Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA.
University of California, Los Angeles, CA, USA.
Health Educ Behav. 2022 Aug;49(4):647-657. doi: 10.1177/10901981211016759. Epub 2021 May 29.
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 = 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.
诊所和社区组织（CBO）是实施基于证据的国家糖尿病预防计划（DPP）的优先场所。这两种项目设置在吸引和帮助最易患糖尿病的人群实现生活方式改变目标方面都具有理论上的优势和劣势。迄今为止，很少有研究比较过这两种设置的实施情况。本研究描述了在 2015 年至 2018 年期间在洛杉矶提供服务的诊所和社区为基础的国家 DPP 样本中的参与者特征和生活方式改变结果（两个诊所，两个 CBO，合并=265 名参与者）。分析检查了参与者的性别、年龄、种族/民族、基线体重指数以及项目属性，如筛查方法和教学语言。负二项回归模型测试了设置对项目出勤率、平均每周体育活动量和体重百分比变化的影响。总体而言，参与者主要是西班牙裔/拉丁裔（81.51%）和女性（90.19%）。由 CBO 运营的项目比由诊所运营的项目更频繁地吸引其他种族/族裔群体，包括黑人参与者（20.56%比 0%）；后者吸引了更多的男性（15.29%比 7.22%）。任何环境中很少有参与者达到国家 DPP 的减肥目标（诊所：15.29%，CBO：20.00%）。最初，参加社区项目与更高的出勤率和平均每周体育活动量相关，但在调整了协变量后，这种关联并不显著。研究结果对国家 DPP 的实施具有实践意义，并有助于为未来在洛杉矶和全国范围内扩大和推广该计划提供信息。
