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Ng BP, Ely E, Papali'i M, Cannon MJ. Delivering the National Diabetes Prevention Program: Assessment of Retention, Physical Activity, and Weight Loss Outcomes by Participant Characteristics and Delivery Modes. J Diabetes Res 2024; 2024:8461704. [PMID: 39165352 PMCID: PMC11335425 DOI: 10.1155/2024/8461704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/13/2024] [Accepted: 07/19/2024] [Indexed: 08/22/2024] Open
Abstract
Type 2 diabetes disproportionately affects older adults, persons from racial and ethnic minority groups, and persons of low socioeconomic status. It can be prevented or delayed through evidence-based interventions such as the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP). This analysis is aimed at evaluating the outcomes (i.e., retention, physical activity, and weight loss) associated with participation in the National DPP LCP by participant characteristics and delivery mode (i.e., in-person, online, distance learning, and combination) using the 2012-2018 Diabetes Prevention Recognition Program (DPRP) data. Across all delivery modes, there were generally no substantial differences in retention between male and female participants, but male participants tended to have higher physical activity and weight loss (e.g., average weight loss for in-person delivery: 5.0% for males and 4.3% for females). Older participants had better retention rates than younger participants in all delivery modes and mostly higher physical activity and weight loss except for distance learning delivery (e.g., average weight loss for in-person delivery: 5.1% for those aged 65+ and 3.3% for those aged 18-34). Among the seven racial and ethnic groups studied, retention was generally highest for non-Hispanic/Latino (NH)-White participants and lowest for Hispanic/Latino participants. Physical activity varied by racial and ethnic groups and delivery mode. NH-White participants generally had the most weight loss except for distance learning delivery, and NH-Black/African American participants had the least (e.g., average weight loss for in-person delivery: 5.1% for NH-White participants, 3.3% for both NH-Black/African American and NH-American Indian/Alaska Native participants, and other racial and ethnic minority groups ranged from 3.4% to 4.9%). Monitoring and identifying disparities across demographics and delivery modes, particularly across multiple racial and ethnic groups, provides information that can be used to improve the implementation of the National DPP LCP by tailoring the intervention to reduce disparities.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing and DisabilityAging and Technology ClusterUniversity of Central Florida, Orlando, Florida, USA
- Division of Diabetes TranslationCenters for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Ely
- Division of Diabetes TranslationCenters for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Papali'i
- Division of Diabetes TranslationCenters for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael J. Cannon
- Division of Diabetes TranslationCenters for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Grudziąż-Sękowska J, Sękowski K, Pinkas J, Jankowski M. Preferred sources of information on diabetes prevention programmes: a population-based cross-sectional study in Poland. BMJ Open 2024; 14:e083362. [PMID: 38760035 PMCID: PMC11103186 DOI: 10.1136/bmjopen-2023-083362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE This study aimed to analyse preferred sources of information on diabetes prevention programmes and to identify sociodemographic determinants influencing these preferences among adults in Poland. DESIGN A cross-sectional survey was carried out between 15 and 18 September 2023 using a computer-assisted web interview. A self-prepared questionnaire included 10 questions on sources of information on type 2 diabetes prevention. PARTICIPANTS Data were obtained from 1046 adults (18-82 years); 53.4% were females. RESULTS Most respondents preferred email communication (46.4%), followed by a doctor or nurse (33.5%), and a letter or leaflet directly delivered to the mailbox (25.8%) for type 2 diabetes mellitus (DM2) prevention information. Younger respondents were more likely to indicate mass media (OR=1.81, 95% CI=1.12 to 2.95, p=0.01) and digital media (OR=1.65, 95% CI=1.02 to 2.67, p=0.04) as a source of information on DM2 prevention. Those who had higher education (OR=1.51, 95% CI=1.16 to 1.96, p=0.002), as well as those with chronic diseases (OR=1.50, 95% CI=1.14 to 1.97, p=0.004), were more likely to indicate digital media. Out of 10 different variables analysed in this study, passive occupational status (OR=1.43, 95% CI=1.04 to 1.96, p=0.03) as well as having chronic diseases (OR=1.51, 95% CI=1.16 to 1.96, p=0.002) were associated with higher odds of indicating healthcare workers as a preferred source of information. Marital status, having children, place of residence, household characteristics and financial status do not significantly decide communication preferences. CONCLUSION Communication on DM2 prevention should be adjusted to public preferences and expectations. Tailoring interventions to different demographic groups can enhance outreach and engagement. Email emerged as a popular choice, suggesting the potential of digital communication in preventive health programmes.
