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Reading JM, Crane MM, Guan J, Jackman R, Thomson MD, LaRose JG. Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings. JMIR Form Res 2024; 8:e53841. [PMID: 38578686 PMCID: PMC11031701 DOI: 10.2196/53841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. OBJECTIVE This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). METHODS Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men's experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. RESULTS Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. CONCLUSIONS Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. TRIAL REGISTRATION ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263.
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Affiliation(s)
- Jean Miki Reading
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Melissa M Crane
- Department of Family and Preventive Medicine, Rush University, Chicago, IL, United States
| | - Justin Guan
- Department of Social and Behavioral Sciences, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Ronston Jackman
- Department of Social and Behavioral Sciences, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Maria D Thomson
- Department of Social and Behavioral Sciences, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Jessica Gokee LaRose
- Department of Social and Behavioral Sciences, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
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Russell LE, Tse J, Bowie J, Richardson CR, Trubek A, Maruthur N, Wolfson JA. Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD. Public Health Nutr 2023; 26:2492-2497. [PMID: 37271725 DOI: 10.1017/s1368980023001106] [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] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants. DESIGN Photo-elicitation in-depth interviews were conducted from June to August, 2021. SETTING Baltimore, MD, USA. PARTICIPANTS Thirteen Black women who participated in DPP. RESULTS The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping. CONCLUSIONS Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.
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Affiliation(s)
- Lauren E Russell
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Jillian Tse
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD21205, USA
| | - Janice Bowie
- Johns Hopkins Bloomberg School of Public Health, Department of Health Behavior and Society, Baltimore, MD, USA
| | | | - Amy Trubek
- University of Vermont, Department of Nutrition and Food Sciences, Burlington, VT, USA
| | - Nisa Maruthur
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Julia A Wolfson
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD21205, USA
- University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, MI, USA
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Abshire DA, Wippold GM, Wilson DK, Pinto BM, Probst JC, Hardin JW. A qualitative study of ecological and motivational factors to inform weight management interventions for Black men in the rural South of the United States. Soc Sci Med 2023; 326:115898. [PMID: 37087973 PMCID: PMC10354809 DOI: 10.1016/j.socscimed.2023.115898] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
RATIONALE AND OBJECTIVE Black men in the rural South of the United States (US) are underrepresented in weight management behavioral trials. Qualitative research is needed to inform interventions that can reduce obesity and health disparities in this population. We explored how intrapersonal, social, and environmental factors affect motivation and weight-related behaviors and how to culturally adapt behavioral interventions for Black men in the rural South. METHODS We conducted individual telephone interviews with 23 Black men (mean age 50 ± 14 years) with overweight or obesity living in rural South Carolina communities in 2020 and 2021. Interviews were audio recorded, professionally transcribed, and coded by two men's health researchers who achieved an intercoder reliability of 70%. Content analysis using QSR NVivo 12 was used to generate themes using deductive and inductive approaches. RESULTS Physical health and health behaviors were perceived as key determinants of overall health. Family, friends, and other social contacts often provided positive social support that increased motivation but also hindered motivation by engaging in behaviors men were trying to avoid. Younger participants had stronger views of rural environments not supporting healthy lifestyles, which compounded personal challenges such as time constraints and lack of motivation. Comfort was discussed as a critical program consideration, and gender concordance among program participants and facilitators was perceived as promoting comfort. Participants noted preferences and benefits of in-person, group programs emphasizing physical activity, and younger participants more strongly endorsed programs that incorporated sports and competition. CONCLUSIONS Findings from this study provide important evidence to inform the development of weight management interventions for Black men in the rural US South. Based on these findings, an innovative, competitive "football-themed" weight management program promoting peer support and integrating competitive physical activities is being evaluated for younger Black men in the rural South.
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Affiliation(s)
- Demetrius A Abshire
- University of South Carolina College of Nursing, 1601 Greene Street, Columbia, SC, 29208, USA.
| | - Guillermo M Wippold
- University of South Carolina, Department of Psychology, Barnwell College 224, 1512 Pendleton Street, Columbia, SC, 29208, USA.
| | - Dawn K Wilson
- University of South Carolina, Department of Psychology, Barnwell College 224, 1512 Pendleton Street, Columbia, SC, 29208, USA.
| | - Bernardine M Pinto
- University of South Carolina College of Nursing, 1601 Greene Street, Columbia, SC, 29208, USA.
| | - Janice C Probst
- University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
| | - James W Hardin
- University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
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Shakya P, Bajracharya M, Skovlund E, Shrestha A, Karmacharya BM, Kulseng BE, Sen A, Steinsbekk A, Shrestha A. How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5054. [PMID: 36981962 PMCID: PMC10048900 DOI: 10.3390/ijerph20065054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.
