Barriers and Facilitators to Real-world Implementation of the Diabetes Prevention Program in Large Healthcare Systems: Lifestyle Coach Perspectives

• Published in: Journal of general internal medicine : JGIM Vol. 35; no. 6; pp. 1684 - 1692
• Main Authors: Halley, Meghan C., Petersen, John, Nasrallah, Catherine, Szwerinski, Nina, Romanelli, Robert, Azar, Kristen M. J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2020; Springer Nature B.V
• Subjects: Body weight loss; Context; Curricula; Delivery of Health Care; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2; Disease control; Health care; Health risks; Humans; Internal Medicine; Iterative methods; Life Style; Lifestyles; Medicine; Medicine & Public Health; Morale; Original Research: Qualitative Research; Prevention; Prevention programs; Qualitative analysis; Qualitative Research; Research Design; Risk analysis; Risk factors; Weight Loss; real-world; semi-structured interviews; Diabetes Prevention Program; implementation
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-020-05744-y

Background Group-based lifestyle change programs based on the Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful real-world implementation. Studies have examined implementation in community settings, but less is known about integration in healthcare systems, and particularly in large, multi-site systems with the potential for extended reach. Objective To examine the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system. Design Semi-structured interviews, based on the RE-AIM framework, were conducted in person for 30–90 min each. Participants Past and present DPP lifestyle coaches in the healthcare system identified using purposive sampling. Approach Thematic analysis of qualitative data to identify key factors influencing the success of DPP implementation. An iterative consensus process was used to model the relationships among factors. Key Results We conducted 33 interviews across 20 clinic sites serving 12 counties. Participants described six key factors as potential barriers or facilitators to implementation, including (1) Broader Context, including the surrounding physical and sociodemographic context; (2) Institutional Context, including finances, infrastructure, and personnel; (3) Program Provision, including curriculum, administration, cost, goals, and visibility; (4) Recruitment Process, including screening and referrals; (5) Lifestyle Coaches, including their characteristics, behaviors, and morale; and (6) Cohort, including group attrition/retention and interpersonal dynamics. These factors were both highly interconnected in their impact on implementation and widely variable across sites within the healthcare system, as illustrated in our multi-level conceptual framework. Conclusions This study identified key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches. With further examination, the conceptual model presented here may be used for planning and managing the implementation of group-based behavioral interventions in these settings.