Change Program Research Articles

545-P: Impact of Participant Characteristics on Weight Loss in the National Diabetes Prevention Program (2012–2021)

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations collaborating to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes. A risk reduction outcome for the LCP is weight loss of at least 5%. This analysis used multivariate logistic regression to assess the association between participant characteristics and 5% weight loss for 470,238 enrolled participants who had the opportunity to attend the 12-month LCP in 2012-2021. Analysis shows that 59% of participants attended the LCP online, 35% in-person, and 6% via distance learning or combination delivery. With respect to demographics, 77% were women, 55% of whom were aged 45-64 and 32% aged 18-44; 61% identified as White, 12% identified as Black or African American, and 12% identified as Hispanic or Latino. The odds of meeting the goal for those aged 65+ and 45-64 were 1.6 and 1.2 times greater than those 18-44, respectively. Those who identified as White had higher odds of meeting the goal than those who identified as Hispanic or Latino, Black or African American with odds ratios (ORs 1.3), or Asian or Asian American (ORs 1.2). Compared with participants enrolled in in-person programs, online participants had the lowest odds of reaching the goal (ORs 0.5), and distance learning participants had odds similar to those of in-person participants (ORs 1.0). The 5% weight loss success was significantly higher among those who attended > 16 sessions (ORs 2.9) for the study population. Women were less likely to meet the goal than men (ORs 0.8). Results of this analysis indicate that participant characteristics strongly impact whether someone meets the 5% weight loss goal. Program delivery strategies tailored to specific populations could be effective in helping participants achieve programmatic goals. Disclosure R.Zhu: None. E.O.Landau: None. E.Ely: None.

629-P: Social Vulnerability Index and Recognition Status with the National Diabetes Prevention Program (National DPP)

Individuals in low socioeconomic status (SES) areas are disproportionately affected by diabetes and have poor lifestyle change outcomes. Organizations delivering the CDC National DPP lifestyle change program receive pending, preliminary, or full recognition status based on specific program criteria and outcomes. Full recognition is critical for organizations to sustain the program and receive reimbursements to cover costs, but organizations in low SES areas may face barriers to receiving it. A multinomial logit model was used to examine the association between the CDC social vulnerability index (SVI) and in-person full recognition organizations at the county level, adjusting for confounders (n=843). Using the National DPP registry, Census data, SVI, and CDC Diabetes Surveillance System, a three-level categorical dependent variable was created: counties without full recognition organizations, counties with at least one non-full recognition organization, and counties with all organizations with full recognition (reference group). The CDC created a four-level categorical SVI (Low, Low-Medium, Medium-High, High) using 16 Census variables to rank counties by social vulnerability: SES, Household Composition and Disability (e.g., age), Minority Status and Language, and Housing Type and Transportation (e.g., vehicle). Of the studied counties, 38.4% had no organizations with full recognition, 22.6% had at least one organization without full recognition, and 39.0% had all organizations with full recognition. Counties with higher SVI were more likely to be in counties without full recognition organizations (High vs. Low; OR=2.71, P <0.001). Counties with high SVI lack fully recognized programs, indicating barriers for organizations in high SVI areas to attain full recognition. This study highlighted the need to develop strategies to ensure organizations in high SVI areas can reach full recognition status to better serve at-risk populations. Disclosure T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None.

547-P: Impact of the COVID-19 Public Health Emergency on Delivery of the National Diabetes Prevention Program Lifestyle Change Program

In January 2020, the Department of Health and Human Services (HHS) declared the COVID-19 pandemic to be a public health emergency (PHE). As a result of this declaration, organizations delivering the National DPP lifestyle change program (LCP) had to decide whether to hold program sessions virtually, in socially distanced spaces, or discontinue (temporarily or permanently). This analysis looks at how CDC-recognized organizations chose to deliver, or not deliver, the LCP during this time. As of data submitted by October 2022, 1,810 organizations had delivered at least one session since 2019, the year leading up to the PHE. At the start of 2020, 1,370 organizations were active: 1,251 in-person, 28 online, 44 distance learning, and 47 combination. The remaining 440 were either approved during the PHE or had gone inactive before the start of it. Of those active at the start of 2020, 219 (16%) had not submitted data on sessions held on or after this time, indicating a pause in delivery. Since the PHE began, 373 new organizations have been approved, 357 of which are still active. Of these new organizations, 241 have been mainly focused on delivery with at least one virtual component. Approval of new organizations in 2020 decreased for those delivering in-person, whereas approval of new online, distance learning, and combination organizations increased by 207%, 158%, and 122%, respectively. Data submitted by in-person organizations in 2020 and 2021 indicated that many of them delivered only virtual sessions during that time, which might explain the large increases in approval of virtual organizations. New enrollment after the start of 2020 among these organizations was 185,596 as of October 2022: 62,217 in in-person organizations, 99,688 in online, 14,859 in distance learning, and 8,832 in combination. As we move out of the PHE, we are mindful of the need to help organizations delivering the LCP adapt to more flexible delivery to accommodate participants’ evolving needs. Disclosure E.Ely: None.