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Affiliation(s)
| | - Kuba Sękowski
- School of Public Health, Centrum Medyczne Ksztalcenia Podyplomowego, Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centrum Medyczne Ksztalcenia Podyplomowego, Warsaw, Poland
| | - Mateusz Jankowski
- School of Public Health, Centrum Medyczne Ksztalcenia Podyplomowego, Warsaw, Poland
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3
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Yoon S, Goh H, Phang JK, Kwan YH, Low LL. Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study. Sci Rep 2023; 13:20554. [PMID: 37996479 PMCID: PMC10667337 DOI: 10.1038/s41598-023-47168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore.
| | - Hendra Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- Population Health and Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Ruelas AL, Martínez Contreras TDJ, Esparza Romero J, Díaz Zavala RG, Candia Plata MDC, Hingle M, Armenta Guirado B, Haby MM. Factors influencing adults to drop out of intensive lifestyle interventions for weight loss. Transl Behav Med 2023; 13:245-254. [PMID: 36694376 PMCID: PMC10105866 DOI: 10.1093/tbm/ibac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Reducing ≥5% of body weight can decrease the risk of developing chronic diseases in adults with excess weight. Although Intensive Lifestyle Interventions (ILIs) that include cognitive-behavioral techniques to improve physical activity and eating habits are the best approach for losing weight, the failure to retain participants is a barrier to their successful implementation. We aimed to investigate the factors influencing adults to drop out of ILIs for weight loss at six months. We conducted retrospective multiple logistic regression analysis of 268 participants with excess weight (body mass index ≥ 25 kg/m2) from a multicenter study (n = 237, in-person ILI in five clinics, delivered by nutrition interns), and a randomized controlled trial (n = 31, one online ILI, delivered by a master's degree student). The same research team conducted both studies in Northern Mexico, using the same intervention components, and identical instruments and techniques to collect the data. We found that older participants (≥50 years) were less likely to drop out of the ILI for weight loss compared to participants <35 years old (OR = 0.34, 95% CI = 0.16-0.70). For each unit increase in the bodily pain scale of the SF-36 (less perceived pain), the risk of dropping out decreased by 2% (OR = 0.98, 95% CI = 0.97, 0.996), while a change in the interventionist during the 6-month intervention more than doubled the risk of dropping out (OR 2.25, 95% CI = 1.23-4.14). Retention in ILIs may be improved by ensuring that the same interventionist remains during the six-month intervention. In addition, ILIs may need further tailoring for younger ages and for participants with higher perceived pain.
