quality (e.g., need to improve English proficiency, reading skills, or educational attainment), health care access and quality (e.g., insurance coverage), neighborhood and built environment (e.g., housing conditions), and social and community context (e.g., racial discrimination; need for childcare; and need for assistance addressing tobacco, alcohol, or drug use). Items used dichotomous response options (1 = "Yes"; 0 = "No"). An overall SDOH score was calculated by summing responses across the 14 items (range: 0-14), with higher scores indicating greater SDOH-related barriers.
Baseline, Month 3
Change in SDOH Score
Time Frame: Month 3, Month 6
The 14-item SDOH questionnaire assessed core health-related social needs and barriers across five domains: economic stability (e.g., food access and housing stability), education access and quality (e.g., need to improve English proficiency, reading skills, or educational attainment), health care access and quality (e.g., insurance coverage), neighborhood and built environment (e.g., housing conditions), and social and community context (e.g., racial discrimination; need for childcare; and need for assistance addressing tobacco, alcohol, or drug use). Items used dichotomous response options (1 = "Yes"; 0 = "No"). An overall SDOH score was calculated by summing responses across the 14 items (range: 0-14), with higher scores indicating greater SDOH-related barriers.
Month 3, Month 6
Change in Illness Perceptions score
Time Frame: Baseline, Month 3
Illness perceptions were measured using the 8-item Brief Illness Perception Questionnaire, adapted to assess participants' perceptions of prediabetes or risk for T2D. The instrument includes 8 scaled items rated from 0 to 10 that capture cognitive and emotional representations of diabetes or risk, including perceived consequences, timeline, personal control, treatment control, identity, illness coherence, concern, and emotional response. A ninth open-ended item asks participants to report perceived causes of their prediabetes or diabetes risk. Item scores were summed, ranging from 0 to 80, with higher scores indicating a more negative perception of prediabetes or diabetes risk. We expected the intervention to reduce Brief IPQ total scores, reflecting a shift toward a more manageable perception of diabetes risk.
Baseline, Month 3
Change in Illness Perceptions score
Time Frame: Month 3, Month 6
Illness perceptions were measured using the 8-item Brief Illness Perception Questionnaire, adapted to assess participants' perceptions of prediabetes or risk for T2D. The instrument includes 8 scaled items rated from 0 to 10 that capture cognitive and emotional representations of diabetes or risk, including perceived consequences, timeline, personal control, treatment control, identity, illness coherence, concern, and emotional response. A ninth open-ended item asks participants to report perceived causes of their prediabetes or diabetes risk. Item scores were summed, ranging from 0 to 80, with higher scores indicating a more negative perception of prediabetes or diabetes risk. We expected the intervention to reduce Brief IPQ total scores, reflecting a shift toward a more manageable perception of diabetes risk.
Month 3, Month 6
Change in Perceived Stress Score
Time Frame: Baseline, Month 3
Perceived stress was assessed using the 10-item Perceived Stress Scale, a widely used and validated measure of the extent to which individuals perceive situations in their lives as stressful, unpredictable, uncontrollable, and overwhelming. Items are rated on a 5-point scale from 0 ("never") to 4 ("very often"), yielding a total score ranging from 0 to 40. Higher scores indicate greater perceived stress.
Baseline, Month 3
Change in Perceived Stress Score
Time Frame: Month 3, Month 6
Perceived stress was assessed using the 10-item Perceived Stress Scale, a widely used and validated measure of the extent to which individuals perceive situations in their lives as stressful, unpredictable, uncontrollable, and overwhelming. Items are rated on a 5-point scale from 0 ("never") to 4 ("very often"), yielding a total score ranging from 0 to 40. Higher scores indicate greater perceived stress.
Month 3, Month 6
Change in Depressive Symptoms Score
Time Frame: Baseline, Month 3
Depressive symptoms were assessed using the Patient Health Questionnaire-2, a brief screening tool for patients with low literacy that measures the frequency of depressed mood and loss of interest or pleasure during the past 2 weeks. Each item is rated on a 4-point scale from 0 ("not at all") to 3 ("nearly every day"), yielding a total score ranging from 0 to 6. Higher scores indicate greater depressive symptom severity.
Baseline, Month 3
Change in Depressive Symptoms Score
Time Frame: Month 3, Month 6
Depressive symptoms were assessed using the Patient Health Questionnaire-2, a brief screening tool for patients with low literacy that measures the frequency of depressed mood and loss of interest or pleasure during the past 2 weeks. Each item is rated on a 4-point scale from 0 ("not at all") to 3 ("nearly every day"), yielding a total score ranging from 0 to 6. Higher scores indicate greater depressive symptom severity.
Month 3, Month 6
Change in Digital Literacy Score
Time Frame: Baseline, Month 3
Digital literacy was assessed using the 8-item eHealth Literacy Scale, a validated self-report measure of perceived ability to locate, evaluate, and apply health information from electronic sources. Each item is rated on a 5-point scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), yielding a total score from 8 to 40. Higher scores indicate better digital literacy.
Baseline, Month 3
Change in Digital Literacy Score
Time Frame: Month 3, Month 6
Digital literacy was assessed using the 8-item eHealth Literacy Scale, a validated self-report measure of perceived ability to locate, evaluate, and apply health information from electronic sources. Each item is rated on a 5-point scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), yielding a total score from 8 to 40. Higher scores indicate better digital literacy.
Month 3, Month 6

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
NYU Langone Health

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
American Diabetes Association

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Lu Hu, PhD, NYU Langone Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 30, 2023

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 7, 2025

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
May 7, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
August 5, 2022

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 5, 2022

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 9, 2022

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 12, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 10, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 22-00783

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The de-identified participant data from the final research dataset used in the published manuscript will be shared upon reasonable request beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research provided the investigator who proposes to use the data executes a data use agreement with NYU Langone Health. Requests may be directed to: Lu Hu (lu.hu@nyulangone.org). The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.

IPD Sharing Time Frame

Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.

IPD Sharing Access Criteria

The investigator who proposed to use the data will have access to the data upon reasonable request. Requests should be directed to lu.hu@nyulangone.org. To gain access, data requestors will need to sign a data access agreement

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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