O8 Translation of the National Diabetes Prevention Program into Cooperative Extension: Barriers and Facilitators

Abstract

<h3>Background</h3> Translation of the Center for Disease Control's National Diabetes Prevention Program (DPP) from clinics to communities can reduce diabetes burden in the U.S. if more organizations adopt and maintain the intervention. Cooperative Extension offers a potentially powerful context for DPP implementation, with a capacity to reach large and diverse populations. There is a critical need to understand the impact of the DPP when implemented with fidelity in Extension, as well as implementation barriers and facilitators. <h3>Objective</h3> The objective of the present study was to evaluate barriers and facilitators of DPP implementation in Extension in Georgia. <h3>Study Design, Setting, Participants</h3> The present study was part of a 12-month, multi-site, hybrid type 2 effectiveness-implementation trial. The implementation evaluation utilized 3 qualitative semi-structured interviews (post-recruitment and mid- and post-implementation) with 12 Extension professionals implementing the DPP in 13 counties across all regions of Georgia. <h3>Measurable Outcome/Analysis</h3> The Consolidated Framework for Implementation Research (CFIR) was used to identify barriers and facilitators of DPP implementation in Extension. Interviews were coded deductively by 2 independent analysts based on CFIR constructs. Constructs were then rated (-2 to +2) to indicate their influence on implementation. Constructs with a strong influence on implementation were then evaluated for their influence on RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework domains. <h3>Results</h3> Preliminary analyses suggest that program length (Time [-2]) and the Intervention's Source (+2) from CDC had strong influences on Reach of the program; the DPP's Evidence Strength and Quality (+2) and the Tension for Change (+2) for more evidence-based Extension programming had strong positive influences on Adoption; and Networks and Communications (+2) had a strong positive influence on Implementation, especially during the COVID-19 pandemic. <h3>Conclusion</h3> Extension's infrastructure, culture, and need for evidence-based programming make it well-suited for DPP implementation. Results of this study can inform implementation strategies to improve the public health impact of DPP implementation in Extension in the future.