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Affiliation(s)
- Alma L Ruelas
- Programa de Doctorado en Ciencias Químico Biológicas y de la Salud, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Teresita de Jesús Martínez Contreras
- Centro de Promoción de Salud Nutricional, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Julián Esparza Romero
- Unidad de Investigación en Diabetes, Centro de Investigación en Alimentación y Desarrollo, A.C. Carretera Gustavo Enrique Astiazarán Rosas, No.46, C.P. 83304, Hermosillo, Sonora, México
| | - Rolando Giovanni Díaz Zavala
- Centro de Promoción de Salud Nutricional, Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Maria Del Carmen Candia Plata
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Brianda Armenta Guirado
- Centro de Investigación en Nutrición y Salud Pública, Instituto Nacional de Salud Pública, Av. Universidad 655, col. Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, México
| | - Michelle M Haby
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Encinas y Rosales s/n Hermosillo, Sonora, 83000, México.,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Corker E, Marques MM, Johnston M, West R, Hastings J, Michie S. Behaviour change techniques taxonomy v1: Feedback to inform the development of an ontology. Wellcome Open Res 2023; 7:211. [PMID: 37745778 PMCID: PMC10511844 DOI: 10.12688/wellcomeopenres.18002.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 09/26/2023] Open
Abstract
Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety of behaviours. The BCTTv1 was intentionally named version 1 to allow for further revisions to the taxonomy. This study aimed to gather data to improve the BCTTv1 and provide recommendations for developing it into a more elaborated knowledge structure, an ontology. Methods: Feedback from users of BCTTv1 about limitations and proposed improvements was collected through the BCT website, user survey, researchers and experts involved in the Human Behaviour-Change Project, and a consultation. In addition, relevant published research reports and other classification systems of BCTs were analysed. These data were synthesised to produce recommendations to inform the development of an ontology of BCTs. Results: A total of 282 comments from six sources were reviewed and synthesised into four categories of suggestions: additional BCTs, amendments to labels and definitions of specific BCTs, amendments to the groupings, and general improvements. Feedback suggested some lack of clarity regarding understanding and identifying techniques from labels, definitions, and examples; distinctions and relations between BCTs; and knowing what they would look like in practice. Three recommendations to improve the BCTTv1 resulted from this analysis: to review the label and definition of each BCT, the 16 groupings of BCTs, and the examples illustrating BCTs. Conclusions : This review of feedback about BCTTv1 identified the need to improve the precision and knowledge structure of the current taxonomy. A BCT ontology would enable the specification of relationships between BCTs, more precise definitions, and allow better interoperability with other ontologies. This ontology will be developed as part of the Human Behaviour-Change Project.
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Affiliation(s)
- Elizabeth Corker
- Centre for Behaviour Change, University College London, London, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Marta M. Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM,) Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, Scotland, UK
| | - Robert West
- Centre for Behaviour Change, University College London, London, UK
| | - Janna Hastings
- Centre for Behaviour Change, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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6
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Corker E, Marques MM, Johnston M, West R, Hastings J, Michie S. Behaviour change techniques taxonomy v1: Feedback to inform the development of an ontology. Wellcome Open Res 2023; 7:211. [PMID: 37745778 PMCID: PMC10511844 DOI: 10.12688/wellcomeopenres.18002.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety of behaviours. The BCTTv1 was intentionally named version 1 to allow for further revisions to the taxonomy. This study aimed to gather data to improve the BCTTv1 and provide recommendations for developing it into a more elaborated knowledge structure, an ontology. Methods: Feedback from users of BCTTv1 about limitations and proposed improvements was collected through the BCT website, user survey, researchers and experts involved in the Human Behaviour-Change Project, and a consultation. In addition, relevant published research reports and other classification systems of BCTs were analysed. These data were synthesised to produce recommendations to inform the development of an ontology of BCTs. Results: A total of 282 comments from six sources were reviewed and synthesised into four categories of suggestions: additional BCTs, amendments to labels and definitions of specific BCTs, amendments to the groupings, and general improvements. Feedback suggested some lack of clarity regarding understanding and identifying techniques from labels, definitions, and examples; distinctions and relations between BCTs; and knowing what they would look like in practice. Three recommendations to improve the BCTTv1 resulted from this analysis: to review the label and definition of each BCT, the 16 groupings of BCTs, and the examples illustrating BCTs. Conclusions : This review of feedback about BCTTv1 identified the need to improve the precision and knowledge structure of the current taxonomy. A BCT ontology would enable the specification of relationships between BCTs, more precise definitions, and allow better interoperability with other ontologies. This ontology will be developed as part of the Human Behaviour-Change Project.
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Affiliation(s)
- Elizabeth Corker
- Centre for Behaviour Change, University College London, London, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Marta M. Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM,) Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, Scotland, UK
| | - Robert West
- Centre for Behaviour Change, University College London, London, UK
| | - Janna Hastings
- Centre for Behaviour Change, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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Gorczyca AM, Washburn RA, Smith P, Montgomery RN, Koon LM, Hastert M, Suire KB, Donnelly JE. Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9902. [PMID: 36011535 PMCID: PMC9408158 DOI: 10.3390/ijerph19169902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
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.
