Community-based Diabetes Prevention Program Research Articles

"People Need to Know; We're Part of the Community. We're Here.": Examining Experiences of Sharing Demographic Information for a Community-Based Diabetes Prevention Program.

Collecting demographic data is critical for identifying inequities in healthcare services and delivery. Inaccurate collection of demographic data can make developing equitable health interventions and improving reach of existing interventions difficult. This study aimed to (a) examine experiences in completing a community-based type 2 diabetes prevention program Small Steps for Big Changes (SSBC) demographic questionnaire (SSBC-DQ) among adults from equity-owed groups, and (b) assess recommendations for improvement to the questionnaire. Adults with no prior involvement in SSBC were recruited. Participants completed the SSBC-DQ online and then engaged in one-on-one structured interviews. Interview data was analyzed using interpretive description and coded using the APEASE criteria. Twelve participant interviews were included in analysis. Five principle themes were developed to capture the experiences of completing the SSBC-DQ: representation, comprehension, demographics are an emotional experience, the role that privilege plays, and beliefs about demographic data. Sixty suggested changes were coded using the APEASE criteria; six suggestions met the criteria for implementation, 20 did not meet the criteria, and 34 required further discussion with the research team. Results from this study illustrate that people's lived experiences can drive their reactions and interpretations to demographic questionnaires. Based on end-user suggestions, SSBC made changes to its demographic questionnaire to be more inclusive. Having a demographic questionnaire that is more inclusive can help SSBC better understand what populations it is and is not reaching in an acceptable and inclusive manner. This will help inform future directions regarding evaluating program reach and equity.

Understanding diabetes risk in the Y Community of Greater Brisbane: Findings from a cross-sectional survey.

This cross-sectional study aimed to understand the need and desire for a diabetes prevention program within the Y (formerly YMCA: Young Men's Christian Association) of the Greater Brisbane region, Queensland, Australia. An anonymous online survey was distributed (March-April 2023) by The Y Queensland targeting adults within the Greater Brisbane Y community. Data were collected on Y membership and branch attended, postcode, diabetes risk in the next 5 years (low, medium, or high), and interest in participation in a diabetes prevention program. Data were analysed via descriptives and cross tabulation with statistical significance considered at p < .05. Respondents (n = 575) were primarily female (65%), attending a Y branch located in the outer city (51%), and aged under 55 years (68%). Twenty Y sites were represented, with a mix of inner-city, outer-city, and regional areas. Overall, 46% (n = 241/530) of respondents were at high diabetes risk, with those living in relatively socio-economically disadvantaged areas more likely (p < .001) to be at high-risk (57%) than intermediate (26%) or low-risk (18%). Most (68%) respondents were interested/potentially interested in program participation; those at high risk of developing diabetes in the next 5 years were most interested (55%). The Y in Greater Brisbane may provide a suitable setting to host a community-based diabetes prevention program. Locations outside the inner city should be prioritised to target those who are relatively socio-economically disadvantaged to align with higher need and demand. SO WHAT?: Findings inform the implementation and prioritisation of a community-delivered diabetes prevention program.

IDF23-0528 Participation in a long-lasting community-based diabetes prevention program during the COVID-19 pandemic

IDF23-0528 Participation in a long-lasting community-based diabetes prevention program during the COVID-19 pandemic

A pilot community-based Diabetes Prevention and Management Program for adults with diabetes and prediabetes.

West Virginia is a rural state with high rates of type 2 diabetes (T2DM) and prediabetes. The Diabetes Prevention and Management (DPM) program was a health coach (HC)-led, 12-month community-based lifestyle intervention. The study examined the impact of the DPM program on changes in glycosylated hemoglobin (A1C) and weight over twelve months among rural adults with diabetes and prediabetes. Program feasibility and acceptability were also explored. An explanatory sequential quantitative and qualitative one-group study design was used to gain insight into the pre- and 12-month changes to health behavior and clinical outcomes. Trained HCs delivered the educational sessions and provided weekly health coaching feedback. Assessments included demographics, clinical, anthropometric, and qualitative focus groups. Participants included 94 obese adults with diabetes (63%) and prediabetes (37%). Twenty-two participated in three focus groups. Average attendance was 13.7 ± 6.1 out of 22 sessions. Mean weight loss was 4.4 ± 11.5 lbs at twelve months and clinical improvement in A1C (0.4%) was noted among T2DM adults. Program retention (82%) was higher among older participants and those with poor glycemic control. While all participants connected to a trained HC, only 72% had regular weekly health coaching. Participants reported overall acceptability and satisfaction with the program and limited barriers to program engagement. Our findings suggest that it is feasible to implement an HC-led DPM program in rural communities and improve A1C in T2DM adults. Trained HCs have the potential to be integrated with healthcare teams in rural regions of the United States.

