PROJECT SUMMARY Type 2 diabetes (T2D) disproportionately affects American Indian communities. American Indian adults are nearly three times more likely to be diagnosed with diabetes, and 2.3 times more likely to die from diabetes compared to non-Hispanic Whites 1. The prevalence of diabetes among American Indians is 18% compared to the national rate of 9% for all-races 2. To address T2D disparities among American Indians, there is an urgent need for culturally and contextually adapted diabetes self-management programs. To understand 1) the types of support systems that may be helpful, and available, for individuals living with T2D in Arizona Tohono O’odham communities and 2) how they may be integrated into diabetes self-management and support (DSMES), we will partner with a community advisory board to culturally adapt a DSMES intervention. This intervention will link T2D programming in tribal health systems to existing community programs to enhance capacity and available resources in a rural Arizona tribal community. Contemporary evidence supports the interrelationship of T2D management behaviors and numerous social-societal contexts 3-10 recognizing that externally motivated, individual-based behavior changes for DM management are not sufficient in and of itself. The integration of social support into diabetes self-management education has demonstrated improvement in disease self-efficacy and glycemic control, while decreasing T2D-associated health care costs 7. Interventions addressing the complexity of inter-related systems and T2D management remain largely under investigated, particularly for American Indian communities 3-6. The first step in address diabetes health disparities for American Indian populations, and the goal of this research, is to create culturally appropriate behavioral interventions that are meaningful for American Indians with T2D and their families. The overarching hypothesis for this application is that a Tribally tailored DSMES intervention will reduce risks for diabetes-related complications. This research supplement builds upon Dr. Godfrey’s educational and clinical training to launch a career as a health disparities scholar through hands-on research, transdisciplinary mentorship, scientific writing, and networking activities. This supplement will directly inform a R01 application to pilot test the culturally adapted DSMES intervention as compared to current diabetes education and management processes within the Tohono O’odham Nation and examine feasibility of the multi-level, multi-sector intervention. Parallel to the parent grant, social support operates as a key component of the proposed supplement by examining multiple domains of influence to develop an intervention addressing the complexity of inter-related systems and T2D management. The impact of this work may extend to other American Indian populations and will contribute new and important information for reducing considerable health burden associated with T2D ...