Pilot-Testing Strategies to Improve Outcomes for Youth With Type 2 Diabetes by Addressing Health-Related Social Needs

Acceptability of Intervention: Health-Related Social Needs Screener

4-item Acceptability of Intervention Measure; completed by all adolescents and caregivers. Questions are specific to acceptability of the screening questionnaire used to assess health-related social needs, with responses ranging from completely disagree to completely agree (5-point scale). A mean of 4 or higher indicates acceptability.

Acceptability of Intervention: Tailored Approach to Address Health-Related Social Needs

4-item Acceptability of Intervention Measure; completed by adolescents and caregivers assigned to arms using a tailored approach (not universal empowerment). Questions are specific to acceptability of the tailored approach used to address health-related social needs, with responses ranging from completely disagree to completely agree (5-point scale). A mean of 4 or higher indicates acceptability.

Acceptability of Intervention: Universal Empowerment Approach to Address Health-Related Social Needs

4-item Acceptability of Intervention Measure; completed by adolescents and caregivers assigned to arms using a universal empowerment approach (not tailored approach). Questions are specific to acceptability of the universal empowerment approach used to address health-related social needs, with responses ranging from completely disagree to completely agree (5-point scale). A mean of 4 or higher indicates acceptability.

Acceptability of Intervention: Text Messages to Address Health-Related Social Needs

4-item Acceptability of Intervention Measure; completed by adolescents and caregivers assigned to arms using text messages without community health workers to support resource connection. Questions are specific to acceptability of the text messages without community health worker approach used to address health-related social needs, with responses ranging from completely disagree to completely agree (5-point scale). A mean of 4 or higher indicates acceptability.

Health-related social needs: Food Insecurity

Six-Item Standard Measure from USDA Economic Research Service; completed by adolescents and caregivers. Food insecurity assessment includes 5 questions assessing presence and frequency of experiences consistent with food insecurity; responses include "often," "sometimes," or "never" as well as "yes" and "no." "Often," "sometimes," or "never" are scored as 1, 2, and 3 respectively, with yes=1 and no=2. The sum of affirmative responses ("often," "sometimes," "yes") is the raw score, with 0-1 indicating high or marginal food security, 2-4 low food security, 5-6 very low food security. Percentage of positive responses (food insecurity: marginal, low, or very low food security) will be reported.

Health-related social needs: Housing Insecurity

3 items from the PhenX repository; completed by adolescents and caregivers. Housing is assessed using 3 questions about living situation, stress related to rent/mortgage, and problems with housing; responses describing worry about losing a place to live or not having a steady place to live, as well as problems with housing, or always, usually, or sometimes worrying about not having enough money to pay rent or mortgage indicate positive housing insecurity. Percentage of positive responses (housing insecurity) will be reported.

Health-related social needs: Transportation Insecurity

1 item from the PhenX repository; completed by adolescents and caregivers to assess lack of reliable transportation for medical appointments (yes/no). Percentage of affirmative responses (transportation insecurity) will be reported.

Hemoglobin A1C

As measured during clinic visit; for adolescents only. Reported as %.

Physical activity

PACE questionnaire is a 2-item survey to evaluate frequency of engagement in at least 60 minutes of daily physical activity over the past 7 days and a typical week. Higher numbers of days indicates greater adherence to physical activity guidelines for adolescents. Administered to adolescent participants only.

Health Literacy

BRIEF Health Literacy Survey is a 4-item questionnaire with 5 response options each ranging from "not at all" to "extremely." Responses are totaled for a possible score of 4-20, with higher scores corresponding to higher health literacy.

Mood

The Mood and Feelings Questionnaire: Short Version will be used to evaluate mood in adolescent and caregiver participants. This 13-item survey includes responses of "not true", "sometimes", and "true", scored as 0, 1, and 2. Total scores range from 0-26, with higher scores indicating higher severity.

Social Support

Multidimensional Scale of Perceived Support Scale (Zimet, Dahlem, Zimet, Farley, 1988); completed by adolescents and caregivers. The 12-item survey includes a 7-item scale of response from "very strongly disagree" (1) to "very strongly agree" (7). There are 3 subscales to indicate significant other, family, and friends support. Responses will be averaged by subscale, with higher numbers indicating greater support. A total score (average of 12 response) will be reported.