Fidelity and maintenance of motivational interviewing skills in diabetes prevention program coaches: a pilot study

ABSTRACT Motivational interviewing (MI) is an effective counseling style for changing lifestyle behaviors. The purpose of this study was to pilot a brief MI workshop on non-healthcare practitioners to deliver a community-based diabetes prevention program. Participants (n = 5) attended a two-day MI workshop, shadowed an expert coach delivering the diabetes prevention program, and finally, were shadowed by the expert coach and received feedback. Participants pre- and post-workshop MI skills were assessed, participants’ satisfaction with the workshop was recorded, and their delivery of the program using MI was assessed using a random selection of participants’ audio recordings of interactions with client. The primary outcome was whether coaches were able to maintain a level of client-centered MI skills for the six months post-training, as assessed by the Motivational Interviewing Competency Assessment (MICA). One session with one client per month for coaches’ first six months post-training was coded. Counseling scores were generated using the MICA. In general, coaches showed improvements from pre- to post-workshop, were satisfied with the training, and were using client-centered care over the six-month study period. The majority (80%) of all sessions were client-centered for all the MICA categories. This pilot study offers preliminary evidence that non-healthcare practitioners attending a brief MI training were able to deliver client-centered coaching in a community-based diabetes prevention program up to six months post-training without the use of any booster training sessions. This suggests that the training used within this study may be sufficient to train future non-healthcare practitioner diabetes prevention program coaches in the community.

Use of Focus Groups to Inform a New Community-Based Youth Diabetes Prevention Program.

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13–22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.

Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes.

ObjectiveThis study aimed to identify facilitators and barriers to the uptake of a community-based diabetes prevention program (DPP) from the perspectives of decliners with prediabetes in a multi-ethnic Asian community.MethodsSemi-structured interviews were conducted with 29 individuals with prediabetes who declined participation in a large community-based diabetes prevention program in Singapore. Thematic analysis was undertaken to identify themes, which were subsequently mapped onto the Capacity-Opportunity-Motivation and Behavior model (COM-B).ResultsWe identified 16 key themes under three COM-B domains. Health status at the time of invitation, perceived ability of self-management, understanding of prediabetes condition and/or the program intention (Capability) were important determinants. Family commitment had the strong potential to enable or hinder physical and social Opportunity related to participation. Many participants desired involvement of physician as part of program invitation and component. Fear of exacerbation coupled with an automatic aversion for suffering influenced Motivation for participation.ConclusionIdentifying facilitators and barriers embedded in the COM-B will assist systematic program modifications to increase participation of individuals with prediabetes. How information about modifiable risk factors is communicated by physicians at the point of diagnosis and program introduction is key to participation. Co-locating programs with family activity, development of mHealth, readiness assessment, and tailored explanation of program purpose may increase participation. These findings will be used to guide future national interventions in the community to ensure successful implementation.

Implementation of a diabetes prevention program within two community sites: a qualitative assessment