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Affiliation(s)
- Pushpanjali Shakya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Monish Bajracharya
- Department of Business and IT, University of South-Eastern Norway, 3800 Bø, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Bård Eirik Kulseng
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Centre for Oral Health Services and Research (TkMidt), 7030 Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
- Institute for Implementation Science and Health, Kathmandu 44600, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06520-0834, USA
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Reading JM, Crane MM, Carlyle K, Perera RA, LaRose JG. A Self-Guided Lifestyle Intervention for Young Men: Findings from the ACTIVATE Randomized Pilot Trial. JOURNAL OF MEN'S HEALTH 2022; 18:191. [PMID: 36846742 PMCID: PMC9949796 DOI: 10.31083/j.jomh1809191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Young men are at high risk for developing obesity-related health complications, yet are markedly underrepresented in lifestyle interventions. This pilot study examined the feasibility and preliminary efficacy of a lifestyle intervention (self-guided + health risk messaging) targeting young men. Methods 35 young men (Age = 29.3 ± 4.27; BMI = 30.8 ± 4.26; 34% racial/ethnic minority) were randomly assigned to the intervention or delayed treatment control. The intervention (ACTIVATE) included 1 virtual group session, digital tools (wireless scale, self-monitoring app), access to self-paced content via a secure website, and 12 weekly texts to reinforce health risk messaging. Fasted objective weight was assessed remotely at baseline and 12-weeks. Perceived risk was assessed via survey at baseline, 2-week, and 12-week. T-tests were used to compare weight outcomes between arms. Linear regressions examined the association between percent weight change and perceived risk change. Results Recruitment was successful as evidenced by 109% of target enrollment achieved in a 2-month period. Retention was 86% at 12 weeks, with no differences by arm (p = 0.17). Participants in the intervention arm experienced modest weight loss at 12 weeks, whereas slight gains were observed in the control arm (-1.6% ± 2.5 vs. +0.31% ± 2.8, p = 0.04). Change in perceived risk was not associated with change in percent weight (p > 0.05). Conclusions A self-guided lifestyle intervention showed initial promise for weight management among young men, but these findings are limited by small sample size. More research is needed to bolster weight loss outcomes while retaining the scalable self-guided approach. Clinical Trial Registration NCT04267263 (https://www.clinicaltrials.gov/ct2/show/NCT04267263).
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Affiliation(s)
- Jean M Reading
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Melissa M Crane
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kellie Carlyle
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
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Weiss L, Quint E, Leto C, Vaughn I, Redrovan A, Fernandes M, Lamourt K, Edgar C, Reso A. Evaluation of an Integrated Health Promotion Program for a low-income urban population: Findings and lessons learned. Public Health Nurs 2020; 38:571-578. [PMID: 33216393 PMCID: PMC8359448 DOI: 10.1111/phn.12839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/01/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Objectives To evaluate a multicomponent pilot program for low‐income individuals with, or at risk for, hypertension, diabetes, and/or overweight. Design Pre‐post evaluation including baseline and follow‐up assessments, satisfaction surveys, program utilization data, and focus groups. Sample The evaluation included 138 participants. The majority were Latinx (88%), female (82%), born outside the United States (80%), and had not graduated from high school (52%). The most common health conditions were hypertension (59%), overweight or obesity (55%), high cholesterol (53%), and diabetes (34%). Measurements Engagement in program activities, health indicators (e.g., blood pressure), and behavior change. Qualitative data focused on perceptions of the program and its impacts. Intervention The program offered a number of health promotion services, including consultation with a nurse and a community health worker (CHW), health and nutrition talks, subsidized farm shares, cooking classes, exercise classes, and home visits. Results There were improvements in general health, blood pressure, and knowledge and behavior related to disease management and healthy eating. Conclusions Program success was attributed to the wide range of complementary program components. The staffing model was also a strength: the CHW/nurse collaboration combined clinical expertise with cultural, language, and community knowledge to create a program that was accessible and empowering.
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Affiliation(s)
- Linda Weiss
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | | | | | - Ivana Vaughn
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | | | | | | | - Colin Edgar
- RiseBoro Community Partnership, Brooklyn, NY, USA
| | - Ada Reso
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
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Ritchie ND, Baucom KJW, Sauder KA. Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges. Diabetes Metab Syndr Obes 2020; 13:2949-2957. [PMID: 32903871 PMCID: PMC7445538 DOI: 10.2147/dmso.s218334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.
