Background: Diabetes Self-Management Education and Support (DSMES) programs effectively support adults with diabetes (AWD) to improve diabetes self-management and lower diabetes complication risks, but low-income Latino/a AWD have had low DSMES uptake. With CHWs, we co-designed a DSMES program (‘FAM-ACT’) to increase engagement for Latino/a AWD with low SES. FAM-ACT was culturally-tailored, CHW-delivered in Spanish and English, involved family/friend ‘support persons’ (SPs), and included online sessions during the COVID-19 pandemic.

Objective: To examine how both FAM-ACT and comparison individual-focused CHW-delivered DSMES engaged AWD and their SPs, pre and during the pandemic, and participant factors associated with intervention engagement.

Methods: 222 dyads (AWD with HbA1c≥7.5% and an SP) were enrolled from 09/2019 to 12/2022, randomized (FAM-ACT or I-DSMES), and invited to attend six DSMES sessions over 6 months. AWD and SPs completed surveys at enrollment.

Results: AWD enrollment decreased slightly during the pandemic (77/409 [19%] pre, 145/894 [16%] during). 47% of enrolled SPs were the AWD’s spouse/partner, 26% adult child, 27% sibling/friend/other. AWD enrollees consistently were majority women (61% pre-pandemic, 62% during). Enrolled AWD preference for Spanish was higher during-pandemic (87%) than it was pre-pandemic (74%). On average, AWDs completed 3.8/6 and SP 2.6/6 DSMES sessions. 135/222 (61%) AWD met pre-determined criteria for ‘engagement’ (≥4/6 sessions). ‘Engaged’ AWDs were more likely female (64%, 58% non-engaged), live separately from their SP (40%, 29%), have A1c>9 (51%, 43%), and prioritize diabetes management (56%, 47%). In the FAM-ACT arm (N=112 dyads), engaged AWDs were more likely to have engaged SPs (50/64 [78%], 3/48 [6%]), SPs with pre-diabetes (32%, 6%) and SPs with higher ‘patient activation’ (61%, 33%). Overall, AWD ‘engaged’ during the pandemic (85/145) were less likely to have graduated high school (30/85 [35%], 27/50 [54%] pre-pandemic) and more likely to prefer Spanish to English (70/85 [82%], 36/50 [72%]).

Conclusions: CHW-delivered, culturally tailored DSMES programs successfully reached and engaged low-SES Latino/a AWD and their SPs, even after pandemic adaptations for online delivery. Engaged AWD had higher A1c, prioritized diabetes and had SPs with pre-diabetes and higher patient activation. Engaged AWD had lower education and preferred Spanish to English. Women AWD enrolled at the same rate pre and during the pandemic.

Implications: SP engagement and cultural and contextual tailoring of CHW-delivered DSMES may support the ability of low SES Latino/a AWD to enroll and engage in DSMES. Assessing motivation and ‘competing demands’ may identify AWD who are able to better engage in the short term.