BackgroundDespite numerous translations of diabetes prevention programs, implementation evaluations are rarely conducted. The purpose of this study was to examine the implementation process and multilevel contextual factors as an evidence-based diabetes prevention program was implemented into two local community organization sites to inform future scale-up. To build the science of implementation, context and strategies must be identified and explored to understand their impact.MethodsThe program was a brief-counseling diet and exercise modification program for individuals at risk of developing type 2 diabetes. A 1-year collaborative planning process with a local not-for-profit community organization co-developed an implementation plan to translate the program. A pragmatic epistemology guided this research. Semi-structured interviews were conducted with staff who delivered the program (n = 8), and a focus group was completed with implementation support staff (n = 5) at both community sites. Interviews were transcribed verbatim and thematically analyzed using a template approach. The consolidated framework for implementation research (CFIR) is a well-researched multilevel implementation determinant framework and was used to guide the analysis of this study. Within the template approach, salient themes were first inductively identified, then identified themes were deductively linked to CFIR constructs.ResultsImplementation strategies used were appropriate, well-received, and promoted effective implementation. The implementation plan had an impact on multiple levels as several CFIR constructs were identified from all five domains of the framework: (a) process, (b) intervention characteristics, (c) outer setting, (d) inner setting, and (e) individual characteristics. Specifically, results revealed the collaborative 1-year planning process, program components and structure, level of support, and synergy between program and context were important factors in the implementation.ConclusionThis study offers insights into the process of implementing a community-based diabetes prevention program in two local sites. Successful implementation benefited from a fully engaged, partnered approach to planning, and subsequently executing, an implementation effort. The CFIR was a useful and thorough framework to evaluate and identify multilevel contextual factors impacting implementation. Results can be used to inform future implementation and scale-up efforts.

Group Social Support Facilitates Adoption of Healthier Behaviors Among Black Women in a Community-Initiated National Diabetes Prevention Program.

The aim of this study was to better understand facilitators and barriers of the early adoption of healthy eating and physical activity behaviors among Black women participating in a community-based, community-initiated diabetes education program. We held focus groups with participants (N = 14) ages 24 to 90 years. Participants were recruited from a multisite, community-based diabetes prevention program in the Southeastern United States. Data were collected in March and June of 2017. Barriers and facilitators of change were categorized using the socioecological model with interpersonal, intrapersonal, community, and environmental factors serving as the foundation for thematic content. Participants reported the adoption of several behavioral changes resulting in positive health outcomes. They also identified several facilitators and few barriers to initial behavior change on participating in the diabetes prevention program. The greatest facilitator was interpersonal, while the greatest barriers were community and/or environmental. Understanding the factors that improve or impede the successful adoption of health behaviors among Black women participating in a behavioral lifestyle program will allow us to develop stronger, more tailored interventions that provide the greatest impact to assist in improving weight loss outcomes and reducing the burden of diabetes among Black women.

The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention

BackgroundThe Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors.MethodsData were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender.ResultsAmong 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants [median weight loss (IQR), 6 months: 5.7% (2.7–9.0) vs. 1.5% (1.2–7.5) p = .01 and 12 months: 4.8% (1.1–9.6) vs. 1.1% (− 2.0–3.7) p = .01, respectively]. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months.ConclusionsThe DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals.Trial registrationNCT01050205, NCT02467881.

The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) program: study protocol for a randomized controlled trial

BackgroundCommunity-based diabetes prevention programs varied widely in effectiveness, and the intervention strategy consisting of lifestyle interventions, stepwise addition of metformin, and financial incentives has not been studied in real-world clinical practice settings. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial is a pragmatic trial that aims to compare the effectiveness of a community-based stepwise diabetes prevention program with added financial incentives (intervention) versus the standard of care (control) in reducing the risk of type 2 diabetes over 3 years among overweight or obese individuals with pre-diabetes.MethodsThis is an open-label, 1:1 randomized controlled trial which aims to recruit 846 adult individuals with isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or both IFG and IGT from Singapore. Intervention arm participants attend 12 group-based sessions (2 nutrition workshops, 9 exercise sessions, and a goal-setting workshop) delivered at community sites (weeks 1 to 6), receive weekly physical activity and nutrition recommendations delivered by printed worksheets (weeks 7 to 12), and receive monthly health tips delivered by text messages (months 4 to 36). From month 6 onwards, intervention arm participants who remain at the highest risk of conversion to diabetes are prescribed metformin. Intervention arm participants are also eligible for a payment/rewards program with incentives tied to attendance at the group sessions and achievement of the weight loss target (5% of baseline weight). All participants are assessed at baseline, month 3, month 6, and every 6 months subsequently till month 36. The primary endpoint is the proportion of participants with diabetes at 3 years. Secondary endpoints include the mean change from baseline at 3 years in fasting plasma glucose, 2-hour plasma glucose, HbA1c, body weight, body mass index, physical activity, and dietary intake.DiscussionThe Pre-DICTED trial will provide evidence of the effectiveness and feasibility of a community-based stepwise diabetes prevention program with added financial incentives for individuals with pre-diabetes in Singapore. The study will provide data for a future cost-effectiveness analysis, which will be used to inform policymakers of the value of a nationwide implementation of the diabetes prevention program.Trial registrationClinicalTrials.govNCT03503942. Retrospectively registered on April 20, 2018.Protocol version: 5.0 Date: 1 March 2019

Impact of Maintenance Session Attendance and Early Weight Loss Goal Achievement on Weight Loss Success in a Community-Based Diabetes Prevention Program Intervention.

