Online Program

Demonstrating a Need for Improved Reach and Retention of Latinos in the National Diabetes Prevention Program

Wednesday, November 4, 2015

Natalie D. Ritchie, PhD, Denver Health Managed Care, Denver Health and Hospital Authority, Denver, CO
Liesel Christoe-Frazier, MA, Counseling Psychology, University of Northern Colorado, Greeley, CO
Rocio I. Pereira, MD, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO
Type 2 diabetes is one of the greatest health threats faced by Latinos in the U.S., affecting 13% of Latino adults compared to 8% of non-Hispanic Whites. The National Diabetes Prevention Program (NDPP) is the most widely available, effective intervention to prevent or delay diabetes onset. Nonetheless, concerns have included its limited reach among Latino and underserved communities. In an effort to improve reach, we implemented the NDPP in an urban safety-net healthcare system with an emphasis on scalability, accessible inclusion criteria, and instruction by bilingual community health workers. Over 1,700 patients have enrolled in the yearlong program of whom 60% were Latino, 27% were Spanish-speaking, and 81% were low-income. We conducted logistic and multivariate regression analyses to determine sociodemographic differences in NDPP participation. Being of Latino ethnicity predicted a significantly lower likelihood of attending the program than being of non-Latino ethnicity, OR 0.52 (P < .01; 95% CI 0.36 – 0.77). Specifically, 48% (n = 216) of Latinos who enrolled attended, versus 60% (n = 178) of non-Latinos. Furthermore, participants of Latino ethnicity attended 35% (3.05; P < .001) fewer sessions than participants of non-Latino ethnicity. Participation did not differ between Spanish- and English-speaking Latinos. Low-income also did not predict disparate participation rates. Despite following previously published recommendations to facilitate reach and retention of Latinos in the NDPP, it is clear that further efforts are urgently needed to increase program participation among this population. We recommend future work to better identify and address barriers to program participation among Latinos.

Learning Areas:

Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Define the need for further efforts to counter diabetes-related health disparities among Latinos. Describe a translation of the National Diabetes Prevention Program in a healthcare setting that follows previous recommendations to facilitate reach and retention of Latino patients. Compare differences in participation in the National Diabetes Prevention Program among Latino and non-Latino patients.

Keyword(s): Latinos, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am clinical health psychologist at Denver Health and Hospital Authority, an academic medical center serving as the region’s largest safety net healthcare system. My clinical and research interests are in health behavior change, in particular for type 2 diabetes prevention. I am especially interested in efforts to reduce health disparities for minority, low-income, and immigrant populations. I am the project director on multiple grant awards addressing diabetes prevention in diverse populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.