644-P: Experiences of Community and Health Care Organizations Delivering the National DPP Lifestyle Change Program

The CDC National DPP lifestyle change program (LCP) is delivered by community and healthcare organizations nationwide to prevent or delay the onset of type 2 diabetes in adults with prediabetes. CDC recognition status assures fidelity and quality in delivering the program but receiving and maintaining it can be challenging. Using a pilot online semi-structured questionnaire, we explored the experiences of community and healthcare organizations delivering the National DPP LCP in receiving and maintaining CDC recognition. Participants were recruited from organizations delivering the National DPP LCP, prioritizing organizations in counties with low socioeconomic status. Participants were asked to discuss the challenges and facilitators their organizations faced in delivering the LCP and in achieving and maintaining CDC recognition. Thematic analysis was used to analyze and report emerging themes. A total of 25 participants completed the questionnaire (all from low SES counties). Our results indicate funding availability was the main facilitator in delivering the program, along with strong partnerships with community organizations and a dedicated team. Barriers to achieving and maintaining CDC recognition to deliver the program included difficulties recruiting and retaining participants, and issues securing funding to cover program costs. Participants reported that easing requirements to achieve/maintain recognition, increasing training opportunities, advocating for better reimbursement, and supporting network development between community organizations can increase the program's sustainability. Our findings highlighted barriers/facilitators related to the success of delivering the National DPP LCP and achieving/maintaining CDC recognition. Strategies to reduce those barriers and promote those facilitators should be considered. Disclosure T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None. Funding University of Central Florida

333-OR: What Motivates People to Enroll in the National Diabetes Prevention Program Lifestyle Change Program

In 2021, the Centers for Disease Control and Prevention (CDC) began collecting data on what motivates people to enroll in the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP). Upon enrolling in the LCP, participants are asked, “Who/what motivated you the most to sign up for this program?” Participants may choose health care professional, blood test results, prediabetes risk test, someone at a community-based organization (CBO), family/friends, current/past participant in the LCP, employer/employer’s wellness plan, health insurance plan, and media advertisements. By October 2022, these data had been collected on 128,116 eligible participants, of whom 25% reported that the prediabetes risk test motivated them the most, followed by their employer/employer’s wellness plan (23%), and health care professional (14%). Motivators were similar in men and women, with the prediabetes risk test and employer/employer’s wellness plan being the top 2 motivators. Across age groups, the prediabetes risk test and employer/employer’s wellness plan motivated adults aged 18-64 years the most, while health care professionals motivated individuals aged 65 years and over the most. Motivators varied across racial/ethnic groups, with family/friends, current/past participants, and someone at a CBO motivating some groups more than others. Though more participants were motivated by the prediabetes risk test, they did not stay in the program as long as those who were motivated by their employer/employer’s wellness plan, family/friends, or someone at a CBO (180 mean days vs. 278, 264, and 261 days, respectively). What might motivate participants to enroll in the LCP may not be what helps them stay in the program longer and may influence their risk reduction outcomes, including weight loss and engagement in physical activity. Understanding motivators can help organizations focus recruitment and enrollment efforts and support participants in achieving their goals. Disclosure M.Papalii: None. E.Ely: None.

