1495-P: Applying Frame to Document Cultural Adaptations in Diabetes Self-Management Education

Introduction and Objective: Black adults with diabetes are in great need for culturally relevant self-management support. Diabetes Self-Management Education (DSME) programs are often culturally adapted, but these changes are rarely documented systematically. Our objective was to describe a DSME program adaptation, using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). We specified what was modified, why changes occurred, and how they affected fidelity. Methods: To document the adaptations, we used data sources from stakeholder advisory board (SAB) meeting records, a facilitator focus group, and program materials. Participants involved in the adaptation process included the research team and SAB members (past Black DSME participants, facilitators and program providers). Using FRAME, we categorized adaptations by timing, type (content, contextual, training), decision-makers, nature of modification, rationale, and relationship to fidelity. Results: Thirty-five unique cultural adaptations were identified. Most occurred during pre-implementation, were planned, and driven by SAB input. Content was contextually adapted by tailoring nutrition education to familiar foods, local food resources, and incorporating culturally relevant coping strategies for emotional wellbeing. Facilitator training emphasized trauma-informed delivery and participant self-advocacy to address healthcare mistrust. Contextual adaptations included modifying facilitation approaches to emphasize trust-building and adapting delivery to improve engagement. Training adaptations involved a one-hour cultural adaptation guidance for facilitators. All adaptations were fidelity-consistent, preserving core DSME functions while improving cultural fit. Conclusion: FRAME enabled systematic documentation of cultural adaptations that enhanced relevance and engagement while maintaining fidelity. Findings offer a transparent model for culturally responsive DSME implementation and inform future adaptation and scale-up efforts.