Purpose The purpose of this study was to understand barriers and facilitators to engagement in a diabetes prevention program for young women at an urban safety-net health care system. Methods Individual semistructured interviews (N = 29) explored motivations, challenges, and successes regarding participation and suggestions for improvement among women aged 18 to 39 years who enrolled in the National Diabetes Prevention Program in the past 2 years. Participants were classified as nonattendees (n = 10), early-withdrawers (n = 9), or completers (n = 10). Interview transcriptions were analyzed using a grounded hermeneutic editing approach. Results Qualitative analysis revealed 4 main themes (enrollment, attendance, experience, and suggestions) with multiple subthemes. Most women were motivated to enroll for health and family concerns. Early-withdrawers and nonattendees reported confusion about the program’s aim and relevancy, logistical barriers, and lack of connection with fellow participants/coaches. Highly engaged women noted persistent motivation, perceived weight loss, and supportive program relationships. Conclusions Multiple barriers/facilitators for young women appear addressable in future adaptations. Additional research is needed to confirm these findings in other settings and explore implementation and effectiveness of adaptations, with a goal of reducing risks prior to conception.

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Intrauterine exposure to maternal obesity and type 2 diabetes increases chronic disease risks in offspring. The National Diabetes Prevention Program (National DPP) is an evidence-based model for promoting weight loss to prevent diabetes in adults; however, women of peak child-bearing age (18-39 years) do not engage sufficiently, limiting the program’s potential to reduce risks across generations. We assessed participation barriers and facilitators among English- or Spanish-speaking young women who enrolled in the program at an urban safety-net healthcare system. Interviewees included 30 women who enrolled but did not attend (n=10), attended few classes (n=10), or completed the program (n=10). Individual semi-structured interviews explored motivations, challenges, and successes regarding participation and suggestions for improvement. Interviews were analyzed using a grounded hermeneutic approach. Qualitative analysis revealed four primary domains (enrollment, attendance, experience, and suggestions) with multiple sub-themes. Most women were motivated to enroll per concern for health and family. Non-attending and minimally engaged women reported confusion about the program’s aim and relevancy, logistical barriers (scheduling conflicts, lack of childcare or transportation), and lack of connection with fellow participants or coaches. Highly engaged women noted persistent motivation to attend, successful weight loss, and supportive relationships in the program. Taken together, multiple barriers/facilitators arose that may be addressable in future adaptations via enhanced education and motivational support throughout the program, providing childcare and transportation, introducing a mobile app, a more flexible class format, and activities to strengthen group cohesion. Future research is needed to explore strategy implementation and effectiveness, with an ultimate goal of reducing risks prior to initial or subsequent child-bearing. Disclosure C. Harrison: Employee; Spouse/Partner; Virta Health Corp. P. Phimphasone-Brady: None. B. DiOrio: None. N. Ritchie: None. K.A. Sauder: None. Funding Centers for Disease Control and Prevention