41-OR: The Health Effects of a Behavior Change Program for Prediabetes—Quasi-Experimental Evidence from 2.1 Million Primary Care Patients in England

Introduction: There is an urgent need to implement population-based measures that prevent diabetes, enhance its detection, and avert its progression to complications. However, there remains widespread doubt among clinicians that lifestyle counseling provided in routine care can improve health. This study aims to investigate whether the largest behavior change program for pre-diabetes globally (the English Diabetes Prevention Programme) leads to improvements in key cardiovascular risk factors. Methods: We exploited the threshold in HbA1c used to decide on program eligibility by applying a regression discontinuity design, one of the most credible quasi-experimental strategies for causal inference, to electronic health data from the Clinical Practice Research Datalink, covering nearly one fifth of all GP practices in England. Using local linear regression, we compared patients lying closely on either side of the threshold for program entry (HbA1c of 42 mmol/mol [6.0%]). The primary outcome was change in HbA1c. Secondary outcomes were body mass index (BMI), weight, blood pressure, and serum lipids. Results: 2 106 469 adult patients met inclusion criteria in 2017-2018 with follow-up ending June 2020. Program referral led to significant improvement in HbA1c (-0.82 mmol/mol, 95%CI -1.42, -0.21), BMI (-1.34, 95%CI -1.86, -0.81), weight (-2.94 kg, 95%CI -4.33, -1.56), and triglycerides (-0.32 mmol/l, 95%CI -0.53, -0.10). There was suggestive evidence that program referral improved HDL (0.04 mmol/l, 95%CI 0, 0.08). Blood pressure and LDL did not significantly improve. Sensitivity analyses showed that improvements in HbA1c were not attributable to being prescribed medication. Conclusion: By leveraging a threshold rule induced by public health guidelines, this analysis provides causal, rather than associational, evidence that lifestyle counseling implemented in a national health system can achieve important health improvements. Disclosure J.M.Lemp: None. C.Bommer: None. M.Xie: None. J.Davies: None. A.Jani: Advisory Panel; Allergan. S.Vollmer: None. T.Barnighausen: None. P.Geldsetzer: None. Funding Chan Zuckerberg Biohub Investigator Award (to P.G.); Alexander von Humboldt Foundation (to T.B.); Ministry of Science, Research, and the Arts Baden-Wuerttemberg; German Research Foundation (INST 35/1314-1 FUGG); State of Baden-Wuerttemberg, Germany

560-P: Examining Characteristics of CDC-Recognized Organizations Delivering the National Diabetes Prevention Program—Full and Full-Plus Recognition

Organizations that deliver the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) can earn CDC-recognition (Pending/ Preliminary/ Full) from the Diabetes Prevention Recognition Program (DPRP). The highest levels of recognition are Full (awarded when risk reduction and eligibility requirements are met) and Full Plus (awarded when retention thresholds are met in addition to achieving Full). As of October 2022, 860 organizations were actively in one of these statuses. The objective of this analysis was to examine the characteristics associated with organizations that achieve the highest levels of recognition. Examining delivery modes, in-person programs achieved Full/Full Plus at a higher rate than organizations using other delivery modes. Of the organizations eligible to advance (those who submitted data for evaluation), in-person organizations moved into Full/Full Plus at a rate of 65.3%, with distance learning, online, and combination organizations achieving these recognition levels at rates of 53.1%, 56.4%, 46.4%, respectively. While under the COVID-19 public health emergency (PHE), many in-person organizations continued to deliver virtually. Organizations classified as Cooperative Extension Sites or Hospitals/Healthcare Systems/Medical Groups/Physician Practices had the highest rate of advancing to Full or Full Plus, 85.7% and 72.4%, respectively. On average, organizations in Full Plus enrolled a higher percentage of participants who identified as non-Hispanic or Latino/Black or African American than organizations in Full at 24% and 20%, respectfully. On average, organizations in Full/ Full Plus enrolled similar percentages of men and women. Organizations in Full Plus enrolled a higher percentage of participants aged 65+. Examining characteristics of organizations provides insight of the recognition trajectory and can shape future support of all recognized organizations. Disclosure K.R.K.Lloyd: None. E.Ely: None.

