Current practices, facilitators, and barriers experienced by program providers implementing the National Diabetes Prevention Program in Los Angeles County

Abstract

Individuals with prediabetes can lower their diabetes risk by participating in the National Diabetes Prevention Program (National DPP), an evidence-based, group lifestyle change program that is taught by a certified lifestyle coach. To date, studies have not explicitly compared National DPP implementation across multiple settings (i.e., types of organizations) to understand comparative setting advantages or challenges to engaging priority groups. The purpose of this study was to gain an in-depth understanding of: (a) the variation in National DPP implementation across clinic, community-based, and digital settings and (b) associated facilitators and barriers. The study focused on three core implementation domains: recruitment, retention, and data reporting. This study used a descriptive, qualitative approach to identify current practices, facilitators, and barriers to National DPP implementation by conducting semistructured key informant interviews in spring 2018 with 12 organizations delivering the National DPP in Los Angeles County. There was a general commonality between in-person settings (clinics and community-based), while the experiences of digital providers were relatively distinct. Recruitment and retention were widely described by all settings as labor- and time-intensive, while data reporting was seen as relatively less burdensome. All respondents reported using multiple recruitment strategies. Lifestyle coaches were seen as key to retention, and they spent substantial time engaging with participants outside of class, which often was not accounted for in program costs. Data reporting was easier for organizations that invested in sophisticated data management systems and had staff with sufficient data experience. This study advances knowledge around the translation of the National DPP in diverse settings in the nation’s largest county and highlights opportunities for targeted, setting-specific support.

Barriers and Facilitators to Enrollment and Retention in the National Diabetes Prevention Program: Perspectives of Women and Clinicians Within a Health System

“…19 Qualitative studies have identified barriers to enrollment and retention, including childcare, transportation, and scheduling, 10,15 length of the year-long program, and discomfort with the group modality. 10,15,20 Identified facilitators to enrollment and retention include intrinsic motivation (e.g., wanting to meet the National DPP challenges), as well as extrinsic factors such as connection with Lifestyle Coach and other participants. 10,15 Next, to address the above-mentioned barriers discovered in our study, we suggest some program modifications.…”

Clinic- and Community-Based National Diabetes Prevention Programs in Los Angeles

“…After considering other factors, however, only attendance remained significantly and positively associated with the other program outcomes; thus, the independent role of program setting remains unclear. Emerging qualitative work provides insights into the relative strength of CBOs with respect to community engagement, including their comparatively greater familiarity with their participants, helping them better anticipate needs and provide more personalized support (Green et al, 2020). Given these findings and the policy implications outlined below, additional studies of this issue are warranted, especially with a larger and more diverse pool of program providers.…”

“…Updated DPRP reporting standards now require programs to report on participant education (CDC, 2018a), but program providers may need technical support to reliably collect and examine this indicator, and other markers of SES. Further discussions about these organizational and program-level factors can be found elsewhere (Green et al, 2020). Fourth, because some measures (e.g., physical activity) were measured by participant self-report and some outcomes were submitted by lifestyle coaches, presumably using measurement standards established by the CDC (2015), reporting errors and bias may have occurred during this data collection process.…”

“…The access to physician recommendation and counseling in this setting can increase motivation for lifestyle change (Holliday et al, 2019). Community-based organizations (CBOs), on the other hand, can target programs in locations where people already congregate (e.g., churches, community centers) and potentially leverage established community standing to engage specific populations (Green et al, 2020; Rehm et al, 2017). Given these theorized trade-offs, it is possible that one setting tends to outperform the other in engaging priority groups and in promoting lifestyle change.…”

Updated USPSTF Screening Recommendations for Diabetes

“…However, these evidence-based strategies have been challenging to implement in clinical practice owing to barriers such as the intense resources required, limitations on reimbursement, and out-of-pocket costs to patients. [17][18][19] If young adults newly identified with abnormal glucose metabolism do not receive the needed intensive behavioral change support, screening may provide no benefit.…”