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Richard A. Washburn
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Patricia Smith
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Robert N. Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Lyndsie M. Koon
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS 66045, USA
| | - Mary Hastert
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kameron B. Suire
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Veldheer S, Scartozzi C, Bordner CR, Opara C, Williams B, Weaver L, Rodriguez D, Berg A, Sciamanna C. Impact of a Prescription Produce Program on Diabetes and Cardiovascular Risk Outcomes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1008-1017. [PMID: 34426064 DOI: 10.1016/j.jneb.2021.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the impact of a fruit and vegetable prescription program on diabetes and cardiovascular risk outcomes. DESIGN Single-arm pre-post study. SETTING Primary care clinic in a community-based hospital. PARTICIPANTS Adults with type 2 diabetes (n = 97), aged > 18 years, with hemoglobin A1c (HbA1c) ≥ 7.0%, and a body mass index (BMI) of ≥ 25 kg/m2. INTERVENTION Over 7 months, participants received monthly group-based diabetes self-management education (DSME) and monthly vouchers ($28-$140/month) redeemable for fruits and vegetables at local markets. ANALYSIS Biomarker changes (HbA1c, BMI, and blood pressure) were assessed with paired t tests. Voucher distribution and redemption were tracked, and voucher redemption rates were calculated. Linear mixed-effect regression models tested associations between biomarkers, voucher redemption rates, and participant characteristics. RESULTS There was a -1.3% (P < 0.001) postprogram change in HbA1c. Reduced HbA1c was associated with higher voucher redemption rates (P = 0.032) and a change in diabetes medications (P = 0.003). There were no associations with BMI, but blood pressure was positively associated with voucher redemption. CONCLUSIONS AND IMPLICATIONS Fruit and vegetable prescription programs may improve diabetes outcomes by incentivizing DSME uptake and retention. Future randomized trials are warranted to identify strategies to improve DSME engagement and voucher redemption rates and assess mechanisms through which these programs influence health outcomes.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA; Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA.
| | - Christina Scartozzi
- Department of Family and Community Medicine, Penn State Health St. Joseph Medical Center, Reading, PA
| | - Candace R Bordner
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | | | | | - Lisa Weaver
- Department of Family and Community Medicine, Penn State Health St. Joseph Medical Center, Reading, PA; Penn State University Berks Campus, Reading, PA
| | - Diana Rodriguez
- Racial and Ethnic Approaches to Community Health (REACH) Project, Pennsylvania State University College of Medicine, Hershey, PA
| | - Arthur Berg
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Christopher Sciamanna
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA; Department of General Internal Medicine, Pennsylvania State University College of Medicine, Hershey, PA
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Dahl M, Søndergaard SF, Diederichsen A, Pouwer F, Pedersen SS, Søndergaard J, Lindholt J. Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study. BMC Public Health 2021; 21:203. [PMID: 33482775 PMCID: PMC7824926 DOI: 10.1186/s12889-021-10172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD. Methods We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis. Results The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives. Conclusion Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10172-6.
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Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Surgery, Regional Hospital Central Denmark, Toldbodgade 12, DK-8800, Viborg, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200, Aarhus N, Denmark.
| | - Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Central Denmark/VIA University College, School of Nursing, Viborg, Toldbodgade 12, DK-8800, Viborg, Denmark.,Department of Public Health, Nursing, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, J.B Winsløws vej 4, DK-5000, Odense C, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,STENO Diabetes Centre Odense, Kløvervænget 112, DK-5000, Odense C, Denmark.,School of Psychology, Deakin University, Geelong Waterfront Campus, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, J.B Winsløws vej 4, DK-5000, Odense C, Denmark.,Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK-5000, Odense C, Denmark
| | - Jes Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark.,Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark.,Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark
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