667-P: Enrollment Characteristics of Adults Aged 18–44 in the National Diabetes Prevention Program (National DPP)

The Centers for Disease Control and Prevention (CDC) estimates that 96 million adults aged 18 years or older had prediabetes in 2019. Of these, 32.2 million, or 33.5%, were aged 18-44, emphasizing the need for efforts to prevent or delay onset of type 2 diabetes within this population. CDC's National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations collaborating to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes or at high risk. While the mean age of participants in the LCP is 51 years, 31.6% of the participants enrolled as of October 2022 were in the 18-44 age group. When examining the characteristics of this age group, 52.1% of participants identified as non-Hispanic or Latino White, 18.4% identified as Hispanic or Latino, and 12.9% identified as non-Hispanic or Latino Black or African American. Overall, 71.4% of participants in this group enrolled in an online program and 81% participated through a worksite wellness program. For those who had the opportunity to complete the year-long LCP, the mean number of days spent in the program was 110. By comparison, among 45-64-year-olds, the mean number of days spent in the program was 161, and for those 65 and older, the mean number of days was 210. This is of note because participants who stay in the LCP longer are more likely to meet the risk reduction outcomes. Participants 18-44 met the programmatic risk reduction 5% weight loss goal at a lower rate (18.4%) than participants aged 45-64 (27%) and 65 and over (40.2%). These findings highlight the opportunity to develop strategies focused on supporting this younger adult population to enroll in and complete the LCP. Disclosure M.Bell: None. M.Papalii: None. S.Van aacken: None. E.Ely: None.

556-P: Early Results of Expanded Options for Demonstrating Risk Reduction in the National Diabetes Prevention Program (National DPP)

In 2012, CDC’s Diabetes Prevention Recognition Program (DPRP) released the first version of the DPRP Standards and Operating Procedures, which defined risk reduction as a minimum 5% mean weight loss for participants who completed the National DPP lifestyle change program (LCP). The most recent version of the Standards, implemented in May 2021, established 3 metrics to show risk reduction: a minimum 5% weight loss; or a minimum 4% weight loss plus a weekly mean of 150+ physical activity minutes; or a 0.2% reduction in HbA1c. As of October 2022, the DPRP has received data from 4,200+ organizations on 650,000+ participants ever enrolled in the LCP. This analysis is limited to 29,352 participants who completed the program after the 2021 Standards were implemented. This study focuses on the 765 participants who provided a pre-intervention HbA1c result within the prediabetes range (5.7%-6.4%), and a post-intervention HbA1c in months 9-12 of the yearlong program. Of those, 211 demonstrated a 0.2% reduction in HbA1c; 53 had a 0.1% reduction in HbA1c; 456 showed no change; and 45 had an increase in HbA1c. The median weight loss for participants who demonstrated a 0.2% reduction in HbA1c was 6.0%, and their median reported physical activity minutes per week was 182.6. This is compared to a 4.5% median weight loss and 156.9 median reported physical activity minutes per week among those who did not demonstrate a 0.2% HbA1c reduction. Those who provided a pre-intervention HbA1c in the prediabetes range (5.7%-6.4%), regardless of whether they provided a post-intervention HbA1c, had a median weight loss of 5.0% compared to those who did not provide a pre-intervention result (4.5% median weight loss). The DPRP has received data on an additional 9,295 participants who have provided a pre-intervention HbA1c but have not yet concluded the program. As a result, those achieving a 0.2% HbA1c reduction may increase over the next 12 months and will provide the opportunity for deeper analysis. Disclosure E.O.Landau: None. E.Ely: None.

690-P: Variation in Physical Activity and Weight Loss by Demographic Characteristics among Participants in the National Diabetes Prevention Program

The National Diabetes Prevention Program lifestyle change program aims to prevent type 2 diabetes by promoting behavioral changes such as increased physical activity and improved nutrition, with a goal of losing ≥5% of body weight. We analyzed data from 2012-2019 from participants who reported weekly physical activity (PA) minutes and weight and who participated either in-person (N=127,092) or online (self-paced, asynchronous interactions with coach) (N=196,670). Among those retained through the core phase (16 sessions), average weekly PA minutes were higher among men than women (228 vs. 182 in-person and 277 vs. 204 online), higher for older than younger participants (210 vs. 187 vs. 164 in-person and 248 vs. 233 vs. 191 online for ≥65, 45-64, and 18-44 years), higher for those with lower BMI (213 vs. 184 in-person and 244 vs. 215 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (187 in-person and 183 online for non-Hispanic Black participants, 183 in-person and 207 online for Hispanic participants, and 198 in-person and 227 online for non-Hispanic White participants). Percent weight loss by session 16 was greater for men than women (6.0 vs. 5.2 in-person and 5.5 vs. 4.2 online), greater for older than younger participants (5.8 vs. 5.3 vs. 4.6 in-person and 5.5 vs. 4.7 vs. 4.0 online for ≥65, 45-64, and 18-44 years), greater for those with higher BMI (5.2 vs. 5.4 in-person and 4.4 vs. 4.6 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (3.8 in-person and 3.7 online for non-Hispanic Black participants, 4.4 in-person and 4.0 online for Hispanic participants, and 5.9 in-person and 4.8 online for non-Hispanic White participants). We found that participants with different demographic characteristics experience program successes differently despite similar time in the program, suggesting a need to understand the reasons for these differences and customize program delivery strategies to address them. Disclosure M.Cannon: None. B.Ng: None. E.Ely: None.

