Community participatory co-design and development of a digital diabetes prevention education program for Hispanic families with obesity: Mixed methods study

Authors: MIHAIL, SANDRA - Children'S Nutrition Research Center (CNRC); PARTIDA, MARBELLY - Children'S Nutrition Research Center (CNRC); VILLANUEVA, LIZETTE - Children'S Nutrition Research Center (CNRC); Thompson, Deborah; O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); REDONDO, MARIA - Baylor College Of Medicine; SOLTERO, ERICA - Children'S Nutrition Research Center (CNRC)

Submitted to: JMIR Formative Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/16/2025
Publication Date: 2/11/2026
Citation: Mihail, S., Partida, M., Villanueva, L., Thompson, D.J., O'Connor, T.M., Musaad, S.M., Redondo, M.J., Soltero, E.G. 2026. Community participatory co-design and development of a digital diabetes prevention education program for Hispanic families with obesity: Mixed methods study. JMIR Formative Research. 10:Article e67800. http://doi.org/10.2196/67800.
DOI: https://doi.org/10.2196/67800

Interpretive Summary: Hispanic youth are disproportionately impacted by obesity and subsequent type 2 diabetes compared to non-Hispanic white youth. Best practices for addressing obesity to prevent the onset of diabetes include family-based programs that promote healthy diet and physical activity behaviors. However, there are many barriers that prevent Hispanic youth and families from participating in family-based disease prevention programs such as lack of transportation, schedule conflicts, and poor accessibility. Digital programs that use web-based programming, smartphones, and other tools like activity trackers can delivery prevention programming directly to families in their home environment, alleviating some of the burden of these barriers.  This study describes the human-centered process by which an in-person diabetes prevention program was adapted into a digital diabetes prevention program for Hispanic adolescents with obesity and their parents. To begin the adaptation process, we started with an evidence-based program that had demonstrated evidence of improving insulin resistance among this population. We worked with youth and families through focus groups, interviews, and other interactive activities to understand youth and parent needs for a digital diabetes prevention program. Participants said they wanted interactive lessons, healthy recipes, and opportunities to ask questions. Based on formative work with our families, the research team created a sample session of the 12-week program and invited youth and families to view the session and provide feedback on content, duration, and level of engagement.  Participants generally found the sample session easy to understand and engaging. We also discussed digital literacy and access and we found that most families had reliable internet and access to digital devices to engage with content. In another interactive activity, we placed our sessions on a web-based platform called Learnworlds and invited youth and families to explore the platform and provide feedback. The digital platform the team built worked, but families suggested practical improvements like larger fonts, simpler navigation, and better color contrasts. We recognized the need for adding an orientation session and tutorial videos to help users get started. The researchers used this feedback to refine the digital program before testing it further in a future pilot study. By involving the end users in every step, this study aimed to make the program more accessible, engaging, and useful for the community it is designed to help. This community-centered approach could help ensure that digital disease prevention programs reach families at high risk for diabetes.

Technical Abstract: Digital health interventions (DHIs) can extend the reach of disease prevention interventions; however, few are evidence-based, theoretically grounded, or developed for high-risk youth and families. Co-design approaches engage end users in the design and development of the DHI, which can lead to increased accessibility and engagement. This study aimed to describe the adaptation of an evidence-based diabetes prevention program for remote, digital delivery. The adaptation of the in-person intervention was guided by a modified Inclusive Digital Health Intervention Design to Promote Health Equity framework and conducted in collaboration with Hispanic adolescents (n=23) with obesity (BMI>=95th percentile) and their parents (n=15). Focus groups identified digital, health education, and support needs. An expert and community panel assisted in developing solutions based on these findings. A sample content session with a food tasting experience was created and reviewed by participants. The research team subsequently built a digital platform to host the content. Participants assessed the usability of the platform, including the ease of use, design components, and technical issues. A second meeting of the expert panel provided recommendations for further refinement and feedback. Findings from focus groups indicated that most participants (31/36, 86.1%) reported stable internet access and multiple digital devices. With regard to format, a few parents (2/9, 22.2%) preferred synchronous content sessions, while most youth and parents favored asynchronous sessions (7/9, 77.8%) lasting 40 to 60 minutes. Health education needs included interactive content, healthy recipes, and the ability to ask questions. Experts suggested offering asynchronous sessions with monthly synchronous meetings to meet both parent and youth needs. After viewing a sample session, families found the content easy to understand and mostly engaging, with (17/21) 81% participating in the food tasting activity and all participants reporting that the activity was feasible. Experts recommended using a more conversational, interactive teaching style to improve the content and using a food box with nonperishable items to increase the ease of food tasting activities. While the digital platform was functional and easy to use, families highlighted the need for larger font and icon sizes, easier navigation, and better color contrasts. On the basis of this feedback, experts advised creating tutorial videos and an orientation session for platform training. The content and platform will continue to be refined before further evaluation in a 12-week feasibility pilot study. The use of a co-design approach provided opportunities to make content more interactive and engaging and to increase the ease of use of the digital platform. Describing the adaptation process using a guiding framework in collaboration with the focus population will inform future studies aiming to adapt evidence-based interventions to a digital platform.