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Affiliation(s)
- Natalie D Ritchie
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado College of Nursing, Aurora, CO, USA
- Correspondence: Natalie D Ritchie Denver Health and Hospital Authority Email
| | | | - Katherine A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
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AuYoung M, Moin T, Richardson CR, Damschroder LJ. The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World. Diabetes Spectr 2019; 32:312-317. [PMID: 31798288 PMCID: PMC6858084 DOI: 10.2337/ds19-0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF This review highlights examples of the translation of the Diabetes Prevention Program (DPP) to underserved populations. Here, underserved populations are defined as groups whose members are at greater risk for health conditions such as diabetes but often face barriers accessing treatment. Strategies to develop and evaluate future DPP translations are discussed.
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Affiliation(s)
- Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Tannaz Moin
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
- VA Health Services Research and Development Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Laura J. Damschroder
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI
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Chambers EC, Gonzalez JS, Marquez ME, Parsons A, Rehm CD. The Reach of an Urban Hospital System-Based Diabetes Prevention Program: Patient Engagement and Weight Loss Characteristics. DIABETES EDUCATOR 2019; 45:616-628. [PMID: 31608798 DOI: 10.1177/0145721719880503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to identify patient and program delivery characteristics associated with engagement and weight loss in a Diabetes Prevention Program (DPP) implemented in an urban hospital system. METHODS Patient and program delivery data were collected between July 2015 and December 2017. DPP eligibility was determined based on age, body mass index (BMI), and hemoglobin A1C data via the electronic health record. Engagement was measured at 3 levels: ≤3 sessions, 4 to 8 sessions, and ≥9 sessions. Weight was measured at each DPP session. RESULTS Among the eligible patients (N = 31 524), referrals and engagement were lower in men than women, in Spanish speakers than English speakers, in younger (18-34 years) and middle-aged (35-54 years) than older adults, and in patients receiving Medicaid than other patients. Referral and engagement were higher in patients with higher BMIs and those prescribed ≥5 medications. Current smokers were less frequently engaged. Prior health care provider contact was associated with higher engagement. Overall, 28% of DPP participants achieved ≥5% weight loss; younger and middle-aged patients and those who gained weight in the prior 2 years were less likely to lose weight. CONCLUSION This assessment identified characteristics of patients with lower levels of referral and engagement. The DPP staff may need to increase outreach to address barriers to referral and during all points of engagement among men, younger patients, and Spanish speakers. Future research is needed to increase understanding with regard to why referrals and engagement are lower among these groups.
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Affiliation(s)
- Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey S Gonzalez
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York.,Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, New York.,The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York
| | - Melinda E Marquez
- Office of Community and Population Health, Montefiore Health System, Bronx, New York
| | - Amanda Parsons
- Office of Community and Population Health, Montefiore Health System, Bronx, New York
| | - Colin D Rehm
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.,Office of Community and Population Health, Montefiore Health System, Bronx, New York
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Nhim K, Gruss SM, Porterfield DS, Jacobs S, Elkins W, Luman ET, Van Aacken S, Schumacher P, Albright A. Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation. Implement Sci 2019; 14:81. [PMID: 31412894 PMCID: PMC6694543 DOI: 10.1186/s13012-019-0928-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. RESULTS The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). CONCLUSIONS In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.
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Affiliation(s)
- Kunthea Nhim
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA.
