This study examined the responses of Latino community residents diagnosed with pre-diabetes using a complex convergent mixed methods design nested within a three-factor factorial design (age, language, and gender) to understand the intervention contents and activities that are most important to study participants for helping them to prevent the development and onset of type 2 diabetes (T2D). Chapter 1 introduces the topic and provides background literature. Chapter 2 systematically synthesized findings from diabetes prevention studies to identify efficacious intervention components and social contextual resources that have been used to support diabetes prevention in Latinos who are prediabetic or at risk of developing diabetes. Chapter 3 analyzed the qualitative portion of one section within the Latino Lifestyles study protocol. Based on the Integrative Mixed Methods (IMM) methodology, we conducted a thematic analysis to identify emergent themes for each of the three focus questions, as administered in individual interviews with 28 Latino and Latina participants. Chapter 4 utilized the findings from Chapter 3 to examine the levels and associations of three potential moderator variables: (a) health motivation, (b) diabetes awareness, and (c) diabetes concern among Latinos diagnosed with prediabetes. A 2x2 cross-tabulation analysis tested group differences in the mention of response phrases as examined by two levels (high versus low) of the potential moderator variables. The study results offered meaningful intervention components such as healthy cooking classes and assistance with lifestyle changes related to diet and exercise for themselves and their families, as expressed by the participants. These findings provide informative intervention components for developing a Latino community-based diabetes prevention program designed to enhance engagement and lifestyle changes for individuals diagnosed with prediabetes.

A mobility-impairing disability includes difficulty moving and maintaining body positions, handling, and moving objects, moving around in the environment, and difficulty with transportation. The negative impact of mobility impairments on daily life is profound and can lead to long-term negative health consequences. Mobility-impairing disabilities are associated with reduction in glucose tolerance, difficulty accessing healthy food, and physical inactivity. This dissertation investigated physical activity in people with mobility-impairing disabilities. First, Chapter 2 investigated the relationship between glucose disposal and physical activity in people with mobility-impairing disabilities. Chapter 3 explored collected survey data regarding physical access to food in a sample of 85 adults with mobility-impairing disabilities. The relationship between difficulty performing specific activities of daily living pertaining to food access and participation in muscle-strengthening activity was investigated. Chapter 4 consisted of an analysis of health-related outcomes to a 12-week self-guided Tai Chi and Qigong intervention compared to a video health information only control group. Results regarding the effects of physical activity on insulin sensitivity (Chapter 2) in people with mobility impairments were mixed. Self-reported muscle strengthening exercise frequency (Chapter 3) was negatively associated with difficulty loading or unloading groceries or other items from a car or transportation and difficulty with store check-out process. The results from Chapter 4 indicated no significant differences in handgrip strength following 12-weeks of self-guided Tai Chi and Qigong when compared to the control group. In sum, the overall results of this research indicated that physical activity is important for individuals with mobility impairments but that interventions to increase muscle strength in this group may need to be more specific or create more overload to elicit muscle-strengthening stimulus. Furthermore, the feasibility of conducting a remotely delivered exercise intervention in individuals with mobility impairments was confirmed; however, future research on a larger sample population is needed to determine the efficacy of this type of intervention on strength outcomes. Clinicians should continue to recommend regular exercise in people with mobility impairments due to the large body of research supporting its use across a variety of populations.