PROJECT SUMMARY West Virginia (WV) is a rural state in Appalachia, a region known for unique cultural traits, but also a history of disempowerment, disadvantage, and poor social determinants that impact effective self-management of type 2 diabetes mellitus (T2DM). WV experiences a high burden of chronic disease as the state has the highest rate of T2DM (16.2%) in the US. Communication in the patient-provider relationship is a key component of chronic disease management and supports the prevention of devastating long-term complications. However, patients living with T2DM are often reluctant to openly share their concerns regarding self-care with their provider. This study aims to test the effectiveness of the Diabetes and Hypertension Self-Management Program (DHSMP), a 12-week group lifestyle intervention implemented in two Patient Centered Medical Homes in WV on improving patients' self-advocacy and communication in the patient-provider relationship regarding their concerns and preferences in management and treatment of their T2DM. The program's impact on relevant clinical (HbA1c, fasting blood glucose, lipids), behavioral (self-care) and psychosocial (diabetes distress) variables will also be assessed and relationships between these variables and patient self-advocacy and patient-provider communication will be explored. The DHSMP utilizes health coaches to deliver group educational sessions and support participants in improving self-care behaviors, including encouraging and empowering participants to self-advocate/communicate their needs to their providers. Using a randomized controlled trial (RCT) design and an integrated and explanatory sequential mixed-method approach, the objectives of this study are: to assess the DHSMP's impact on improving patient self-advocacy and communication with providers regarding diabetes compared to an active control group (Aim 1), to understand participants' experiences and perceptions of the DHSMP and patient-provider communication regarding diabetes self-management via focus groups and interviews (Aim 2a), and to assess differences in experiences/perceptions of self-advocacy and patient- provider communication based on various participant characteristics (Aim 2b). This study is innovative in that it is the first RCT to test the impact of a lifestyle intervention on patient self-advocacy and patient-provider communication regarding diabetes care, management, and related distress. Furthermore, this study will advance understanding of patient-provider relationships and fill an important gap by informing strategies to address patient-provider communication regarding self-management of diabetes among rural Appalachian adults. This fellowship will also equip Ms. Brenna Kirk (PI) with skills and experience in managing a multi-site intervention, conducting mixed-methods research, disseminating results via publications/presentations, and will enhance her understanding of rural clinical management of chronic diseases and...