The purpose of this study was to examine how maintenance session attendance and 6-month weight loss (WL) goal achievement impacted 12-month 5% WL success in older adults participating in a community-based Diabetes Prevention Program (DPP) lifestyle intervention. Data were combined from 2 community trials that delivered the 12-month DPP-based Group Lifestyle Balance (GLB) to overweight/obese adults (mean age = 62 years, 76% women) with prediabetes and/or metabolic syndrome. Included participants (n = 238) attended ≥4 core sessions (months 0-6) and had complete data on maintenance attendance (≥4 of 6 sessions during months 7-12) and 6- and 12-month WL (5% WL goal, yes/no). Multivariate logistic regression was used to estimate the odds of 12-month 5% WL associated with maintenance attendance and 6-month WL. Associations between age (Medicare-eligible ≥65 vs <65 years) and WL and attendance were examined. Both attending ≥4 maintenance sessions and meeting the 6-month 5% WL goal increased the odds of meeting the 12-month 5% WL goal. For those not meeting the 6-month WL goal, maintenance session attendance did not improve odds of 12-month WL success. Medicare-eligible adults ≥65 years were more likely to meet the 12-month WL goal (odds ratio = 3.03, 95% CI, 1.58-5.81) versus <65 years. The results of this study provide important information regarding participant attendance and WL for providers offering DPP-based lifestyle intervention programs across the country who are seeking Medicare reimbursement. Understanding Medicare reimbursement-defined success will allow these providers to focus on and develop strategies to enhance program effectiveness and sustainability.

Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program.

Improving diet and physical activity (PA) can reduce the risk of developing type 2 diabetes (T2D); however, long-term diet and PA adherence is poor. To impact population-level T2D risk, scalable interventions facilitating behavior change adherence are needed. Text messaging interventions supplementing behavior change interventions can positively influence health behaviors including diet and PA. The Behavior Change Wheel (BCW) provides structure to intervention design and has been used extensively in health behavior change interventions. Describe the development process of a bank of text messages targeting dietary and PA adherence following a diabetes prevention program using the BCW. The BCW was used to select the target behavior, barriers and facilitators to engaging in the behavior, and associated behavior change techniques (BCTs). Messages were written to map onto BCTs and were subsequently coded for BCT fidelity. The target behaviors were adherence to diet and PA recommendations. A total of 16 barriers/facilitators and 28 BCTs were selected for inclusion in the messages. One hundred and twenty-four messages were written based on selected BCTs. Following the fidelity check a total of 43 unique BCTs were present in the final bank of messages. This study demonstrates the application of the BCW to guide the development of a bank of text messages for individuals with prediabetes. Results underscore the potential utility of having independent coders for an unbiased expert evaluation of what active components are in use. Future research is needed to demonstrate the feasibility and effectiveness of resulting bank of messages.

Little Earth Strong: A Community-Level, Culturally Appropriate Diabetes Prevention Pilot Targeting Urban American Indians

The purpose of this study was to develop a culturally appropriate, community-based diabetes prevention program, named Little Earth Strong, through partnership with an urban, Indigenous, American Indian community and determine its feasibility in lowering diabetes risks. Using a community-based participatory research, community-level intervention approach, and after conducting a focus groups with key stakeholders (n = 20), a culturally appropriate health intervention was designed across six stages. This included providing nutrition and physical activity individual, family, and group counseling and conducting individual level biometric tests at a monthly Progress Powwow. Community participants (n = 69) included Indigenous individuals ages 18 to 64 years and their families residing in an urban American Indian housing organization. Findings included the project's feasibility, sustainability, and future needs. Lessons learned included the need the need to situate health interventions within Indigenous culture, engage multiple stakeholders, remain flexible and inclusive of all community members, address cultural concerns regarding biometric testing, and focus on specific ages and groups. The outcome variables included qualitative focus group data regarding feasibility and design and quantitative biometric data including hemoglobin A1C levels and weight in which a significant decrease in A1C values were found among womenConclusions: Little Earth Strong was both feasible and successful in decreasing A1C levels using a community-level approach, especially in high participators who attended most events. These results demonstrate the promise of diabetes prevention fitness and nutrition interventions that are collaboratively designed with the community.

