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

Abstract

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.