Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA.
RTI International, RTP, NC, and the University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Implement Sci. 2019 Aug 14;14(1):81. doi: 10.1186/s13012-019-0928-9.
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.
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.
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).
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.
国家糖尿病预防计划（National DPP）正在迅速扩大，旨在帮助那些有患 2 型糖尿病风险的人预防或延缓疾病的发生。2012 年，美国疾病控制与预防中心（Centers for Disease Control and Prevention）资助了六个全国性组织，以扩大和维持国家 DPP 生活方式改变干预（LCI）在多个州的推广。本研究旨在描述在四年资助期间的覆盖范围、采用情况、维持情况，并评估站点层面的因素与参与者出勤率和参与时间之间的关联。
采用“RE-AIM”框架（Reach、Effectiveness、Adoption、Implementation 和 Maintenance）指导 2012 年 10 月至 2016 年 9 月的评估。采用多水平线性回归分析，检验参与者层面的人口统计学特征与站点层面的策略以及参加的课程数量、7-12 个月的出勤率和参与时间之间的关联。
六个资助的全国性组织将参与的站点数量从 2012 年的 68 个增加到 2016 年的 164 个，覆盖了 38 个州，招募了 14876 名合格参与者。截至 2016 年 9 月，National DPP LCI 的覆盖范围已获得 42 家私人保险公司和 7 家公共付款人的认可。近 200 家雇主被招募来为其员工提供现场 LCI。与更高的整体出勤率、7-12 个月的出勤率和更长的参与时间相关的站点层面策略包括使用自我推荐或口碑作为招募策略、为参与提供非货币激励以及使用文化适应来满足参与者的需求。从医疗保健提供者或医疗系统获得转介的站点在 7-12 个月的出勤率和参与时间也更长。在参与者层面，65 岁以上的参与者（与 18-44 岁或 45-64 岁的参与者相比）、超重的参与者（与肥胖的参与者相比）、非西班牙裔白人（与非西班牙裔黑人或多种族/其他种族的参与者相比）和基于血液测试或妊娠糖尿病史合格的参与者（与风险测试呈阳性的参与者相比），结果更好。
在 National DPP LCI 快速传播的时代，本评估的结果可用于增强项目实施，并将经验教训转化为类似组织和环境。
