Clinic- and Community-Based National Diabetes Prevention Programs in Los Angeles

Abstract

Clinics and community-based organizations (CBOs) are priority settings for implementing the evidence-based National Diabetes Prevention Program (DPP). Both program settings present theoretical advantages and disadvantages for engaging and helping populations most at risk for diabetes achieve lifestyle change goals. To date, few studies have compared implementation across them. The present study describes participant characteristics and lifestyle change outcomes across a sample of clinic- and community-based National DPPs which delivered services in Los Angeles during 2015 to 2018 (two clinics, two CBOs, combined n = 265 participants). Analyses examined participant gender, age, race/ethnicity, baseline body mass index, and program attributes such as screening method and language of instruction. Negative binomial regression models tested for differences in program attendance, mean weekly physical activity, and percent change in body weight by setting. Overall, participants were largely Hispanic/Latinx (81.51%) and female (90.19%). Programs operated by CBOs engaged other race/ethnic groups including Black participants more frequently than those operated by clinics (20.56% vs. 0%); the latter engaged more men (15.29% vs. 7.22%). Few participants in any setting met the National DPP’s weight loss goal (clinic: 15.29%, CBO: 20.00%). Participating in a community-based program was initially associated with higher attendance and mean weekly physical activity, but associations were not significant after adjusting for covariates. Study results have practice implications for National DPP implementation and can help inform future efforts to scale and spread the program in Los Angeles and nationally.

Provider–Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes

“…These have ranged from the implementation of nutrition-and physical-activity-related policy, system, and environmental change interventions (PSEs) [26] to the scaling of evidence-based lifestyle behavior programs, such as the National Diabetes Prevention Program [27]. The latter, however, can be resource and time intensive, and difficult to establish in the community setting [28]. However, in recent years, brief lifestyle interventions, such as the "Small Steps for Big Changes Program", have sought to address existing resource and time constraints typically encountered in T2DM lifestyle programs [29].…”

Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study

“…VV participants’ results were also better than results from a recent NDPP report among mostly Latinas in Los Angeles, California (2.15% at 16 weeks). 18 , 59 , 60 Whether or not the difference is due to characteristics of providers, of those who visit their physicians, or of patients’ family members is beyond the scope of this study. Certainly, the role of clinicians has been noted as a powerful motivator for healthy behavior in H/L culture, 61 especially among monolingual Spanish-speaking Latinos.…”

“…VV participants' results were also better than results from a recent NDPP report among mostly Latinas in Los Angeles, California (2.15% at 16 weeks). 18,59,60 Whether or not the difference is due to characteristics of providers, of those who visit their physicians, or of patients' family members is beyond the scope of this study.…”

Three Cooperative Extension initiatives funded to address Michigan's opioid crisis

“…This community case study describes implementation of several evidence-based strategies and funded initiatives to address the opioid crisis by a statewide educational health service organization. While many organizations provide statewide, community-based educational programming for adults on such health issues as diabetes prevention ( 11 ) or nutrition education ( 12 ), few have delivered wide-spread prevention education on opioid misuse. This novel case study shares statewide approaches to address the opioid crisis with prevention education and other public health management strategies from a period between 2018 and 2022.…”