546-P: Impact of the COVID-19 Public Health Emergency on Enrollment and Outcomes in the National Diabetes Prevention Program

The National Diabetes Prevention Program is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program (LCP) to prevent or delay type 2 diabetes. Using data submitted to the Diabetes Prevention Recognition Program (DPRP), this study examines the impact of the COVID-19 public health emergency (PHE) on delivery of the LCP by looking at how adapting delivery from in-person to virtual allowed the 12-month intervention to continue. Participant start dates were categorized into 3 groups: 1) enrolled/concluded pre-PHE start, 2) enrolled pre-PHE start/concluded post-PHE start, and 3) enrolled/will conclude post-PHE start. As of October 2022, enrollment was at 658,385: 348,672 in group 1, 124,077 in group 2, and 185,636 in group 3. Mean reported weekly physical activity (PA) minutes and mean weight loss (WL) were calculated for each quarter of the LCP for each group. Despite the PHE causing abrupt changes in daily life, results show that participants whose time in the LCP overlapped or was entirely within the PHE, had strong PA and WL outcomes. Regardless of phase, participants who attended sessions in the 3rd quarter and the 4th quarter, on average, met programmatic goals of 150 PA minutes and 5% weight loss. These outcomes are indicative of lifestyle change, contributing to reducing the risk of developing type 2 diabetes. Disclosure E.Ely: None.

Call for reflection on the feminist Left: why care, solidarity and abolitionism cannot sufficiently underwrite a radical programme of social change – Fraserian critical theory and an extended review of Cannibal Capitalism

This article first introduces and reviews Nancy Fraser's latest book Cannibal Capitalism. Next, it discusses the book's its programme for critical theory in the framework of Fraser's previous scholarship. It focuses on two ingredients of ‘Fraserian' critical theory: the role of difference in social justice-driven research and the separation of ontological and normative parts of such research. It then applies these specifically to feminist radical theories and explains why current, ostensibly non-economic, care-, solidarity- and abolitionist resistance programmes cannot underwrite sufficiently radical political programmes for social change. While these programmes' alternative ontologies are resourceful for informing and fomenting resistance, their potential to radically change social structures hinges upon their ability to relate their programme to other socially dominated and economically oppressed groups on the Left. Because capitalism codes both social domination and economic oppression, radical programmes would integrate their ostensibly non-economic ontological resources with a critique of capitalism to illuminate the common struggles of socially dominated and economically oppressed. ‘System crises critique' articulated by Fraser in Cannibal Capitalism is an example of one such ‘radical’ programme, which mobilises the working class as well as other marginalised groups, which are simultaneously economically oppressed and socially dominated.

The equilibrium domestic abuse behaviour change and healthy relationships programme: a service description and evaluation framework

PurposeDomestic abuse (DA) is a major issue with serious psychological, social, societal and economic impacts. Consequently, there has been an increased focus by policymakers and multiple statutory and third-sector agencies on addressing harms associated with DA and fostering healthy intimate and domestic relationships. This paper details the development and implementation of a whole family approach to DA set within a community social services setting.Design/methodology/approachA detailed description of the development and implementation of a new whole family approach is provided. This includes a focus on the equilibrium programme, an accredited strengths-based, solution-focused group element that has been devised and established for those engaging in harmful behaviours.FindingsThe importance of governance, programme support and practitioner supervision are discussed along with the ways these are used by the service. The evaluation framework presented will enable the impact of the programme to be determined over the coming years.Practical implicationsThere is clear need to address the significant problem of DA/intimate partner violence. This paper provides a model and accredited treatment approach to implementing a whole family approach to DA set within a community social services setting. This provides an opportunity for early intervention based on a strengths-based, solution focussed approach to addressing harmful behaviours and building skills and resilience.Originality/valueThis paper details a whole system approach to early intervention with families in which there is DA. Providing input via social care child and family support services prior to legal involvement provides an opportunity to avoid an escalation of harms. It also enables solutions to conflict to be found which take account of the relationship between parents and children.

