Understanding and Addressing Risks of Low Socioeconomic Status and Diabetes for Heart Failure

This randomized controlled trial employs a 2:1 allocation ratio. The study aims to include 402 individuals from Baltimore City and Hagerstown, Maryland, characterized by low neighborhood and individual socioeconomic status, type 2 diabetes, obesity, and evidence of subclinical heart dysfunction, without a prior clinical diagnosis of heart failure. The 6-month multi-level intervention consists of three key components:

1. Problem Solving - Diabetes Self-Management Training (DECIDE): Participants will engage in a biweekly evidence-based behavioral change program known as DECIDE. This program focuses on problem-solving training, aiding individuals in managing chronic conditions by overcoming obstacles and challenges. It aims to enhance self-care, improve control of metabolic risk factors, and includes tailored education on heart failure prevention. 2. Community Health Worker Support: Participants will receive ongoing support from community health workers as part of the intervention. These workers will conduct telephone and/or home visits at least monthly, offering assistance in following areas:

* Reinforcing patient education about disease self-management * Helping patients access care and addressing barriers to care and treatment * Serving as facilitators and navigators to clinical care, social services, and other community resources * Providing encouragement and support to engage, activate, and empower patients and their support systems 3. Health Coaching and Partnership with Community Facilities: Participants will engage in supervised aerobic and resistance exercise training at the local Young Men's Christian Associations (YMCAs). The participants will receive instructions on gradually increasing the activity levels throughout the 6-month intervention to achieve physical activity goals (150 minutes of moderate to vigorous exercise per week).

• Change in cardiac biomarker, high-sensitivity cardiac troponin-T (hs-cTnT) [Срок оценки: Baseline and 6 month follow up]
• Change in hemoglobin A1c [Срок оценки: Baseline and 6 month follow up]
• Change in specific problem solving skills as assessed by Health Problem-Solving Scale (HPSS) subscales. [Срок оценки: Baseline, 6 month follow up, 12 month follow up]
• Changes in self care measures as assessed by Summary of Diabetes Self-Care Activities Scale (SDSCA) [Срок оценки: Baseline, 6 month follow up, 12 month follow up]
• Changes in disease knowledge as assessed by Diabetes and Cardiovascular Disease (CVD) Knowledge Test [Срок оценки: Baseline, 6 month follow up, 12 month follow up]
• Changes in physical activity as assessed by Modified Physical Activity Questionnaire (MPAQ) [Срок оценки: Baseline, 6 month follow up, 12 month follow up]
• Change in weight (kgs) [Срок оценки: Baseline and 6 month follow-up]
• Change in BMI [Срок оценки: Baseline and 6 month follow-up]
• Change in hip and waist circumference (centimeters) [Срок оценки: Baseline and 6 month follow up]
• Change in Metabolic Syndrome Severity Z score [Срок оценки: Baseline and 6 month follow up]
• Change in self-management as assessed by the Patient Activation Measure (PAM-13). [Срок оценки: Baseline, 6 month follow up,12 month follow up]
• Change in quality of life and overall health and well-being as assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 [Срок оценки: Baseline, 6 month follow up,12 month follow up]