• Attendance Barriers and Facilitators to the University of Arizona Cooperative Extension-led National Diabetes Prevention Program

      da Silva, Vanessa; Rahim-Sepulveda, Martina; Hingle, Melanie; Speirs, Kate (The University of Arizona., 2019)
      The National Diabetes Program (NDPP) is a group, lifestyle-change intervention offered over 12 months, which has been shown to prevent or delay the onset of Type 2 Diabetes by 58%. The program promotes healthy eating, physical activity, and modest weight loss. In the NDPP, for every session attended and every 20 minutes of physical activity completed, participants lost 0.3% of their initial body weight. However, a major challenge to program success is attendance given its 12-month duration, with less than 50% of participants making it to the half-way point in the NDPP. Non-attendance and reduced retention rates have been associated with poorer health outcomes in the NDPP, underscoring the importance of maximizing attendance and retention in this long-duration program. This study examined barriers and facilitators to participant attendance in the first 6 months of the University of Arizona Cooperative Extension-led NDPP. Data from qualitative semi-structured interviews with NDPP participants (n=28) and educators shows that the emerging themes influencing program attendance include 1) program implementation; 2) participant-specific factors; 3) external environment; and 4) coach-specific factors. Common barriers and facilitators were interest, program curriculum, flexibility, and clarity; commitments, Cooperative Extension network, motivators, timing, support system, readiness, and cost. The Cooperative Extension infrastructure is well positioned to address the barriers to program attendance in the UA CE-NDPP. While there are some areas it has limited control, such as interest, motivators, and readiness of participants; the Cooperative Extension system has the capacity to address several of the engagement issues reported in this study.
    • Using RE-AIM to Evaluate the Potential Public Health Impact of a Community-Based Family-Focused Diabetes Prevention Program

      Hingle, Melanie; Hopkins, Laura Lee; Going, Scott; da Silva, Vanessa (The University of Arizona., 2016)
      Overweight and obesity in U.S. children has reached epidemic proportions, affecting one in three of children and adolescents (ages 2 to 19). Chronic diseases such as type 2 diabetes, previously linked with adult obesity, are now observed in youth. Early intervention is key to reversing this trend. However, successful translation of clinical obesity prevention interventions to the broader community remains a major challenge, in part, due to ineffective adaptation of interventions from controlled clinical settings to more diverse settings. A process evaluation framework - RE-AIM - was used to guide "real world" translation of a family-focused diabetes prevention trial at the YMCA for overweight and obese 9-12-yr-olds (E.P.I.C. Kids), with particular attention paid to factors influencing adoption, implementation, and maintenance by the program by this established community organization. Preliminary evaluation suggested a moderate to high potential for successful implementation and dissemination of the E.P.I.C. Kids program on a larger scale, thereby laying the foundation for replication in other community settings.