Retrospective analysis of factors influencing the implementation of a program to address unprofessional behaviour and improve culture in Australian hospitals

BackgroundUnprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers.MethodData relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers.ResultsFour enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers.ConclusionAspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.

Determinants of motivation and adherence to a web application for health behaviour change: A qualitative study with cancer survivors.

Given the increasing number of cancer survivors, eHealth may be an effective means to improve lifestyle-related behaviours. Limited data are available on the use of eHealth by post-cancer patients. The present study aimed to analyse the contexts of use to identify the determinants of cancer survivors' adherence and motivation to use a web application offering nutrition and physical activity coaching. Individual semi-structured interviews were conducted with cancer survivors who participated in an 8-week online program for health behaviour change. The interviews were analysed using thematic analysis. Fifteen patients with a mean (SD) age of 62 (4.2) years completed the interview. Four themes relating to the environment and context of use were identified: digital use, social relations, health, and digital health interventions. Participants were familiar with digital tools through their professional work. Their motivation and adherence to the program improved through social relations; notably, a supportive family in addition to a trusted prescriber, continuity in the care pathway, and an appropriate choice of design features in the digital health intervention. With cancer survivorship, individuals no longer define themselves as sick but still need support to envisage the future more serenely. Cancer survivorship plays a special role in people's adherence to online interventions for health behaviour change in addition to the influence of their social relations and health environment.

Time to move beyond monological perspectives in health behavior change communication research and practice.

Chronic disease self-management and health behavior change programs are becoming increasingly important to health service delivery to prevent the development of chronic disease and optimize health outcomes for those who suffer from it. To train people to deliver these programs effectively, we need to understand both the what and how of program delivery. While there is an abundant literature on what, and a merging evidence about what techniques to use, such as goals setting and self-monitoring, the literature on how programs should be delivered is less well developed. This paper reviews emerging research in this area and identifies an underlying monological approach. We argue that this currently dominant model cannot address the key issues in this area. By considering the theoretical framework of Dialogism, we introduce the method of Conversation Analysis to the field of behavior change interventions. Extensive research into health communication has endeavored to show the importance of language and the organization of interactions. We demonstrate and discuss how a monological approach to interventions prevents exploration of what professionals do to deliver intervention content. In doing so, we show that techniques do not account for how successfully an intervention is delivered.

Evaluation of a mobile behavior change program for weight loss in breast cancer survivors: A prospective single-arm pilot study.

12070 Background: Post-diagnosis weight gain is common among women with early-stage breast cancer and is associated with increased risk of recurrence, breast cancer death, and all-cause mortality. Intentional weight loss following diagnosis is difficult to maintain. Targeted lifestyle interventions focusing on behavioral changes and education that can be implemented long-term are needed. Methods: This was a prospective single-arm pilot study in patients with history of early-stage breast cancer (NCT04753268). Key eligibility criteria included body mass index (BMI) ≥27.5 kg/m2, stage I-III breast cancer, and completion of active cancer treatment ≥6 months prior to study enrollment. Patients were recruited at the Dempsey Center in Lewiston, ME and via social media. Participants were given access to the Noom mobile application, which utilizes cognitive behavioral therapy, motivational interviewing, and self-determination theory to induce behavior change using an educational curriculum of daily articles, virtual health coaching, social networking, food records, and physical activity logs. The primary endpoint was change in self-reported weight from baseline to 26 weeks. Secondary endpoints included change in physical activity measured using step count and the Global Physical Activity Questionnaire (GPAQ), change in diet patterns analyzed using the Nutrition Data System for Research, patient-reported outcome (PRO) measures, and metrics for engagement with the mobile application. Results: 31 patients were enrolled; 24 at the Dempsey Center and 7 via social media. Mean age was 56.8 and mean baseline BMI was 33.5 kg/m2. Mean weight change was -4.8 kg (range +0.6 to -19.9 kg, p < 0.001) and mean percent weight change was -5.6%; 11/31 patients (35.5%) lost ≥5% of their initial weight. Average daily step count increased by 54.7% (p = 0.004). Mean GPAQ score for physical activity increased from 990 to 1773 (p = 0.01), and the proportion of patients who met physical activity guidelines increased from 45.1% to 74.2%. Mean energy intake did not change significantly over 26 weeks (p = 0.779). Improvements were observed in PROMIS-Physical Functioning T-scores and Body Image Scale scores (p = 0.04, p < 0.001 respectively). Metrics of engagement with Noom that were predictive of weight loss ≥5% included total articles read (p = 0.012), total weights logged (p = 0.006), total food records logged (p = 0.001), messages sent to coach (p = 0.001), and number of times the application was opened (p = 0.014). Conclusions: In this pilot study, breast cancer survivors lost weight and became more physically active using a commercially-available mobile application. This digital weight loss program is a scalable intervention, and these findings support future studies investigating impact on breast cancer outcomes. Clinical trial information: NCT04753268 .