Comparative Effectiveness of Three Different Delivery Models for a Community-Based Diabetes Prevention and Management Education Program in Older Adults

Abstract Objectives The purpose was to compare the effects of three different delivery models for a diabetes prevention and management education (DPME) program on nutrition and diabetes knowledge (NDK), self-efficacy, dietary behaviors, skin carotenoid score (SCS), Body Mass Index (BMI), and fasting plasma glucose (FPG) among older adults. Methods We investigated dietary perceptions and health education needs of the community-dwelling older persons through interviewer-administered questionnaires in Lubbock, Texas (n = 186). This was then used to modify the national Diabetes Prevention Program (DPP), where the core elements were healthy eating within limited budget, enhancing self-efficacy, nutrition misconceptions, and practical problem-solving skills. The intervention was a clustered randomized trial (CRT). We recruited six community centers (two blocks of three). Two centers were randomly assigned to receive DPME through education and support from nutrition professionals (Pro, n = 23), two centers were assigned to trained peer educators (Peer, n = 27), and two centers were assigned to receive written materials (Passive, n = 26). Pro and Peer groups received weekly 45-minuate DPME sessions and the written materials for 10 weeks. Passive group received the DPME written materials on a weekly basis. Outcome measures were assessed at baseline and at the end of the intervention. Results The majority of subjects were Hispanics (72.4%), followed by Caucasians (14.5%) and African Americans (11.8%). Regression models demonstrated a significant improvement in self-efficacy score in Peer group (+0.38 ± 0.24) compared to the other two groups (+0.18 ± 0.32 for Pro and +0.11 ± 0.45 for Passive, P &amp;lt; 0.05). We found significant within-group improvements in NDK (P &amp;lt; 0.01), SCS (P &amp;lt; 0.001), and dietary behaviors (P &amp;lt; 0.001) for both Pro and Peer groups, with no significant differences between the two groups. Passive group did not show any significant changes in any of the outcomes measures. Budget management strategies were the most frequently reported element that empowered participants for changing their dietary behaviors. Conclusions Peer education provides a sustainable resource for diabetes prevention programs for community-dwelling elderly people. Passive information dissemination had no benefits to diabetes prevention for older adults. Funding Sources TTU Start-Up Funds.

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

ObjectiveThis two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months.MethodsAdults aged 18–75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants’ homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype “Living Well, Taking Control” (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded.ResultsThe target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (− 1.7 kg, 95% CI − 2.59 to − 0.85). Higher attendance was associated with greater weight loss (− 3.0 kg, 95% CI − 4.5 to − 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI − 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm.ConclusionsThis voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors.Trial registrationTrial registration number: ISRCTN70221670, 5 September 2014Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM.

Effects of Mobile Health Prompts on Self-Monitoring and Exercise Behaviors Following a Diabetes Prevention Program: Secondary Analysis From a Randomized Controlled Trial.