| | - Stephanie M Gruss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Deborah S Porterfield
- RTI International, RTP, NC, and the University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sara Jacobs
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194, USA
| | - Wendi Elkins
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194, USA
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Susan Van Aacken
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Patricia Schumacher
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
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Abshire DA, Wilson DK, Sweeney AM, Pinto BM. Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men. Am J Mens Health 2019; 13:1557988319855155. [PMID: 31148501 PMCID: PMC6545657 DOI: 10.1177/1557988319855155] [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] [Indexed: 11/26/2022] Open
Abstract
Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today’s Health (PATH) trial. African American men (n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA (B = 1.15, SE = .41, p = .006). Exercise attitudes (B = .16, SE = .07, p = .037), exercise self-concept (B = .28, SE = .06, p < .001), exercise support from friends (B = .12, SE = .06, p = .048), and places for walking and cycling (B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men. ClinicalTrials.gov # NCT01025726
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Affiliation(s)
| | - Dawn K Wilson
- 2 Department of Psychology, University of South Carolina, College of Arts and Sciences, Columbia, SC, USA
| | - Allison M Sweeney
- 2 Department of Psychology, University of South Carolina, College of Arts and Sciences, Columbia, SC, USA
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Gary-Webb TL, Walker EA, Realmuto L, Kamler A, Lukin J, Tyson W, Carrasquillo O, Weiss L. Translation of the National Diabetes Prevention Program to Engage Men in Disadvantaged Neighborhoods in New York City: A Description of Power Up for Health. Am J Mens Health 2018; 12:998-1006. [PMID: 29540131 PMCID: PMC6131470 DOI: 10.1177/1557988318758788] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022] Open
Abstract
The Diabetes Prevention Program (DPP) landmark randomized trial demonstrated that participants with prediabetes could reduce their risk for type 2 diabetes by 58% if they achieved 5%-7% weight loss through healthy eating and increasing physical activity. The National DPP (NDPP) is a group intervention based on the DPP and has been widely disseminated by the Centers for Disease Control and Prevention (CDC) and many healthcare institutions. While data show that the program is effective in diverse populations, enrollment among men from low-income and minority communities is low. Thus, the study piloted a novel adaptation focused on men living in disadvantaged neighborhoods. The study approach to adaptation and implementation used characteristics of participatory research, including input from an expert panel of African American and Latino leaders, ongoing consultation with an Advisory Panel, and focus groups with members of the target population. Discussions with these groups focused on male perspectives regarding health promotion and barriers and facilitators to participation in health programming for men. There was general agreement when reviewing ongoing pilot program implementation that the adapted program should have male-only groups with male coaches, as the Advisory Panel had originally suggested. The pilot programs were implemented at five New York City Department of Parks and Recreation sites in Harlem, the Bronx, and Brooklyn in 2015-2016.
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Affiliation(s)
- Tiffany L. Gary-Webb
- Departments of Behavioral and Community Health
Sciences and Epidemiology, University of Pittsburgh Graduate School of Public Health,
Pittsburgh, PA, USA
| | | | - Lindsey Realmuto
- Center for Evaluation Research, The New York
Academy of Medicine, New York, NY, USA
| | - Alexandra Kamler
- Center for Evaluation Research, The New York
Academy of Medicine, New York, NY, USA
| | - Jennifer Lukin
- Department of Medicine, Albert Einstein
College of Medicine, Bronx, NY, USA
| | - William Tyson
- Department of Medicine, Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Olveen Carrasquillo
- Department of Medicine, Miller School of
Medicine, University of Miami, Miami, FL, USA
| | - Linda Weiss
- Center for Evaluation Research, The New York
Academy of Medicine, New York, NY, USA
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Walker EA, Weiss L, Gary-Webb TL, Realmuto L, Kamler A, Ravenell J, Tejeda C, Lukin J, Schechter CB. Power Up for Health: Pilot Study Outcomes of a Diabetes Prevention Program for Men from Disadvantaged Neighborhoods. Am J Mens Health 2018; 12:989-997. [PMID: 29540129 PMCID: PMC6131473 DOI: 10.1177/1557988318758787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 01/15/2023] Open
Abstract
There is a significant evidence base for the Diabetes Prevention Program, a lifestyle intervention to prevent onset of type 2 diabetes among high-risk individuals; however, translation of this intervention for men has been challenging. This report presents outcomes of the pilot study of an adapted 16-week diabetes prevention program entitled " Power Up for Health." The study goal was to better engage men of color with prediabetes from disadvantaged neighborhoods of New York City. It was implemented at five different recreation centers located in predominantly low-income neighborhoods across New York City. The curriculum was facilitated by male lifestyle coaches only; one group was conducted in Spanish. Primary outcome was weight loss from baseline to 16 weeks. Other measures included lifestyle activities, depressive symptoms, and self-reported health status. Men ( N = 47) were screened by telephone. Of the 29 eligible men who began the program, 25 attended at least 4 sessions (52% non-Latino Black, 32% Latino, mean age 51.7 ± SD 9.9 years, mean body mass index 35 ± SD 6.9 kg/m2). End of program outcomes ( n = 23) varied by site and included a mean weight loss of 3.8% (9.7 lbs); 3 of the 5 sites had a mean weight loss of 5.6%, meeting the national goal of 5%-7%. Men ( n = 23) attended a mean of 11.6 of 16 sessions. Improvement in depressive symptoms, healthy eating and exercise, and health status were also seen. While recruitment was challenging with many lessons learned, the adapted men's diabetes prevention program shows promise of success for participants and their coaches.
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Affiliation(s)
| | - Linda Weiss
- New York Academy of Medicine, New York,
NY, USA
| | | | | | | | | | - Carlos Tejeda
- Albert Einstein College of Medicine,
Bronx, NY, USA
- Montefiore Health Systems, Bronx, NY,
USA
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