Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities

Abstract

The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0–6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = −5.99 ± 8.0 kg, −5.4%, FB = −1.68 ± 3.3 kg, −1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas.

Implementation of the Diabetes Prevention Program in Georgia Cooperative Extension According to RE-AIM and the Consolidated Framework for Implementation Research

“…Effectiveness, adoption, implementation, and maintenance were respectable. Effectiveness measured by average weight loss and physical activity exceeded program goals and were similar to results of other research (Damschroder et al, 2017a, b;Ely et al, 2017;Gorczyca et al, 2022). All Extension professionals trained to implement the DPP eventually adopted the program, and a majority began another (and in some cases, multiple) DPP cohorts following conclusion of this study.…”

Enrollment, Engagement, and Effectiveness of a Large-Scale Diabetes Prevention Program Using Synchronous Distance Technology

“…The findings of the study provide further support for the effectiveness of the distance learning delivery of the NDPP [23][24][25]. This study is novel in its analysis of a community based not-for-profit program serving over 2000 participants with a distance learning DPP.…”

A Case Study of Nutrition Educators' Perspectives on the Delivery of Virtual Community Nutrition Programming

“…Formative research on the development of an asynchronous virtual adult nutrition program suggested that participants could be motivated through this format of delivery by "making the eLearning program engaging and interactive, keeping all lessons <10 minutes in length, offering an official certificate of completion, providing positive feedback, and including interactive games" (Stotz et al, 2017, p. 153). Social media platforms such as Facebook may help with the delivery of asynchronous education (Gorczyca et al, 2022). In addition to this, asynchronous virtual delivery was found to help in time management of staff in WIC clinics (Bensley et al, 2011).…”

“…Some researchers suggest that offering virtual programming could be a cost-effective solution to increasing the reach and that future research is needed to explore the comparison of costs (Stosich et al, 2016). This is built from the assumption that it will take less work from the educator to reach more participants since they will not be taking the time to secure resources, such as food, space, and time, to deliver programming (Bensley et al, 2011;Gorczyca et al, 2022;Stosich et al, 2016). However, little research has been done to determine its cost effectiveness and gain educator's perspectives on how the workload shifts when the delivery method shifts.…”

“…From the participant's perspectives, Stotz et al (2019) found that study participants preferred an asynchronous model that could be accessed by mobile device. Platforms such as Facebook offer the opportunity to provide asynchronous education and may save educators time spent on program delivery (Gorczyca et al, 2022). When looking at nutrition educator's perception, educational methods such as cooking videos, recipes, and step-by-step teaching tools were preferred curriculum components for a virtual setting (Hohlt, 2022;Stotz et al, 2017).…”