BackgroundA number of mobile health (mHealth) apps exist that focus specifically on promoting exercise behavior. To increase user engagement, prompts, such as text messages, emails, or push notifications, are often used. To date, little research has been done to understand whether, and for how long, these prompts influence exercise behavior.ObjectiveThis study aimed to assess the impact of prompts on mHealth self-monitoring and self-reported exercise in the days following a prompt and whether these effects differ based on exercise modality.MethodsOf the possible 99 adults at risk for developing type II diabetes who participated in a diabetes prevention program, 69 were included in this secondary analysis. Participants were randomly assigned to 1 of the following 2 exercise conditions: high-intensity interval training or moderate-intensity continuous training. In the year following a brief, community-based diabetes prevention program involving counseling and supervised exercise sessions, all participants self-monitored their daily exercise behaviors on an mHealth app in which they were sent personalized prompts at varying frequencies. mHealth self-monitoring and self-reported exercise data from the app were averaged over 1, 3, 5, and 7 days preceding and following a prompt and subsequently compared using t tests.ResultsIn the year following the diabetes prevention program, self-monitoring (t68=6.82; P<.001; d=0.46) and self-reported exercise (t68=2.16; P=.03; d=0.38) significantly increased in the 3 days following a prompt compared with the 3 days preceding. Prompts were most effective in the first half of the year, and there were no differences in self-monitoring or self-reported exercise behaviors between exercise modalities (P values >.05). In the first half of the year, self-monitoring was significant in the 3 days following a prompt (t68=8.61; P<.001; d=0.60), and self-reported exercise was significant in the 3 days (t68=3.7; P<.001; d=0.37), 5 days (t67=2.15; P=.04; d=0.14), and 7 days (t68=2.46; P=.02; d=0.15) following a prompt, whereas no significant changes were found in the second half of the year.ConclusionsThis study provides preliminary evidence regarding the potential influence of prompts on mHealth self-monitoring and self-reported exercise and the duration for which prompts may be effective as exercise behavior change tools. Future studies should determine the optimal prompting frequency for influencing self-reported exercise behaviors. Optimizing prompt frequency can potentially reduce intervention costs and promote user engagement. Furthermore, it can encourage consumers to self-monitor using mHealth technology while ensuring prompts are sent when necessary and effective.International Registered Report Identifier (IRRID)DERR2-10.2196/11226

Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH).

High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.

Evaluation of a Community-Based Diabetes Prevention Program in Thailand: A Cluster Randomized Controlled Trial.

Objectives: Lifestyle interventions have been shown to effectively reduce the incidence of diabetes, but evidence from middle-income countries is scarce. We evaluated the effectiveness of a lifestyle program to prevent diabetes in primary-care settings in Thailand. Methods: A matched-pair cluster randomized controlled trial was conducted in 68 primary care units in 8 provinces. The primary care units were randomly assigned to intervention or control arms. Individuals aged 30 to 65 years with impaired oral glucose tolerance were recruited and followed up for 2 years. The intervention included periodic group-based activities on healthy lifestyle behaviors; the control group received a one-time education program. The primary outcome was the incidence rate of type 2 diabetes at 24 months after the intervention. Results: A total of 1903 individuals participated (873 in the control group and 1030 in the intervention group). At baseline, participants’ characteristics did not differ between groups. After 24 months, the incidence rates (per 100 person-year) of diabetes was 12.1% (95% CI 10.7% to 13.8%) in the intervention group, and 16.6% (95% CI 14.6 to 18.8%) in the control group (P < .001). Overall, the adjusted hazard ratio for diabetes incidence was 0.72 (95% CI 0.60 to 0.86). A mean body weight reduction of 1.5 kg was observed in the intervention group, whereas, an increase of 0.4 kg was observed in the control group (P < .001). Conclusion: A community-based lifestyle modification through participatory group activities can prevent or delay the incidence of diabetes among Thai populations with impaired glucose tolerance.

Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries.

To examine the cost-effectiveness of a community-based Diabetes Prevention Program (DPP) for Medicaid beneficiaries from the perspective of the health care sector. A total of 847 Medicaid enrollees at high risk for type 2 diabetes participating in a community-based DPP. Pre- and post clinical outcome and cost data were used as inputs into a validated diabetes simulation model. The model was used to evaluate quality-adjusted life years (QALYs) and health care costs over a 40-year time horizon from the perspective of the health care sector. Clinical outcome and cost data were derived from a study examining the effect of financial incentives on weight loss. Study participants lost an average of 4.2 lb (p<.001) and increased high-density lipoprotein cholesterol by 1.75mg/dl (p=.002). Intervention costs, which included financial incentives for participation and weight loss, were $915 per participant. The incremental cost-effectiveness ratio was estimated to be $14,011 per QALY but was sensitive to the time horizon studied. Widespread adoption of community-based DPP has the potential to reduce diabetes and cardiovascular-related morbidity and mortality for low-income persons at high risk for diabetes and may be a cost-effective investment for Medicaid programs.