1
|
Perkison WB, Fwelo P, Velasco-Huerta F, Heredia NI, Yang JJ, Beg SS, Reininger BM, Rodriguez SA, Almohamad M, Pulicken C, Garza E, White GE, Fernandez ME. Pilot Study to Assess the Effectiveness of the Sustainable Culturally Adaptive Nutrition Program (SCAN) to Improve Adherence to the National Diabetes Prevention Program. Am J Health Promot 2024:8901171241237522. [PMID: 38514206 DOI: 10.1177/08901171241237522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The Sustainable Culturally Adapted Nutrition Program (SCAN) is a novel adaptation to the National Diabetes Prevention Program (NDPP) that aims to improve attendance and effectiveness. This paper presents its feasibility and impact through the initial 6-month outcomes. DESIGN A pragmatic quasi-experimental pilot study with intervention (DPP plus SCAN) and control (DPP only) groups. SAMPLES AND INCLUSION CRITERIA Sustainable Culturally Adapted Nutrition Program participants were recruited from federally qualified health center (FQHC) clinic patients enrolled in a NDPP in Houston, Texas. Participants needed to be (1) ≥18 years old, (2) body mass index >25, (3) no prior diagnosis of diabetes, and (4) not pregnant. INTERVENTION Sustainable Culturally Adapted Nutrition Program cooking classes were designed to teach skills to prepare fresh produce, and utilized Motivational Interviewing (MI) techniques to encourage participants to adapt these skills for foods that were culturally important to them. OUTCOME MEASURES (1) National Diabetes Prevention Program attendance, (2) BMI and (3) percent weight loss. ANALYSIS We used linear mixed models to test the association between weights and NDPP attendance. RESULTS 22 intervention and 15 control participants completed the program to the 6-month point. Intervention participants had increased DPP attendance over controls (7.14 vs 6.87 session). Intervention participants also demonstrated on average, 1.5% weight loss for each additional SCAN class attended (P = .144). CONCLUSIONS The SCAN adaptation shows promising results for effectively increasing both NDPP attendance and weight loss.
Collapse
Affiliation(s)
- William B Perkison
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Pierre Fwelo
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Fernanda Velasco-Huerta
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Natalia I Heredia
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - James J Yang
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Sidra S Beg
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Belinda M Reininger
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Serena A Rodriguez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Maha Almohamad
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Catherine Pulicken
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Ella Garza
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Grace E White
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| |
Collapse
|
2
|
Perkison WB, Rodriguez SA, Velasco-Huerta F, Mathews PD, Pulicken C, Beg SS, Heredia NI, Fwelo P, White GE, Reininger BM, McWhorter JW, Chenier R, Fernandez ME. Corrigendum: Application of implementation mapping to develop strategies for integrating the National Diabetes Prevention Program into primary care clinics. Front Public Health 2023; 11:1330474. [PMID: 38074761 PMCID: PMC10704148 DOI: 10.3389/fpubh.2023.1330474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.933253.].
Collapse
Affiliation(s)
- William B. Perkison
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Serena A. Rodriguez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- The University of Texas Health Science Center School of Public Health, Dallas, TX, United States
| | - Fernanda Velasco-Huerta
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Patenne D. Mathews
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Catherine Pulicken
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Sidra S. Beg
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Natalia I. Heredia
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Pierre Fwelo
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Grace E. White
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Belinda M. Reininger
- The University of Texas Health Science Center School of Public Health, Brownsville, TX, United States
| | - John W. McWhorter
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Roshanda Chenier
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Maria E. Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
3
|
Perkison WB, Rodriguez SA, Velasco-Huerta F, Mathews PD, Pulicken C, Beg SS, Heredia NI, Fwelo P, White GE, Reininger BM, McWhorter JW, Chenier R, Fernandez ME. Application of implementation mapping to develop strategies for integrating the National Diabetes Prevention Program into primary care clinics. Front Public Health 2023; 11:933253. [PMID: 37181720 PMCID: PMC10169622 DOI: 10.3389/fpubh.2023.933253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate referrals, and limited reimbursement incentives to support program delivery. A framework or approach that can address these and other barriers of practice is needed. Objective We used Implementation Mapping, a systematic planning framework, to plan for the adoption, implementation, and maintenance of the National DPP in primary care clinics in the Greater Houston area. We followed the framework's five iterative tasks to develop strategies that helped to increase awareness and adoption of the National DPP and facilitate program implementation. Methods We conducted a needs assessment survey and interviews with participating clinics. We identified clinic personnel who were responsible for program use, including adopters, implementers, maintainers, and potential facilitators and barriers to program implementation. The performance objectives, or sub-behaviors necessary to achieve each clinic's goals, were identified for each stage of implementation. We used classic behavioral science theory and dissemination and implementation models and frameworks to identify the determinants of program adoption, implementation, and maintenance. Evidence- and theory-based methods were selected and operationalized into tailored strategies that were executed in the four participating clinic sites. Implementation outcomes are being measured by several different approaches. Electronic Health Records (EHR) will measure referral rates to the National DPP. Surveys will be used to assess the level of the clinic providers and staff's acceptability, appropriateness of use, feasibility, and usefulness of the National DPP, and aggregate biometric data will measure the level of the clinic's disease management of prediabetes and diabetes. Results Participating clinics included a Federally Qualified Health Center, a rural health center, and two private practices. Most personnel, including the leadership at the four clinic sites, were not aware of the National DPP. Steps for planning implementation strategies included the development of performance objectives (implementation actions) and identifying psychosocial and contextual implementation determinants. Implementation strategies included provider-to-provider education, electronic health record optimization, and the development of implementation protocols and materials (e.g., clinic project plan, policies). Conclusion The National DPP has been shown to help prevent or delay the development of diabetes among at-risk patients. Yet, there remain many challenges to program implementation. The Implementation Mapping framework helped to systematically identify implementation barriers and facilitators and to design strategies to address them. To further advance diabetes prevention, future program, and research efforts should examine and promote other strategies such as increased reimbursement or use of incentives and a better billing infrastructure to assist in the scale and spread of the National DPP across the U.S.
Collapse
Affiliation(s)
- William B. Perkison
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Serena A. Rodriguez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- The University of Texas Health Science Center School of Public Health, Dallas, TX, United States
| | - Fernanda Velasco-Huerta
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Patenne D. Mathews
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Catherine Pulicken
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Sidra S. Beg
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Natalia I. Heredia
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Pierre Fwelo
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Grace E. White
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Belinda M. Reininger
- The University of Texas Health Science Center School of Public Health, Brownsville, TX, United States
| | - John W. McWhorter
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Roshanda Chenier
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Maria E. Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|