Wagner Gerit, Koon Lyndsie M, Smith Patricia, Suire Kameron B, Hastert Mary, Donnelly Joseph E, Olfert Melissa D, Estabrooks Paul, Gorczyca Anna M
Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States.
JMIR Form Res. 2025 Jul 2;9:e70406. doi: 10.2196/70406.
Rural living adults are disproportionately affected by type 2 diabetes compared to their urban counterparts. The Centers for Disease Control and Prevention's National Diabetes Prevention Program (National DPP) is an evidence-based intervention that reduces the risk of type 2 diabetes through increased physical activity and modest weight loss, but overall reach remains limited, specifically in rural communities.
This qualitative study aimed to examine the fit of the National DPP delivered digitally using Zoom or Facebook to rural living adults at risk for type 2 diabetes.
Focus group scripts assessed the characteristics and perceptions of rural adults at risk for type 2 diabetes, infrastructure supports for implementation and sustainability, and external factors that could influence program fit. A reflexive thematic analysis was conducted separately on coded transcripts for each focus group. Themes were then deductively linked to the Practical, Robust Implementation and Sustainability Model domains.
Two focus groups were conducted with 14 participants after participating in the National DPP for 6 months, delivered through Zoom (n=9) or Facebook (n=5). Participants highlighted positive relationships between Practical, Robust Implementation and Sustainability Model constructs related to participant characteristics (ie, value of health improvements, weight loss, and reduced medication dependence as primary motivators) and perceptions of compatibility (ie, content alignment with participant needs) as well as infrastructure (ie, digital platforms provided better access) with program success in reach and engagement. Conversely, both formats were negatively impacted by interruptions in internet connectivity. External factors, such as referral pathways from local health care providers, could improve program reach. When considering differences between implementation infrastructure, Zoom facilitated greater social engagement and accountability compared to Facebook.
This study identified contextual factors influencing the fit of digitally delivering the National DPP to rural living adults, including opportunities for using existing connections and health motivations to help improve acceptability, while tailoring curriculum, modality, and technology may improve appropriateness for rural populations.
ClinicalTrials.gov NCT05387434; https://clinicaltrials.gov/study/NCT05387434.
与城市成年人相比，农村成年人受2型糖尿病的影响更为严重。美国疾病控制与预防中心的国家糖尿病预防计划（National DPP）是一项基于证据的干预措施，通过增加身体活动和适度减重来降低2型糖尿病的风险，但总体覆盖面仍然有限，特别是在农村社区。
本定性研究旨在探讨通过Zoom或Facebook以数字方式提供的国家糖尿病预防计划对有2型糖尿病风险的农村成年人的适用性。
焦点小组脚本评估了有2型糖尿病风险的农村成年人的特征和看法、实施和可持续性的基础设施支持以及可能影响项目适用性的外部因素。对每个焦点小组的编码记录分别进行了反思性主题分析。然后将主题与实用、稳健实施和可持续性模型领域进行演绎联系。
在通过Zoom（n = 9）或Facebook（n = 5）参与国家糖尿病预防计划6个月后，对14名参与者进行了两个焦点小组访谈。参与者强调了实用、稳健实施和可持续性模型结构与参与者特征（即健康改善、体重减轻和药物依赖减少的价值作为主要动机）、兼容性看法（即内容与参与者需求的一致性）以及基础设施（即数字平台提供了更好的获取途径）之间的积极关系，这些与项目在覆盖面和参与度方面的成功有关。相反，两种形式都受到互联网连接中断的负面影响。外部因素，如当地医疗保健提供者的转诊途径，可以提高项目覆盖面。在考虑实施基础设施的差异时，与Facebook相比，Zoom促进了更大的社交参与和问责制。
本研究确定了影响以数字方式向农村成年人提供国家糖尿病预防计划适用性的背景因素，包括利用现有联系和健康动机来帮助提高可接受性的机会，同时调整课程、模式和技术可能会提高对农村人口的适用性。
ClinicalTrials.gov NCT05387434；https://clinicaltrials.gov/study/NCT05387434 。