Stakeholder analysis: Medicare Diabetes Prevention Program awareness and implementation.

The Medicare Diabetes Prevention Program (MDPP) provides unprecedented coverage of a behavior change program for older adult Medicare beneficiaries, but uptake has been extremely limited; only 1.5 sites deliver the program per 100,000 beneficiaries nationwide. Inadequate reach and utilization of the MDPP threaten its long-term success; thus, the purpose of this project was to determine facilitators and barriers to MDPP implementation and use in western Pennsylvania. We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Using an implementation science framework, we conducted individual interviews with 5 program suppliers and 3 health care providers (N = 8) to determine their perspectives on positive aspects of the program and reasons for MDPP unavailability and lack of use. Data were analyzed using Thorne and colleagues' approach of interpretive description. Three main themes emerged: (1) facilitators and attributes of the MDPP, (2) barriers to MDPP implementation, and (3) suggestions for improvement. Facilitators of the program included technical support and webinars from Medicare to assist with the application process. Barriers such as financial reimbursement constraints and a lack of a systematic referral process were noted. Stakeholders suggested refinements to participant eligibility and performance-based payments, a seamless method of flagging and referring patients through the electronic health record, and ongoing virtual program delivery options. Findings from this project can be used to improve implementation of the MDPP in western Pennsylvania, support Medicare policy refinement, and inform implementation research to promote broader adoption of the MDPP across the United States.

Government Responsiveness through Gub Report Innovation in Central Java Province, Indonesia

Innovation in public services is a must in responding to challenges in today's digital era. Public services previously slow, transparent, and full of KKN can be trimmed with innovation. The public can monitor the government and provide criticism or input. Government officials are required to be able to work with this technological development or what we know as e-government. E-government is a digitization process initially carried out manually, simplifying bureaucracy and providing various services to the community. This study aims to determine the function of the government's response to various community complaints through the Gub Report channel in Central Java Province. The method used in this study is a qualitative-descriptive method using secondary data related to the substance of the study, such as documents, previous research journals, and related regulations. This study found that for 2022, from January to October, the number of complaints recorded was 18,543, and a total of 9,758 complaints were processed. Public sector organizations must experience classic constraints: limited capacity and unequal human resources. To realize a responsive government, Central Java Province needs to receive complaints from the community through direct and open government services. The selection process of the echelon apparatus is more selective and competitive in preparing its change program through public service innovation, educating the public about the process of using the Gub report website channel, and educating the public about the procedures for using the Gub report website channel.

Community-funded behavioural change initiatives: Water quality in Ireland

Mitigating the deterioration in water quality is contingent on changing human behaviours. Community-based behavioural change initiatives are one approach to changing people's actions, which is distinct from many behavioural change programmes that target the actions of individuals. This paper examines a behavioural change initiative aiming to foster proactive community engagement in the management and protection of water catchments in Ireland. The initiative comprises a grant scheme for community groups to undertake a variety of activities to support improvements in water quality, ranging from education and awareness activities to physical interventions. The analysis finds that higher grant awards and a greater number of grant applications are positively associated with either a higher likelihood of engagement with public and private sector stakeholders or participation in the State's River Basin Management Plan process on improving water quality. While this demonstrates some success for the grant scheme, questions remain unanswered with respect to the efficacy of schemes like this. With limited quantitative data available both on the precise nature of interventions applied and measured target outcomes, it was not possible to discern what community group or project attributes are critical to the success of the grant scheme. This deficiency means that effectively replicating or scaling up successful projects like this will be practically challenging.